hospice 101 phases of grief nov 3 2006
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Midwest Palliative & Hospice CareCMidwest Palliative & Hospice CareCenterenter
HOSPICE 101HOSPICE 101
Midwest Palliative & Hospice CareCenterMidwest Palliative & Hospice CareCenter2050 Claire Ct., Glenview, IL 600252050 Claire Ct., Glenview, IL 60025
847-467-7423847-467-7423
Midwest Palliative & Hospice CareCMidwest Palliative & Hospice CareCenterenter
PresentersPresenters
Midwest Palliative & Hospice CareCenterMidwest Palliative & Hospice CareCenter
Families with Children CounselorsFamilies with Children Counselors
Midwest Palliative & Hospice CareCMidwest Palliative & Hospice CareCenterenter
What is Hospice?What is Hospice?
A special way of caring for A special way of caring for people with life limiting people with life limiting
illness.illness.
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GOALS OF HOSPICEGOALS OF HOSPICE
Comfort and quality of life Comfort and quality of life as as defined by the patient.defined by the patient.
Support for the family as the primary Support for the family as the primary unit of care.unit of care.
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WHERE ARE PATIENTS WHERE ARE PATIENTS CAREDCARED FORFOR??
At home At home Independent or Assisted Living Independent or Assisted Living
facilityfacility Long Term Care or Skilled Care Long Term Care or Skilled Care
FacilityFacility HospitalHospital Hospice Inpatient UnitHospice Inpatient Unit
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ELIGIBILITYELIGIBILITY Patients who desire to end curative phase of Patients who desire to end curative phase of
treatmenttreatment Patients who want to be kept as physically, Patients who want to be kept as physically,
emotionally and spiritually comfortable as emotionally and spiritually comfortable as possible.possible.
Patients whose doctors certify that they have a Patients whose doctors certify that they have a prognosis of 6 months or lessprognosis of 6 months or less
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THE HOSPICE THE HOSPICE TEAMTEAM
PatientPatient Patient’s familyPatient’s family Primary physicianPrimary physician Hospice physicianHospice physician NursesNurses
ChaplainsChaplains Social workersSocial workers Nursing AssistantsNursing Assistants VolunteerVolunteer Others as needed by Others as needed by
plan of careplan of care
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COMMON COMMON QUESTIONSQUESTIONS
Can I change my mind?Can I change my mind? Nutrition, hydration, CPRNutrition, hydration, CPR
““Giving Up”Giving Up” For cancer patients onlyFor cancer patients only
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HOW DO I TALK HOW DO I TALK ABOUT THIS?ABOUT THIS?
Midwest Palliative & Hospice CareCMidwest Palliative & Hospice CareCenterenter
ASK YOUR LOVED ONE ASK YOUR LOVED ONE WHAT S/HE THINKS IS WHAT S/HE THINKS IS
HAPPENING.HAPPENING.
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WHAT ARE YOUR LOVED WHAT ARE YOUR LOVED ONE’S GOALS?ONE’S GOALS?
WHAT IT IS S/HE REALLY WHAT IT IS S/HE REALLY WANTS?WANTS?
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HELP THE PERSON HELP THE PERSON IDENTIFY AND ASSESS IDENTIFY AND ASSESS
THE BENEFITS AND THE BENEFITS AND BURDENS OF VARIOUS BURDENS OF VARIOUS
TREATMENTS.TREATMENTS.
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BEREAVEMENTBEREAVEMENT
Telephone ContactTelephone Contact
Memorial ServicesMemorial Services
Support GroupsSupport Groups
Individual CounselingIndividual Counseling
ReferralReferral
Midwest Palliative & Hospice CareCMidwest Palliative & Hospice CareCenterenter
RESOURCESRESOURCES
National Palliative Care & National Palliative Care & Hospice OrganizationHospice Organization
800.658.8898800.658.8898 www.nhpco.orgwww.nhpco.org
www.Medicare.comwww.Medicare.com
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Personal Loss ActivityPersonal Loss Activity
Midwest Palliative & Hospice CareCMidwest Palliative & Hospice CareCenterenter
Phases of Phases of GriefGrief
Midwest Palliative & Hospice CareCMidwest Palliative & Hospice CareCenterenter
Helping Children Cope Helping Children Cope with Griefwith Grief
Author: Author: Alan Wolfelt, Ph.DAlan Wolfelt, Ph.D 13 Dimensions13 Dimensions
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Shock/Denial/Disbelief/Shock/Denial/Disbelief/NumbnessNumbness
Most intense 6-8 weeks after deathMost intense 6-8 weeks after death Can resurface over timeCan resurface over time
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Lack of FeelingsLack of Feelings
Appear unaffected by deathAppear unaffected by death
Continue with age appropriate activities to Continue with age appropriate activities to avoid intense emotionsavoid intense emotions
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Physiological ChangesPhysiological Changes
Grief may be expressed through physical Grief may be expressed through physical symptomssymptoms
Symptoms are usually temporary and normalSymptoms are usually temporary and normal
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RegressionRegression
Occurs when previously mastered tasks are no Occurs when previously mastered tasks are no longer completedlonger completed
Can represent need for protection and securityCan represent need for protection and security
If ongoing, may need therapeutic interventionIf ongoing, may need therapeutic intervention
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““Big Man”/”Big Woman” SyndromeBig Man”/”Big Woman” Syndrome
Opposite of regressionOpposite of regression
Take on adult rolesTake on adult roles
Can be an attempt to replace the deceasedCan be an attempt to replace the deceased
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Disorganization and PanicDisorganization and Panic
Feeling of being overwhelmed and anxiousFeeling of being overwhelmed and anxious ManifestationsManifestations
RestlessnessRestlessness IrritabilityIrritability Inability to concentrateInability to concentrate
Routines are important Routines are important
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Explosive EmotionsExplosive Emotions
FeelingsFeelings AngerAnger HatredHatred TerrorTerror
Directed at anyone or Directed at anyone or anythinganything
Enjoyable events lose their Enjoyable events lose their appealappeal
Important to validate Important to validate feelings of pain, frustration feelings of pain, frustration
and hurtand hurt
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Acting-Out BehaviorActing-Out Behavior
Result of Explosive EmotionsResult of Explosive Emotions
May be associated with feelings of May be associated with feelings of abandonmentabandonment
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FearFear
““Who will take care of Who will take care of me?”me?”
Fear of own deathFear of own death
Fatalistic ViewFatalistic View
Consistency is Consistency is importantimportant
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ReliefRelief
Natural expression after witnessing prolonged Natural expression after witnessing prolonged illnessillness
Difficult to admitDifficult to admit Associated with guiltAssociated with guilt
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Loss/Emptiness/SadnessLoss/Emptiness/Sadness
Most difficult emotionsMost difficult emotions
May demonstrate physiological changesMay demonstrate physiological changes
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Guilt and Self-BlameGuilt and Self-Blame
May assume responsibility of deathMay assume responsibility of death
““If only I had done something differently”If only I had done something differently”
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ReconciliationReconciliation
Grief no longer Grief no longer overwhelms daily overwhelms daily functioningfunctioning
Begin to feel hope and Begin to feel hope and anticipation for the anticipation for the futurefuture
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QuestionsQuestions