End of Life Issues: Grief
Death unfortunately is a very big part of life - End of Life Issues: Grief introduction. There is no one on this earth that believes they are going to live forever, nor are they naive enough to believe that their loved ones will live forever. No age can escape death, because it does not discriminate, and with death comes grief. Grief, bereavement, and mourning have distinct meanings. Bereavement is being in a state of loss, grief is the reactions one has to the loss, and mourning is the expression of grief. Whatever the cause of death the deceased loved ones will experience grief; which makes grief an all encompassing end of life issue.
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Grief has seven stages which include shock or disbelief, denial, bargaining, guilt, anger, depression, and acceptance/hope.(Dryden-Edwards, MD, 2012) A person experiencing grief can have any of these stages in any order, some people don’t experience all of them, and some stages may last longer then others. The symptoms of grief can include but are not limited to emotional, physical, social, or religious. Grieving for children and adolescents may reflect whichever developmental stage they are in.
Nearly 4% of children under 18 experience the death of a parent.(Sandler, Ma, Tein, Ayers, Wolchik, Kennedy & Millsap, 2010) A study in England reported that out of 1746 adolescents only 8% reported they had never experienced a significant death. A significant death can be a sibling, but in most cases for youth it is a parent. (“Interventions to support,” 2006) Although research can show the impact of death on an adult, very little research has been done on the overall impact on youth. To understand how grieving youth respond to grief it also has to be understood how bereavement impacts youth’s development and how their development impacts bereavement.
In children under three death is not understood; ages four and five see death as a sleeping state, but permanence still isn’t understood. In ages five through nine death is personified, but understood as permanent; and by the age of nine, or early adolescence, death starts to take shape and make sense as it would with an adult. There are three different phases of adolescent development. Early adolescents who are in bereavement are in a fragile state of trying to emotionally separate themselves from their parents. Often times they will idolize the person who died, question why the death had to occur, fear that someone else will die and believe they are different from their peers because they feel more mature due to the stresses of the death.
Middle adolescents are still trying to become independent and have conflict with themselves due to their needed dependence. After a death of a loved one they may view the world as dangerous, protest the indifference in the world, believe that existence is arbitrary, and view themselves as vulnerable, as well as partake in aggressive risk taking. Lastly, there is later adolescence have to master intimacy and closeness in their own personal relationships. When they face bereavement they believe that others need them, the world is unsafe and unpredictable, and feel trustworthy and more mature than their peers.
There are many ways youth and adolescents can be helped with bereavement. Most do not differ from the methods that are used with adults, which include but are not limited to peer support, counseling, therapeutic sessions or a combination of these. There is one program called the Family Bereavement Program that is a 14- session (12 group and two individual) program focused on strengthening family and reducing problematic grief. In this program positive coping and perceptions of having their feelings understood are targeted. Music therapy is also used to help everyone of any age cope with bereavement; however the bereaving youth seem to benefit more from this therapy than adults. This is because young people have always made more time in their lives for music and have a stronger relationship with music.
The reason why such lengths are taken for youth and adolescents is because it has been shown that unresolved grief is more likely to lead youth into drug use to cope with their drug use, have suicidal thoughts, depression and anxiety.(Finlay & Jones, 2000) To help avoid grieving individuals to be allowed to slip through the cracks it is the responsibility of health care providers to target the signs of grief and decide if this person needs counseling. In order to do this accurately it helps if the family physician has history of the patients responses to other previous losses; for example loss of job, divorce, or marriage of child. (Secundy, 1977)
Apart of palliative care normally includes bereavement counseling. Unfortunately palliative care has limited resources and it makes sense to use the majority of those resources on the care of those who are alive and not on bereavement services. Due to this issue, there is somewhat of a screening process for bereavement counseling. Families that are functional usually tend to already have a good platform for coping with the lose; then there are the intermediate and hostile dysfunctional families.
The intermediate families show good family connections, but are weakened under the stress of grief, this family is the best candidate for group bereavement counseling; while the hostile dysfunctional families haven’t got along for some time and will benefit better from individual counseling.
Another issue that coincides with palliative care and grief is the issue of health care providers feelings of loss after a patient dies. Practitioners who work in palliative care and with hospice patients they lose patients very frequently. Whether close to these patients or not, their job requires them to put their emotions aside and care for these patients as well as view these loses as normal; the cycle of life and death. However the reality can’t be ignored that these incidents are affecting them in some way, shape, or form. For a doctor it is hard for them to not feel guilty over a patients death.
This is because there are such high expectations for them to not make mistakes. Doctors are often put on a pedestal as being stoic and lack emotion, where they must be professional at all times. The truth is, however, that they are human and often times will relate with a patient on a personal level. Either because they relate to the patients ailments, or perhaps the patient reminds them of a family member. Other attributes may be that a substantial amount of time was spent with this patient. There seems to be even more problems with this area when it comes to general practice. Often times if the doctor was intensely involved with the dying patient they would make home visits.
The typical hospice nurse lasts two years and then moves on to a different field and this may be due to the grief related stress which may have something to do with the fact that it seems unprofessional to express feeling of mourning. There isn’t much grief training built into nursing school, but perhaps there should be. The internet full of stories of nurses grieving, and a lot of these include hospice nurses. They are all heart felt and sincere stories, but almost all of them explain that they have been working for ‘X’ amount of years and never really allowed themselves the opportunity to grieve.
As a human, a person is guaranteed to experience the death of a loved one at least one, but as a nurse they will build bonds with patients over and over again and will experience death on an unnatural level and there should be more methods for grieving and counseling for professional that deal with it often. One option for anyone is that if they are grieving they can go to hospice and ask for bereavement counseling, even if the person they are grieving over didn’t use hospice.
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