1. Hospital Practice 5 The Grieving Process

2. Grieving ? Grief - noun Grief - noun Grieving – adjective Grieving – adjectiveSynonyms Inconsolable Anguished Sorrowful Brokenhearted Mournful

3. The Grieving Process ? Describes the behavior of a person in the event of : Describes the behavior of a person in the event of : Loss of a loved one, social status, or a loved material in possession Loss of a loved one, social status, or a loved material in possession OR OR Changes in one’s body as a result of the aging process, disease, or physical injury that leaves one disabled in some way. Changes in one’s body as a result of the aging process, disease, or physical injury that leaves one disabled in some way.

4. Why is it important to learn ? In the course of his work, the RT will often care for patients who are grieving the loss of a body part or body function. In the course of his work, the RT will often care for patients who are grieving the loss of a body part or body function. He may also care for persons with illness that will lead to death. He may also care for persons with illness that will lead to death. RT has to interact in a therapeutic manner with patients who is grieving RT has to interact in a therapeutic manner with patients who is grieving It will improve your ability to care for the grieving patient if you assess him prior to beginning care to determine which phase of the grieving process he may be going through. It will improve your ability to care for the grieving patient if you assess him prior to beginning care to determine which phase of the grieving process he may be going through.

5. Important -Beware Before one can interact in a therapeutic manner with a patient who is grieving, he must examine his own feelings about death and loss of something or someone of major importance to your well being. (Consider past reaction to a loss and how you were able to cope with the situation.) Before one can interact in a therapeutic manner with a patient who is grieving, he must examine his own feelings about death and loss of something or someone of major importance to your well being. (Consider past reaction to a loss and how you were able to cope with the situation.) It is not unusual for a health worker to be filled with emotion when he cares for a person who has suffered a tremendous loss. It may be therapeutic to discuss these feelings with a colleague or a counselor. It is not unusual for a health worker to be filled with emotion when he cares for a person who has suffered a tremendous loss. It may be therapeutic to discuss these feelings with a colleague or a counselor.

6. Behavioral theory of grieving process All persons grieve in an individual manner based on learned attitudes and values that are the result of cultural and environmental factors. All persons grieve in an individual manner based on learned attitudes and values that are the result of cultural and environmental factors. Behavioral theories of grieving process are complex and diverse. Behavioral theories of grieving process are complex and diverse. (The general theory of Dr. Elisabeth Kubler-Ross is used here to summarize the phases of the grieving process in a concise manner). (The general theory of Dr. Elisabeth Kubler-Ross is used here to summarize the phases of the grieving process in a concise manner).

7. Stages of grieving

8. Phase 1 : Denial When verification of a terminal illness or permanent disfigurement is made to the patient by the physician, the initial response is one of shock and denial. When verification of a terminal illness or permanent disfigurement is made to the patient by the physician, the initial response is one of shock and denial. This first response is used by the patient as a defense until he can become accustomed to the idea. This first response is used by the patient as a defense until he can become accustomed to the idea. The idea of one’s own death is difficult to face. Death happens to other people, “not to me” The idea of one’s own death is difficult to face. Death happens to other people, “not to me”

9. How to react in this stage of denial? If the RT is questioned about the possibility of death or permanent disability, he should respond with a reflective answers and give support without being unrealistic. For example: If the RT is questioned about the possibility of death or permanent disability, he should respond with a reflective answers and give support without being unrealistic. For example: Patient ; “Do you think my disease is incurable?” Patient ; “Do you think my disease is incurable?” RT : “ You feel that you have an incurable disease?” RT : “ You feel that you have an incurable disease?”

10. Phase II: Anger If the illness proceeding death is lengthy, or as the recognition of disfigurement and handicap is verified, the patient moves into the second phase of the grieving process. If the illness proceeding death is lengthy, or as the recognition of disfigurement and handicap is verified, the patient moves into the second phase of the grieving process. In this phase, the client becomes angry. He may hurl criticism and abuse at family members or at health workers. In this phase, the client becomes angry. He may hurl criticism and abuse at family members or at health workers. He feels that he has been done a serious injustice, and hopeless rage is his only defense. He feels that he has been done a serious injustice, and hopeless rage is his only defense.

11. How to deal with the stage of anger? If the RT is insulted or verbally abused, he should not take the abuse personally. If the RT is insulted or verbally abused, he should not take the abuse personally. He should be matter-of-fact and understanding in his responses. He should be matter-of-fact and understanding in his responses. Releasing anger is therapeutic to these patients and should be permitted. Releasing anger is therapeutic to these patients and should be permitted.

12. Phase III: Period of Bargaining The patient becomes a “good patient”. He tries to follow all medical advice and become submissive. The patient becomes a “good patient”. He tries to follow all medical advice and become submissive. He may feel guilty for his outbursts of anger. He has hopes that if he is “good” he will be spared. He may feel guilty for his outbursts of anger. He has hopes that if he is “good” he will be spared. Perhaps, he thinks, there will be a miraculous cure or, at least, less pain and suffering. Perhaps, he thinks, there will be a miraculous cure or, at least, less pain and suffering.

13. Phase IV: period of Depression The patient accepts the reality of his impending death, permanent disability, or disfigurement. The patient accepts the reality of his impending death, permanent disability, or disfigurement. He begins to mourn for his past life and all that he has lost or is losing. He is often silent and retiring at this time. He begins to mourn for his past life and all that he has lost or is losing. He is often silent and retiring at this time.

14. How to deal in the depression stage? The patient in the depression period is often silent and retiring at this time. The patient in the depression period is often silent and retiring at this time. Quiet support is the best response of the health worker during this period. Quiet support is the best response of the health worker during this period.

15. Phase V: Period of Acceptance If the patient is dying, he will lose interest in the outside world and become interested only in his immediate surroundings and the support of persons near him. If the patient is dying, he will lose interest in the outside world and become interested only in his immediate surroundings and the support of persons near him. He deals with his pain and illness and begins to disengage from life He deals with his pain and illness and begins to disengage from life

16. If the patient is facing a permanent handicap or disfigurement and not death, this is the time when he makes his first attempts at rehabilitation. If the patient is facing a permanent handicap or disfigurement and not death, this is the time when he makes his first attempts at rehabilitation. He faces the reality that he must make the most of his life. This does not mean that the handicap is forgotten or totally accepted. The handicapped person may have a longer grieving period than the who suffers the loss of a loved one because he is constantly reminded that he is no longer the person that he once was. He faces the reality that he must make the most of his life. This does not mean that the handicap is forgotten or totally accepted. The handicapped person may have a longer grieving period than the who suffers the loss of a loved one because he is constantly reminded that he is no longer the person that he once was.

17. Dealing with a patient in the acceptance stage Dying patients - The health workers should be quietly supportive during this time. Communication should be reflective, and the client should be allowed to discuss whatever he desires. Dying patients - The health workers should be quietly supportive during this time. Communication should be reflective, and the client should be allowed to discuss whatever he desires. Rehabilitating patient - Allow him to direct his own care as much as possible. He will inform you of the assistance that he needs. Stand by to assist; do not take the lead. Be matter-of-fact and comply with requests for assistance. Rehabilitating patient - Allow him to direct his own care as much as possible. He will inform you of the assistance that he needs. Stand by to assist; do not take the lead. Be matter-of-fact and comply with requests for assistance.

18. End of grieving process Next :- Problem solving