NURS 6512 Week 11 Final Exam
Therapeutic Technique with Grieving Individuals
Below are examples of some useful techniques in grief counseling that stem from a range of different theoretical frames.NURS 6512 Week 11 Final Exam
Cognitive restructuring
The underlying assumption with this approach is that our thoughts influence our feelings; particularly the secret self scripts that are constant in our minds. It is not unusual for the grieving person to experience some irrational self scripts, (e.g. “I’m all alone” or “no one will ever love me again”) as they get overwhelmed by the reality of the loss. The role of the counselor is to identify these thoughts of the client, challenge them for accuracy and help the client replace those thoughts with more functional and realistic ones. This technique is particularly useful in challenging feelings of false guilt.
Writing
Writing can be used to help the survivor express their feelings and thoughts more freely. Such free expression is a crucial gesture in grief recovery. For example, having the client write a letter to the deceased can help them take care of “unfinished business” as they get an opportunity to express things that were left unsaid before the loss. If and when appropriate, the counselor can encourage the client to write extensive and honest letters to promote an authentic and free expression of thoughts and feelings.
Role playing
Role playing is particularly effective in helping the client adjust to the new environment after the loss of a loved one by helping them build the skills and recognize their ability to make new adjustments and move on with life as normal. The counselor can be involved in role playing either as a facilitator or to model possible new behaviors for the client.NURS 6512 Week 11 Final Exam
Evocative language
The counselor may choose to use “tough” words (e.g. “your son is dead” rather than “you lost your son”) to encourage a greater revelation of the reality of the loss, thus inducing relevant feelings to help the client experience and express painful emotions that need to be felt after a loss. This should only be applied after a healthy rapport and trust has developed between the client and the counselor or else it may be viewed as insensitive by the client. As such, timing is an important factor when using this technique. The counselor can also encourage the survivor to speak of the deceased in past tense. This serves as a constant reminder that the loss has occurred thus promoting a real acknowledgement and growing acceptance of the loss.
Memory book
The role of the memory book is to get family and significant others together to reminisce the life of the deceased. The book can include the stories about significant events and memorabilia such as photographs, poems, drawings, etc. This creates an opportunity for the family and significant others to grieve together and offer support to one another. This has the potential to ease the painful emotions associated with the loss. The purpose is to encourage the fullest expression of feelings and thoughts regarding the loss.
Working with patients and their families at the end of life is a demanding yet incredibly rewarding process. The “work” of grieving a significant loss is a complex, uncomfortable, and often lengthy process. Pain experienced by grieving persons is often palpable and apparent to others, eliciting our desire to “help.” However, if we have unresolved or recent grief issues ourselves, then we may avoid “going there” so as not to stir up our own discomfort. NURS 6512 Week 11 Final Exam
Reacting to our patients’ suffering and having feelings about our personal grief experiences is a normal process. Research suggests that we, like all healthcare providers, experience anxieties, fears, uncertainties, doubts, and depression. Many health professionals have not had the opportunity to work through their own feelings about death and dying. Yet we are expected to help others face and confront anxieties and fears which we ourselves have not yet mastered.
Consequently our first intervention is with ourselves. Step one for healthcare professionals is to process our personal grief experiences and, thereby, build a foundation for helping others. In doing our own work we will enhance our grief intervention skills by gaining a more in-depth understanding about what the experience of grief may be like for our patients. With less discomfort about the topic ourselves, we will be less likely to avoid raising issues of loss with our patients and families.
After building an increased awareness of our personal histories, the next step is to look more deeply at how those personal characteristics influence our nursing interventions. Once we have become more aware and taken stock of all of our life experiences in death, dying, loss, and grief then we can slowly, systematically over time, work on dealing with areas that need attention. Sometimes to build our courage for this journey we need to remind ourselves frequently, “If I cannot face my own issues about loss, how can I help others?” Our interventions can then be based on a greater peace and comfort with loss, which will in turn help build a positive foundation for helping and create more comfort for our patients and families in addressing these issues. To build this foundation, healthcare professionals must obtain knowledge about death, dying, grief and loss as well as explore personal experiences and responses to grief. (The module “Grief: Sociocultural Aspects” provides additional structured exercises for the development of this kind of self-reflection and self-awareness.)NURS 6512 Week 11 Final Exam
Obstacles to Providing Care
There can be numerous obstacles to compassionate care giving for the bereaved. First, it is important to identify what specific parts of death, dying, grief, and loss are the most difficult to provide compassionate support. Just as some nurses have difficulty watching a surgical procedure, other nurses are equally uncomfortable when they are with a patient who is experiencing intense physical or emotional pain, and still others may struggle with helping people who are denying their impending death.
Second, we need to identify the ways that we react to suffering. How do we limit our compassion? Examples of these limiting reactions are to deny or push it away, compulsive doing, be a rescuer or cool professional. Evidence of our limitations can be seen in the common, though unskillful, practice of entering a crying patient’s room and not acknowledging his/her tears.
Third, we need to identify which of our attitudes, beliefs, fears, and concerns actually block us from giving compassionate support. Sometimes a belief such as “in order to have a ‘good death’ a person needs to acknowledge and accept the fact he/she is dying” will drive the nursing intervention rather than the patient’s needs. One common example of a limiting fear is “saying the wrong thing.” In this situation, our challenge is to develop the courage to begin. We must say and do something, even if we don’t know exactly what words to use. Many people, particularly healthcare providers, often hide behind their desire to offer the “perfect” response that will make the person’s pain “go away.” Free yourself of that unrealistic goal. Remember that offering support and comfort will not take away the pain of grief. NURS 6512 Week 11 Final Exam And to know what to say, recall the information and principles presented here, then use your own words to communicate those ideas. As with all parts of being a novice, practice is essential to build skills. Talking about loss, grief, death, and dying builds experience and experience builds expertise. The more you do it the easier it becomes. While there are some common phrases to avoid, such as “I understand how you feel or what you are going through,” (It is presumptuous to assume you really understand someone else’s experience because every situation is different.) you could say, “I learned from my patients how hard it can be; most families I have worked with experience considerable pain” or “I have some small sense of the difficulty dealing with these things, both from personal experience and my work here with families.” Generally, if we are sincere and connected with our patients and families, they will feel our compassion (which is most important), and they will not require us to have the “perfectly worded” response.
Fourth, it is critical to identify the conditions in the work environment or organization that block our compassionate intervention. Once we identify these conditions, we can assess what can be changed and who in the organization can help remove these barriers. We also need to understand which conditions call for our flexibility and require creativity to find ways to accomplish our goal of compassionate care giving for the bereaved in spite of the institutional barriers. Sometimes nurses, inhibited by their own discomfort about loss and grief, hide behind those barriers as an excuse for not implementing grief interventions. There is usually something that the nurse can offer in the area of loss and grief, even in the most challenging circumstances.
Principles and Strategies for Intervention
The Tasks of Grievers as an Intervention Guide
From the broadest perspective–the purpose of grief interventions is to assist patients and families with the mourning (the outward expression of grief) and the internal work of the grief process. It is key that the nurse understands “the big picture” about what mourning often looks like as well as the tasks of the bereaved.NURS 6512 Week 11 Final Exam
Just as with developmental tasks associated with human development over the life span, accomplishing certain grief tasks can facilitate, but does not guarantee a healthy outcome for the individual. Grief tasks generally parallel normal grief symptoms and phases. It is helpful, therefore, to assess where people are in the grief process so we can assist them in their work. Nurses in a variety of settings can address different aspects of these needs. For example, when a patient’s end-of-life care occurs in an intensive care unit, nurses can serve a critical role in the family members’ grief process with the approaches they use to meet the first need to acknowledge the reality of the impending death. Think for a moment what kind of “standard procedures” ICU nurses would create if they were guided by this priority. This focus might include helping families at the time of death acknowledge the reality of the loss by supporting them in seeing or touching their loved one’s body. Or allowing them to observe as you disconnect monitors and IVs, or prepare the body for transfer to the morgue.NURS 6512 Week 11 Final Exam