Relating to Terminally Ill Patients and their Loved

Ones

Catherine HausenflukeIndependent Consultant

512-966-4955

Goals for This SessionKnow More about Dying and Grief

Come to Terms with Your Own Morality

Understand Grief and What are the Rules

Understand the Dying Process

Relating to a Dying Person

What Can We Do

What Not to Do or Say

A Little Bit About Hospice

Dame Cicely Sanders : 1918-2005Born in EnglandNursing DegreeSocial Work DegreeDoctorOpened 1st Stand Alone Hospice 1967

A Little Bit About Hospice (cont)

Hospice Came to US in 1960’sMedicare pays 100% Terminal Illness with 6 Months or Less to LiveDoes Not Hasten Nor Postpone DeathTeam ApproachVolunteer Programs Medicare MandatedHappens in a variety of places

Our Culture

Death DenyingBelieve Women are more Emotional than MenBelieve there is ClosureBelieve that tears or crying is badDeath is a punishment from GodBelieve there is something we can do to “Fix” itBelieve being “strong” is an admirable and desirable reaction to loss

Death and Dying

Understanding your feelingsabout death and dying

is essential in order to care and supportthe patient and the family.

Death and Dying (cont)Confrontation with your own mortality is inevitable –

but remember when visiting with the patient, it is about THEIR needs not your needs.

What is Grief?Grief: A natural reaction to a significant loss.

We grieve when:a loved one dies;

a significant relationship ends; a loved one is in a chronic or terminal

illness. We also grieve when we lose something we have valued:

Job; Financial Security; Possessions, Family Pet, Home

About Crying

Some people do, some people don’tThere are no rules for crying

Crying is nature’s way of releasing tension and expressing emotion

It lets others know that you need to be comforted

Chemical make up

Grief: Elisabeth Kubler-Ross

ShockDenialAnger

BargainingDepression Acceptance

“If Grief is a GameThese are the Rules

by: Danny Mack

You will come into this world with a capacity

to love and be loved.

Rule Number 1

Love of your parents – unconditionalYou will love many peopleYou will receive love

Dark side of love is griefWe love greatly and we mourn greatlyThe degree of grief is commensurate to the love relationship

You Will Lose Everyone You Love

Rule Number 2

Two things in life that are certain:Taxes and DeathYou will lose people that are important to you

Your Loss Will Affect YouPhysically, Emotionally and Spiritually

Rule Number 3

Physical:Lack of SleepChest/Stomach PainsOvereating/Lack of AppetiteInability to ConcentrateLoss of MemoryFatigueHeadachesTension

Your Loss Will Affect YouPhysically, Emotionally and Spiritually

Rule Number 3 cont

Emotionally:SadnessDepressionFearAngerTearfulnessDoubtHallucinations/Hearing VoicesRegretGuilt

Your Loss Will Affect YouPhysically, Emotionally and Spiritually

Rule Number 3 cont

Spiritually:Affirm or adjust your religions conceptsAnger at GodDenial of God

No One Will Understand How You Feel

Rule Number 4

People will say the wrong thingsFriends will abandon youComfort and understanding maybe difficult to findYour grief is YOUR grief – no one else is you

Others Will Want You ToHurry Up and Get Over

Your Grief

Rule Number 5

Why don’t you just get over it?Eye rolls or other facial expressions of impatienceImpatient with yourself – shouldn’t I be over this by now?Special occasions and the anniversaries will be difficultSlow and painful process – surrender Life will always be different – it will never be the same

Grief Will ComeWhen You Least Expect It

Rule Number 6

Different emotions all at the same time crashing over youMusic, a smell, a soundA time of dayIgnoring it will be unsuccessfulFeel the sadness until it subsides

Some Days Will BeMore Difficult Than Others

Rule Number 7

Special OccasionsAnniversary of the onset of the illness – deathDevelop a planHave a time of remembrance

Tears Will BeYour Companion

Rule Number 8

Crying during a season of grief releases toxins from the body and brings healing.Crying is a natural part of the healing process

You Will Grieve TheRest of Your Life

Rule Number 9

Healing the wounds of the heart takes timeYou will grieve the loss of your loved one the rest of your lifeYour grief is a reflection of the love you have experiencedIt is a journey that will last a lifetime

No One Will Tell YouThese Rules

Rule Number 10

Experiencing the loss of a loved oneLife will be good once again – but it will never be the same

The Art of Listening

http://www.youtube.com/watch?v=7rZ6Xl1Nzbo&feature=youtu.be

The Art of ListeningHave you ever felt like the person you were with wasn’t listening?How did that make you feel?Do you think in your head what your response is going to be, and only hear part of what is being said?Do you feel uncomfortable with long pauses or silence?Do the dying patients and their families deserve to have your full attention?

Communication

Communication is the act of exchanging ideas, messages, thoughts, and information both verbally and non-verbally.

This includes listening, talking, and body language.

Patients have feelings, wishes, and opinions. They have the right to be heard, to make peace with themselves and their families, to “get things in order”, and to die with dignity.

Communication Tips

Every person is different!!! No two people react to life’s events alike, even when they live together in a loving relationship such as a marriage and family. Accept another’s personhood and space.

Non-verbal communication can often “speak louder than words”. Watch facial expressions, body language, and eye contact. If the verbal and non-verbal are not matching up, help clarify.

Listening is important!! Don’t plan a rebuttal while a speaker is talking. Reflect the feeling you hear being expressed by the speaker.

Communication Tips (cont) Feelings are real – more important, at times, than the

facts! They indicate exactly what is happening in a communication.

Never tell someone how they “should” feel.

Speak as clearly as you can about an issue, not a person. Judging, critical comments do not encourage the other person to be open to you.

Express affection, appreciation, and affirmation (verbally and non-verbally) as often as it’s possible and real.

Be at ease with silence.

Active Listening Techniques

☺Stop Talking!!!! Listen to what is being said both directly and indirectly☺Show external signs of listening by eye contact, nodding appropriately, smiling, gestures, posture☺Remove distractions such as doodling, tapping or paper shuffling☺Concentrate☺Allow plenty of time and do not interrupt☺Observe signals that a person wants to talk such as leaning forward, seeking eye contact, stealing glances at you

Active Listening (cont)

☺Don’t argue either verbally or mentally☺Listen to how something is said☺Listen for what is not said and to the person’s nationality, religion, experience, conditioning, and feelings☺Paraphrasing helps you to clarify what is being said. Repeat or rephrase what you feel is trying to be conveyed.☺Ask open ended questions to encourage free discussion

RELATING TO A HOPSICE PATIENT

PLEASE NO TALKING

DURING THE REST OF THIS EXERCISE

What are you feeling?

How did you feel when I took your square?

What NOT to say

What TO say or do

The advice that I would share with a Volunteer is: Volunteering is the ministry of presence. You don’t have to have an agenda or activities planned for your visits to your patients, you don’t have to have memorized a speech or have a doctorate in social work or counseling…and certainly none of us have all the answers. Our patients conditions can change from day to day. Just go…visit with an open heart and let your spirit guide you as to what to do or say…(if anything). Sometimes our patients and families just need to know that they are not alone in the process of dying, they need to know another human being cares enough to spend time with them and value their lives, honor their grief, and listen to whatever needs to be expressed.

A Butterfly’s Lesson”One day, a small oppening appeared on a cocoon; a man sat and watched the butterfly for several hours as it struggled to force its body through that little hole.