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Relating to Terminally Ill Patients and their Loved Ones

Catherine Hausenfluke Independent Consultant 512-966-4955. Relating to Terminally Ill Patients and their Loved Ones. Goals for This Session. Know More about Dying and Grief Come to Terms with Your Own Morality Understand Grief and What are the Rules Understand the Dying Process

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Relating to Terminally Ill Patients and their Loved Ones

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  1. Catherine Hausenfluke Independent Consultant 512-966-4955 Relating to Terminally Ill Patients and their Loved Ones

  2. Goals for This Session • Know 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

  3. A Little Bit About Hospice Dame Cicely Sanders : 1918-2005 Born in England Nursing Degree Social Work Degree Doctor Opened 1st Stand Alone Hospice 1967

  4. A Little Bit About Hospice (cont) Hospice Came to US in 1960’s Medicare pays 100% Terminal Illness with 6 Months or Less to Live Does Not Hasten Nor Postpone Death Team Approach Volunteer Programs Medicare Mandated Happens in a variety of places

  5. Our Culture Death Denying Believe Women are more Emotional than Men Believe there is Closure Believe that tears or crying is bad Death is a punishment from God Believe there is something we can do to “Fix” it Believe being “strong” is an admirable and desirable reaction to loss

  6. Death and Dying Understanding your feelings about death and dying is essential in order to care and support the patient and the family.

  7. 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.

  8. 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

  9. About Crying Some people do, some people don’t There 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

  10. Grief: Elisabeth Kubler-Ross Shock Denial Anger Bargaining Depression Acceptance

  11. “If Grief is a GameThese are the Rulesby: Danny Mack

  12. You will come into this world with a capacity to love and be loved. Rule Number 1 Love of your parents – unconditional You will love many people You will receive love Dark side of love is grief We love greatly and we mourn greatly The degree of grief is commensurate to the love relationship

  13. You Will Lose Everyone You Love Rule Number 2 Two things in life that are certain: Taxes and Death You will lose people that are important to you

  14. Your Loss Will Affect YouPhysically, Emotionally and Spiritually Rule Number 3 Physical: Lack of Sleep Chest/Stomach Pains Overeating/Lack of Appetite Inability to Concentrate Loss of Memory Fatigue Headaches Tension

  15. Your Loss Will Affect YouPhysically, Emotionally and Spiritually Rule Number 3 cont Emotionally: Sadness Depression Fear Anger Tearfulness Doubt Hallucinations/Hearing Voices Regret Guilt

  16. Your Loss Will Affect YouPhysically, Emotionally and Spiritually Rule Number 3 cont Spiritually: Affirm or adjust your religions concepts Anger at God Denial of God

  17. No One Will Understand How You Feel Rule Number 4 People will say the wrong things Friends will abandon you Comfort and understanding maybe difficult to find Your grief is YOUR grief – no one else is you

  18. Others Will Want You ToHurry Up and Get OverYour Grief Rule Number 5 Why don’t you just get over it? Eye rolls or other facial expressions of impatience Impatient with yourself – shouldn’t I be over this by now? Special occasions and the anniversaries will be difficult Slow and painful process – surrender Life will always be different – it will never be the same

  19. Grief Will ComeWhen You Least Expect It Rule Number 6 Different emotions all at the same time crashing over you Music, a smell, a sound A time of day Ignoring it will be unsuccessful Feel the sadness until it subsides

  20. Some Days Will BeMore Difficult Than Others Rule Number 7 Special Occasions Anniversary of the onset of the illness – death Develop a plan Have a time of remembrance

  21. 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

  22. You Will Grieve TheRest of Your Life Rule Number 9 Healing the wounds of the heart takes time You will grieve the loss of your loved one the rest of your life Your grief is a reflection of the love you have experienced It is a journey that will last a lifetime

  23. No One Will Tell YouThese Rules Rule Number 10 Experiencing the loss of a loved one Life will be good once again – but it will never be the same

  24. The Art of Listening http://www.youtube.com/watch?v=7rZ6Xl1Nzbo&feature=youtu.be

  25. The Art of Listening Have 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?

  26. 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.

  27. 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.

  28. 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.

  29. 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

  30. Active Listening (cont) • Don’t argue either verbally or mentally • Listen to how something is said • Listen for what is notsaid 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

  31. RELATING TO A HOPSICE PATIENT

  32. PLEASE NO TALKING DURING THE REST OF THIS EXERCISE

  33. What are you feeling?How did you feel when I took your square?

  34. What NOT to say

  35. What TO say or do

  36. 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.

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