in LongTerm Care Acknowledgement This training program is supported in part with funding from the Government of Ontario through the Ontario CLRI The views expressed herein do not necessarily reflect the views of the Province ID: 1046945
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1. Module 2Communication at End-of-Lifein Long-Term Care
2. AcknowledgementThis training program is supported in part with funding from the Government of Ontario through the Ontario CLRI. The views expressed herein do not necessarily reflect the views of the Province.
3. 3VIDEOS: Palliative MythsEpisode 1Episode 2
4. What do I think/feel about death, dying, and loss?Identify feelings and beliefs related to hospice palliative/end of life care.Explore personal values about death and dying.Explore personal experiences of grief and loss.Review William Worden’s Tasks of Grieving.Review active listening and the needs of the bereaved.4
5. Personal Values about DeathWhat are my personal values about Death?Role? Meaning?Beliefs about life after death?What I fear the most?Preferences for when and where I die?Complete the self-reflective handout on your own. After you finish, find one other person in the group and share some of your answers. Give your undivided attention as you share and listen.5
6. Answer the Following Questions…What was difficult to discuss; and why?What was easier to discuss; and why?How does it feel to discuss these topics with others?What surprised you as you listened to someone else talk about death?What did you learn about yourself in doing this exercise?6
7. 7Create a list of objects, values, and/or people that you cherish in your life and that give you meaning and purpose for living. Activity Time:Listing of cherished objects, values, and people
8. Grief & Loss Vocabulary GRIEVING: A normal, natural, and individual (internal) response to a lossMOURNING: The process by which we publicly work through a loss. It is a form of healing and people need opportunities to experience this process. BEREAVEMENT: The event of loss 8
9. 9DR. ELISABETH KÜBLER-ROSSVIDEO: Stages of GriefLink To Video
10. Stages of Dying/GriefDenial Anger Bargaining Depression Acceptance10
11. THE FOUR TASKS OF MOURNING DR. WILLIAM WORDEN1: TO ACCEPT THE REALITY OF THE LOSS2: EXPERIENCE THE PAIN OF THELOSS AND EXPRESS IT WITHOUT JUDGEMENT3: ADJUST TO THE NEW REALITYWITHOUT THE LOST PERSON OR OBJECT4: RE-ESTABLISH AND RE-INVESTIN EMOTIONAL TIES11T.E.A.R.
12. Activity: Remembering a Loss12
13. Manifestations of Grief13Physical Behavourial Emotional Spiritual Cognitive
14. PHYSICAL MANIFESTATIONS OF GRIEF14Tightness in the throatShortness of breathDisturbed sleep patternsLoss of energyChange in appetiteDry mouthHollowness in the stomachTightness in the chest
15. BEHAVIOURAL MANIFESTATIONS OF GRIEF15Crying/sighingWithdrawal of independenceLoss of interestRestlessnessHostile outburstsTreasuring objects that belong to the deceasedVisiting places that remind the survivor of the deceased
16. EMOTIONAL MANIFESTATIONS OF GRIEFSadness and painAnger hostilityPersonal guilt or shame (e.g. remorse, regret) AnxietyLoneliness and HelplessnessMood swingsShockYearningReliefNumbness16
17. SPIRITUAL MANIFESTATIONS OF GRIEF17Doubts about God/Higher Power/CreatorLack of belief or faith in a higher powerUnable to pray, despairGuiltDreams: seeing the deceasedHopelessnessDecreased value of lifeShameRegretResentments
18. COGNITIVE MANIFESTATIONS OF GRIEF18Disbelief ConfusionFoggy mindPoor memoryForgetfulness, absent mindedInability to concentratePoor judgmentPoor reasoningPerception distortionAbility to learn is compromised
19. 聽HeartUndivided AttentionEyesEars‘To Listen’ in Chinese (Traditional)19
20. VIDEO: The Grieving Process: Coping with DeathLink To Video20
21. When you are worried about what words to say, pay attention to how you are saying them.Dr. Albert MehrabianNonverbal communication21
22. NEEDS OF THOSE IN MOURNING22SHARE FEELINGS - Allow people to ventilate their emotions and fears.AFFIRM THEIR PERSONHOOD – Provide support and let them verbalize memories.FEEL SUPPORTED AND ACCEPTED – They may have fear of abandonment.
23. NEEDS OF THOSE IN MOURNING23Expressions of DEPENDENCY are to be expected.To FIND MEANING IN THE DEATH EXPERIENCE – Do not minimize this. People expend massive amounts of psychic energy in the process.6. Need for REALITY-TESTING - To be reminded to stay in the present.
24. LOVE AND GRIEF24“Only people who avoid love can avoid grief. The point is to learn from it and remain vulnerable to love” -John Brant
25. LOVE AND GRATITUDELove and GratitudeThe agony is so great…And yet I will stand it.Had I not loved so very muchI would not hurt so much.But goodness knows I would not want to diminish that previous loveBy on fraction of an ounce. I will hurt!!And I will be grateful to the hurtFor it bears witness to The depth of our meanings,And for that I will be eternally grateful. 25
26. Death ends a life, but not a relationship26Image Source: theinvisiblestring.comThere is a string that is invisible that connects us with the people we love.