From the following article:
https://complicatedgrief.columbia.edu/professionals/complicated-grief-professionals/overview/
"Grief is the response to loss of something meaningful
Grief is the natural response to losing a loved one. Most people don’t need grief therapists, even when the loss is sudden and unexpected and very, very sad. People have natural ways of adapting to attachment loss, usually with the support of friends and relatives, and everyone does it in their own way. You can think of healing after loss as analogous to healing after a physical wound. The loss, like the injury, triggers a pain response which can be very strong. Injuries also activate a healing process. Loss does too. However, a wound complication, like an infection, can interfere with healing. So, too, maladaptive thoughts, dysfunctional behaviors or inadequate emotion regulation can interfere with adaptation to loss.
CG is not less likely after loss of a rewarding relationship
Mental health training does not usually include learning about the syndrome of complicated grief. However, trainees often are taught that grief is complicated if there was an ambivalent relationship to the person who died. This is a misconception. Adapting to a loss is more difficult if a person can imagine how things could have been different. People might do this because the relationship was conflictual. However, this is uncommon. Most people with complicated grief have had an especially strong and rewarding relationship to the person who died.
Key definitions
Grief is the response to loss that contains thoughts, behaviors, emotions and physiological changed; if the loss is permanent, so too is the grief, but its form evolves and changes as a person adapts to the loss
Acute grief occurs in the early period after a loss and often dominates the life of a bereaved person; strong feelings of yearning, longing and sorrow are typical as are insistent thoughts and memories of the person who died. Other painful emotions, including anxiety, anger, remorse, guilt or shame are also common. Activities are often focused on doing or not doing things to try to deal with the loss.
Integrated grief is the lasting form of grief in which loss-related thoughts, feelings and behaviors are integrated into a bereaved person’s ongoing functioning; grief has a place in the person’s life without dominating.
Complicated grief is a persistent form of intense grief in which maladaptive thoughts and dysfunctional behaviors are present along with continued yearning, longing and sadness and/or preoccupation with thoughts and memories of the person who died. Grief continues to dominate life and the future seems bleak and empty. Irrational thoughts that the deceased person might reappear are common and the bereaved person feels lost and alone.
Adapting to loss entails accepting the reality of the death, including its finality, consequences and changed relationship to the person who died; adapting means seeing the future as holding possibilities for a life with purpose and meaning, joy and satisfaction.
Examples of Grief “Complications”
Maladaptive thoughts are typically counterfactual, grief-focused or catastrophizing; its natural to second guess a loved one’s death, especially if it was sudden, unexpected or untimely; most people worry about whether they are grieving in “the right way” and many dread the future in a world without their deceased loved one. People with complicated grief ruminate over these kinds of thoughts.
Dysfunctional behaviors are typically related to avoiding reminders of the loss and/or escaping from the painful reality. A bereaved person may try to feel close to the person who died through sensory stimulation and day dreaming about being with them – looking at pictures, listening to their voice, smelling their clothes, trying to recall what it was like to be together. Bereaved people are often inclined to avoid places, people or activities that hold reminders of the person who died. These behaviors are problematic when they become the only way of managing painful emotions.
Inadequate emotion regulation is another common problem for people with complicated grief. Acute grief is typically highly emotional. Most people have a range of ways to regulate these emotions. They balance the pain with periods of respite, giving themselves permission to set the grief aside for a time. People with complicated grief have trouble doing this; instead, they often focus on things that increase emotional activation. Regular routines including adequate sleep, nourishing meals, adequate exercise and social contacts may be disrupted, making emotions more difficult to manage."
https://complicatedgrief.columbia.edu/professionals/complicated-grief-professionals/overview/
Showing posts with label Hospitalized Patients. Show all posts
Showing posts with label Hospitalized Patients. Show all posts
Thursday, April 9, 2020
Wednesday, April 8, 2020
Monday, April 6, 2020
Sample Script for SCP when visiting a hospital patient by phone or other electronic means
Revised script following the April 1 Supervision Zoom Meeting (also can be emailed by Joan to you as a WORD/PDF document)
Definition of a Phone Visit:
A phone visit can include phone, SKYPE, WhatsApp, Facetime or other electronic platform depending on what makes sense for you and the individual.
Consent:
Because spiritual care visits are traditionally provided in-person, it is important to obtain explicit consent to hold the visit by this alternative means and to document that consent was obtained from the patient/family member.
Two Scripts Included In this Guideline:
Preparing for a Phone Visit:
As much as is possible and reasonable:
If speaking with the nurse before the patient you might ask - What do I need to know about their health status today? - Do they have any hearing or speaking impediments? – is there anything else I need to know before I make this call? - Who are their emergency contacts?
Introduction:
Hello, is this [patient name]?
If the person who answers the phone is NOT the person you have been asked to speak with…
If the person who answers the phone is the person i.e. “Yes, this is (patient name):
“Hello [name]. My name is [name]. I’m from the Spiritual Care Department. I am not calling with any medical or urgent news. I’m part of the team that provides emotional and spiritual support to patients and families. Is now a good time to chat for a few minutes?
If the person says this is NOT a good time:
No worries. I will call you back at a later time. Is there a time of day that works best for you? OK. I will try to call you back at that time. If you find you could use some spiritual or emotional support in the meantime, ask you nurse to contact me. Otherwise, I will talk with you soon.
If they say “Yes this is a good time,” continue below.
Wonderful. Usually I come around to visit people in the hospital to offer spiritual and emotional support. But, to help prevent the spread of the Corona Virus, we are reaching out to people by phone. I just wanted to check-in. (select phrase that feels most natural to you) How are you holding up?/How you are doing?/How have things been going for you?
We recognize that hospitalizations can be stressful and affect you spiritually and emotionally as well as physically. Has anything been particularly challenging for you lately?
Other questions you might ask to deepen the conversation:
If this lead to conversation/pastoral interventions, proceed with conversation.
Suggestions if this comes up at the beginning of the conversation:
ONLY If they ask about the purpose of the call during the conversation.
The reason I was calling you is that upon your admission to the hospital, you or somebody who was with you, indicated that you might want to talk to a chaplain. I was calling to see how I could support you.
OR
The reason I was calling you is because [name] referred you. They thought that you might benefit from talking to a chaplain.
If a follow up appointment seems appropriate
We have talked about some pretty important things today. Would it be helpful to you for me to follow up with you on another day? Would that be okay with you?
Closing:
Close the conversation Well, thank you for talking with me on the phone today. If appropriate, offer prayer/blessing/song etc.
Introduction If the person who answers the phone is NOT the person you have been asked to speak with…
Is [patient’s name] currently available?
If yes
Proceed with conversation as listed above.
If no. No worries. I will try back at another time to reach [patient’s name].
If yes. Wonderful. Is this a good time to speak with them?
Refer back to the general script on Page 2
If this lead to conversation/pastoral interventions, proceed with conversation.
We recognize that hospitalizations can be stressful and affect families/friends spiritually and emotionally, as well as the patient. Has anything been particularly challenging for you lately?
Other questions you might ask to deepen the conversation:
If a follow up appointment seems appropriate:
We have talked about some pretty important things today. Would it be helpful for me to follow up with you again? Would that be okay with you?
What is the best way to reach you?
Closing:
Thank you for talking with me today and please know that Spiritual Care is available to you whenever you might need it. You can reach me by asking a nurse. I will also call back at another time to try to reach [patient’s name].
Hi I’m ……. The On-call chaplain. I understand from the nurse/Dr. that you are going through a very difficult time right now. How might I be of help to you?
Can you tell me a bit about the person you are concerned about and what they might hope for or want now?
How can we best honour them?
Things to offer:
Definition of a Phone Visit:
A phone visit can include phone, SKYPE, WhatsApp, Facetime or other electronic platform depending on what makes sense for you and the individual.
Consent:
Because spiritual care visits are traditionally provided in-person, it is important to obtain explicit consent to hold the visit by this alternative means and to document that consent was obtained from the patient/family member.
Two Scripts Included In this Guideline:
A. Referral made by patient, family member or
staff member (non-emergency) –
B. On-Call Emergency (usually involving
end of life situations) –
Preparing for a Phone Visit:
As much as is possible and reasonable:
If speaking with the nurse before the patient you might ask - What do I need to know about their health status today? - Do they have any hearing or speaking impediments? – is there anything else I need to know before I make this call? - Who are their emergency contacts?
A. General Script: For referral or patient-generated request
Introduction:
Hello, is this [patient name]?
If the person who answers the phone is NOT the person you have been asked to speak with…
·
See
suggested script on page 3
If the person who answers the phone is the person i.e. “Yes, this is (patient name):
“Hello [name]. My name is [name]. I’m from the Spiritual Care Department. I am not calling with any medical or urgent news. I’m part of the team that provides emotional and spiritual support to patients and families. Is now a good time to chat for a few minutes?
If the person says this is NOT a good time:
No worries. I will call you back at a later time. Is there a time of day that works best for you? OK. I will try to call you back at that time. If you find you could use some spiritual or emotional support in the meantime, ask you nurse to contact me. Otherwise, I will talk with you soon.
If they say “Yes this is a good time,” continue below.
Wonderful. Usually I come around to visit people in the hospital to offer spiritual and emotional support. But, to help prevent the spread of the Corona Virus, we are reaching out to people by phone. I just wanted to check-in. (select phrase that feels most natural to you) How are you holding up?/How you are doing?/How have things been going for you?
·
If
this leads to conversation/pastoral interventions, proceed with conversation.
We recognize that hospitalizations can be stressful and affect you spiritually and emotionally as well as physically. Has anything been particularly challenging for you lately?
·
If
this leads to conversation/pastoral interventions, proceed with conversation.
Other questions you might ask to deepen the conversation:
·
On
the other hand, has anything been helping you cope?
·
Have
you had people call you while in the hospital? –
·
As
I said, one of the things that I am here for is spiritual support. That can mean different things for different
people. Sometimes it means supporting
people in a certain religion and praying for them. Sometimes it means helping them connect to
their meaning and purpose, but not a certain religion. Are you of a certain religious or spiritual tradition?
·
Can
you tell me a little bit about what you find most meaningful? - Any other
thoughtful questions/statements that work during in-person visits.
If this lead to conversation/pastoral interventions, proceed with conversation.
Suggestions if this comes up at the beginning of the conversation:
ONLY If they ask about the purpose of the call during the conversation.
The reason I was calling you is that upon your admission to the hospital, you or somebody who was with you, indicated that you might want to talk to a chaplain. I was calling to see how I could support you.
OR
The reason I was calling you is because [name] referred you. They thought that you might benefit from talking to a chaplain.
If a follow up appointment seems appropriate
We have talked about some pretty important things today. Would it be helpful to you for me to follow up with you on another day? Would that be okay with you?
Closing:
Close the conversation Well, thank you for talking with me on the phone today. If appropriate, offer prayer/blessing/song etc.
Introduction If the person who answers the phone is NOT the person you have been asked to speak with…
Is [patient’s name] currently available?
If yes
Proceed with conversation as listed above.
If no. No worries. I will try back at another time to reach [patient’s name].
If yes. Wonderful. Is this a good time to speak with them?
Refer back to the general script on Page 2
If this lead to conversation/pastoral interventions, proceed with conversation.
We recognize that hospitalizations can be stressful and affect families/friends spiritually and emotionally, as well as the patient. Has anything been particularly challenging for you lately?
·
If
this lead to conversation/pastoral interventions, proceed with conversation.
Other questions you might ask to deepen the conversation:
·
On
the other hand, has anything in particular been helping you cope?
·
As
I said, one of the things that I am here for is spiritual support. That can mean different things for different
people. Sometimes it means supporting
people in a certain religion and praying for them. Sometimes it means helping them connect to
their meaning and purpose, but not a certain religion. Are you of a certain religious or spiritual
orientation?
·
I
like to know a little bit more about people.
Can you tell me a little bit about what you find most meaningful?
·
Any
other thoughtful questions/statements that work during in-person visits.
If a follow up appointment seems appropriate:
We have talked about some pretty important things today. Would it be helpful for me to follow up with you again? Would that be okay with you?
What is the best way to reach you?
Closing:
Thank you for talking with me today and please know that Spiritual Care is available to you whenever you might need it. You can reach me by asking a nurse. I will also call back at another time to try to reach [patient’s name].
B. For On-Call Situations Involving End
of Life Situations:
Hi I’m ……. The On-call chaplain. I understand from the nurse/Dr. that you are going through a very difficult time right now. How might I be of help to you?
Can you tell me a bit about the person you are concerned about and what they might hope for or want now?
How can we best honour them?
Things to offer:
·
Bereavement
support
·
Funeral
planning assistance and information
·
Prayers
·
Scripture
reading
·
Song/hymn
as appropriate
·
Blessing
of the body – scan, remembrance and prayers
·
5
Finger prayer
·
Invite
the family to gather around the bed and place a hand on the deceased, as
appropriate, or hover above
“LOVE”
When you need to talk a
family member on phone or video through saying goodbye to a patient who is in their
last hours or minutes.
Lead the way forward
“I am [name], one
of the [professionals] on the team.”
“For most people,
this is a tough situation.”
“I’m here to walk you through it if you’d like.”
“Here’s what our institution / system / region is doing for
patients with this condition.”
(State the part directly relevant to that person.)
(State the part directly relevant to that person.)
Offer the four things that matter to most people
“So we have the
opportunity to make this time special.”
“Here are five
things you might want to say. Only use the ones that ring true for you.”
“Please forgive me”
“I forgive you”
“Thank you”
“I love you”
“Goodbye”
“Do any of those
sound good?”
Validate what they want to say
“I think that is a beautiful thing to say”
“If my [daughter] were saying that to me, I would feel so valued
and so touched.”
“I think he/she can hear you even if they can’t say anything back”
“Go ahead, just say one thing at a time. Take your time.”
Expect emotion
“I can see that
he/she meant a lot to you.”
“Can you stay on the line a minute? I just want to check on how
you’re doing”
Thursday, April 2, 2020
Prayers for the Hospitalized Adult Population with Covid-19
Prayers written or adapted by chaplains from Cincinnati Children’s Hospital Medical Center in response to the Covid-19 crisis.
A Prayer for an Adult Patient to Read for Themselves
Dear God,
Help me be aware of how much my family and friends love me, even though they can’t be with me.
Remind them of how much I love each of them, especially (name family and friends here).
I am also mindful of the animals who share life with us.
Help the people caring for me have wisdom.
Help me feel your love and presence as you guide me through this time of sickness.
Let good memories sustain me as I wait to know what comes next.
Free me from pain, free me from fear.
Surround me with your love, empower me with your courage.
Amen
A Prayer for an Adult Patient to Read for Themselves
God of Love and Comfort,
Here I am, sick and in the hospital.
Please take away any fear or pain I might be feeling right now.
Guide the staff who are caring for me.
Help me remember that I am not alone,
because you are with me,
and because I am surrounded by love from my family and friends.
Help my family and friends to know that I am sending them love, too.
In your name I pray, Amen
God of Love and Comfort,
Here I am, sick and in the hospital.
Please take away any fear or pain I might be feeling right now.
Guide the staff who are caring for me.
Help me remember that I am not alone,
because you are with me,
and because I am surrounded by love from my family and friends.
Help my family and friends to know that I am sending them love, too.
In your name I pray, Amen
A Prayer for an Adult Patient to Read for Themselves
God of Love and Comfort,
Here I am in this hospital.
I’ve never been this sick before. I don’t feel well, and I am afraid. Please help me.
I didn’t want this to happen.
There are people who need me.
There are things I hope to do in my life.
Please heal me, so I can return to my family, and accomplish my dreams.
No matter what happens next, make sure the people I care about know that I love them,
I’m grateful for them,
and I will never forget them.
Amen.
God of Love and Comfort,
Here I am in this hospital.
I’ve never been this sick before. I don’t feel well, and I am afraid. Please help me.
I didn’t want this to happen.
There are people who need me.
There are things I hope to do in my life.
Please heal me, so I can return to my family, and accomplish my dreams.
No matter what happens next, make sure the people I care about know that I love them,
I’m grateful for them,
and I will never forget them.
Amen.
A Prayer for an Adult Near Death to be Read by Staff
*Adapted from Final Confessional Prayer in Where Healing Resides, CCAR Press, 2013
Source of all life,
All is now in Your hands.
Receive all of _______’s worries and fears.
Wash them away.
Let goodness flow over them and surround them now. Help them as they ready for their next passage.
Let them know that You will walk alongside them, and be present with them and with us,
for their soul in entwined with ours.
Source of life, as they come close to You, bathe them in Your light.
Love them and carry them.
Shelter them under Your protecting wings. Ready a place in Your garden for them.
Into Your hand we trust their soul. Gently, lovingly, tend them now. May they be at peace.
Amen
*Adapted from Final Confessional Prayer in Where Healing Resides, CCAR Press, 2013
Source of all life,
All is now in Your hands.
Receive all of _______’s worries and fears.
Wash them away.
Let goodness flow over them and surround them now. Help them as they ready for their next passage.
Let them know that You will walk alongside them, and be present with them and with us,
for their soul in entwined with ours.
Source of life, as they come close to You, bathe them in Your light.
Love them and carry them.
Shelter them under Your protecting wings. Ready a place in Your garden for them.
Into Your hand we trust their soul. Gently, lovingly, tend them now. May they be at peace.
Amen
A Prayer for an Adult Patient who has Died to be Read by Staff
Ever-present God,
I hold up this precious life to you,
Giving thanks for the love that has been given and received. May they be granted peace, now and forever,
Amen.
Ever-present God,
I hold up this precious life to you,
Giving thanks for the love that has been given and received. May they be granted peace, now and forever,
Amen.
A Prayer for an Adult Patient who has Died to be Read by Staff
Ever-present God,
We come before you grateful for the life of this person. We are heartbroken that this moment has come.
Still, we are grateful for the love this individual shared, the beauty they created,
and the strength of their spirit.
We are grateful that throughout all of their life, including right now,
You have been with them.
We are grateful for the love that surrounds them- Your love and the love of their family and friends.
As this person transitions from this life into the next, may they be pain-free and unafraid,
surrounded by love, light, comfort, and peace.
Please comfort and care for this person’s family and friends, and all who cared for or care about them.
May they be comforted by Your love
and the memories they share with their loved one.
In Your holy name we pray, Amen.
Ever-present God,
We come before you grateful for the life of this person. We are heartbroken that this moment has come.
Still, we are grateful for the love this individual shared, the beauty they created,
and the strength of their spirit.
We are grateful that throughout all of their life, including right now,
You have been with them.
We are grateful for the love that surrounds them- Your love and the love of their family and friends.
As this person transitions from this life into the next, may they be pain-free and unafraid,
surrounded by love, light, comfort, and peace.
Please comfort and care for this person’s family and friends, and all who cared for or care about them.
May they be comforted by Your love
and the memories they share with their loved one.
In Your holy name we pray, Amen.
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