Thursday, April 9, 2020

Grief is the Response to loss of something meaningful - from the Centre for Complicated Grief

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/

Monday, April 6, 2020

Sample Script- Supporting Healthcare Workers during COVID19

I cut all of this information out of the patient script and have copied it into its own script ideas for use when supporting healthcare workers either by phone or in-person:


Specific Responses to Specific Concerns During COVID19:

(Adapted from the resource found at file:///C:/Users/Dell%20User/Documents/Spiritual%20Care%20Education/Telehealth%20Chaplaincy/VitalTalk-COVID19.html /  It is a free resource that can be downloaded and you may wish to review the whole document.)

When coping needs a boost, or emotions are running high

What they say
What you say
I’m scared.
This is such a tough situation. I think anyone would be scared. Could you share more with me?
I need some hope.
Tell me about the things you are hoping for? I want to understand more.
Nobody cares about us. You people are incompetent!
I can see why you are not happy with things. I am willing to do what is in my power to improve things for you. What could I do that would help?
I want to talk to your boss.
I can see you are frustrated. I will ask my boss to come by as soon as they can. Please realize that they are juggling many things right now.
Do I need to say my goodbyes?
I’m hoping that’s not the case. And I worry time could indeed be short. What is most pressing on your mind?



Anticipating

When you’re worrying about what might happen (or when you’re supporting a healthcare provider who is worried about something that might happen)

What you fear
What you can do
That patient’s son is going to be very angry.
Before you go in the room, take a moment for one deep breath. What’s the anger about? Love, responsibility, fear?
I don’t know how to help this family understand why their loved one isn’t being transferred to the ICU like they want/expect.
Remember what you can do: you can hear what she’s concerned about, you can explain what’s happening, you can help her prepare, you can be present. These are gifts.
I am afraid of burnout, and of losing my heart.
Can you look for moments every day where you connect with someone, share something, enjoy something? It is possible to find little pockets of peace even in the middle of a maelstrom.
I’m worried that I will be overwhelmed and that I won’t be able to do what is really the best for my patients.
Check your own state of being, even if you only have a moment. If one extreme is “wiped out,” and the other is “feeling strong,” where am I now? Remember that whatever your own state, that these feelings are inextricable to our human condition. Can you accept them, not try to push them away, and then decide what you need

Grieving

Supporting Healthcare Workers Who are Grieving Over the Limitations Imposed on Them by COVID19



What they are saying or thinking
What you can do
I should have been able to do more to support that person.
Notice: am I talking to myself the way I would talk to a good friend? Could I step back and just feel? Maybe it’s sadness, or frustration, or just fatigue. Those feelings are normal. And these times are distinctly abnormal.
OMG I cannot believe we don’t have the right equipment / how mean that person was to me / how everything I do seems like its blowing up
Notice:  am I letting everything get to me? Is all this analyzing really about something else? Like how sad this is, how powerless I feel, how puny our efforts look? Under these conditions, such thoughts are to be expected. But we don’t have to let them suck us under. Can we notice them, and feel them, maybe share them?
And then ask ourselves: can I step into a less reactive, more balanced place even as I move into the next thing?




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:

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.)

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”


Thinking About Your Will

Hi everyone,
In these pandemic times, it is even more important that each of us, and the people we work with, have thought about and created a will.  This is true, and yet, when we need it most, there are fewer social workers around to help our patients do this (this may be less true in the hospital setting where Social Workers are still working.  There is a huge shortage of SWs in the community setting.)

Based on an Ontario will checklist I found on-line, I put together this document. It is NOT legal advice. It's just 'things to think about.' We have used it with some PCOT patients and hope that you may find it useful. Remember that it does not replace a visit or consultation with a lawyer. On the other hand, if someone is very ill and a lawyer cannot get to them, it provides some help as they put something down on paper.  As long as it is signed by the individual and witnessed, signed and dated by two people who are not named in the will, it will be considered a legal will from what I understand.

Please feel free to use as you see appropriate.

May blessings abound,
kathy


Thinking About Your Will



Note:  This document does not provide legal advice.



Resources used to provide this document were accessed on Monday April 6, 2020 and are as follows:









Anyone developing a will should always make sure that the resources being used are for residents of Ontario (as these are).



Checklist For Making A Will



Steps To Help You Prepare

1.     Gather and review all the documents related to your estate.

2.     List key documents such as”

a.      Birth, death, marriage & divorce certificates;

b.     Deeds & mortgages;

c.      Bank account numbers;

d.     Investment portfolio account numbers;

e.     Insurance policy numbers;

f.       Funeral plans and burial lot information.



3.     List your advisors such as your banker, lawyer, accountant, investment dealer, and insurance agent. Include their company names and addresses

4.     Make sure you family and executor(s) know where this information is located. Some of it may be needed right after your death. Don't keep it with your will.



What To Consider When Making Your Will

5.     Who will you select as executor and, if you wish, co-executor?  (this is the person who will make sure that what you put in your will is honoured.) Consider naming an alternate executor in case the executor is not able to act. Speak to these people to be sure they will agree to act.

6.     Do you want to leave bequests? Bequests are specific items of personal property (such as a car, jewelry, china, silver, art, furs, etc.) or a sum of money that you wish to leave to a specific person.

7.     To whom do you wish to leave the remainder of your estate? Spouse? Children? Charities? Is it to go directly or through a trust? If it is being left to children, are they to receive it immediately or at some future time?

Note: If the children are minors, you might want to specify a certain age.



8.     How do you want your estate distributed (your estate is anything that is left over after the specific bequests have been distributed.)

9.     If one of your children has died, do you want his or her children to

receive that share, or do you want it to go to your other children?



10.Who will you name as a guardian for dependant children or disabled

adult children? Make sure the guardian agrees to act!

11.If you are in a second marriage and both of you have children from previous marriages you may wish to consider the available options.  For example, the remainder of your estate can go to:

a.       your spouse absolutely;

b.     your children absolutely;

c.      your spouse for his or her use while alive, and then, after your spouse dies, to your children;

d.     your children and the children of your spouse.



It is very important that you and your spouse discuss the various

options and agree upon your plans.



12.In the event that a minor (child, grandchild, niece or nephew) inherits a share of your estate, who do you want to receive their share?

13.If one of your beneficiaries is dead, who do you want to receive their share?



Friday, April 3, 2020

Feast and Fast in the Time of an Epidemic

Feast and Fast in the Time of an Epidemic

Jim Burklo


Let us fast from hugging and handshaking
And let us feast on bowing and waving.
Let us fast from hoarding food and toilet paper
And let us feast on the food in the back of our pantries.
Let us fast from gathering physically
And let us feast on communing virtually.
Let us fast from obsessing about the future
And let us feast on the everyday wonders of the present.
Let us fast from casting blame for our troubles
And let us feast on showing compassion for the most vulnerable.
Let us fast on being scared
And let us feast on getting prepared.
Let us fast from fear
And let us feast on the perfect Love that casts it out.

MindfulChristianity 

Lockdown {a poem}

Lockdown 
Fr. Fichard Hendrick, Ireland 

Yes there is fear.
Yes there is isolation.
Yes there is panic buying.
Yes there is sickness.
Yes there is even death.
But,
They say that in Wuhan after so many years of noise
You can hear the birds again.
They say that after just a few weeks of quiet
The sky is no longer thick with fumes
But blue and grey and clear.
They say that in the streets of Assisi
People are singing to each other
across the empty squares,
keeping their windows open
so that those who are alone
may hear the sounds of family around them.
They say that a hotel in the West of Ireland
is offering free meals and delivery to the housebound.
Today a young woman I know
is busy spreading fliers with her number
through the neighbourhood
So that the elders may have someone to call on.
Today Churches, Synagogues, Mosques and Temples
are preparing to welcome
and shelter the homeless, the sick, the weary.
All over the world people are slowing down and reflecting.
All over the world people are looking at their neighbours in a new way.
All over the world people are waking up to a new reality,
To how big we really are.
To how little control we really have.
To what really matters.
To Love.
So we pray and we remember that
Yes there is fear,
but there does not have to be hate.
Yes there is isolation,
but there does not have to be loneliness.
Yes there is panic buying,
but there does not have to be meanness.
Yes there is sickness,
but there does not have to be disease of the soul.
Yes there is even death,
but there can always be a rebirth of love.
Wake to the choices you make as to how to live now.
Today, breathe.
Listen, behind the factory noises of your panic.
The birds are singing again.
The sky is clearing,
spring is coming,
and we are always encompassed by Love.
Open the windows of your soul
and though you may not be able
to touch across the empty square,
Sing.