Eugene Dufour

Hospice Palliative Care Consultant – Bereavement Specialist – Trauma Therapist

Phone: 519-476-2116

Email: edufour@tcc.on.ca

Providing Excellent and Compassionate Care toOur Clients, Their Families, Our Coworkers and Ourselves

During the COVID – 19 Pandemic.

Session One: Coping With Multiple and Complex Loss.

– Working with complicated grief.

– COVID – 19 and complicated grief

– Coping with multiple losses.

– Coping with traumatic grief.

– Companioning Model of Grief.

“ The human soul doesn’t want to be advised or fixed or saved.

It simply wants to be witnessed….exactly as it is.”

Parker Palmer

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Focus One: Provide the Health Care Worker an opportunity to

debrief and defuse from the suffering that you have been

experiencing. The webinars will help you identify “Pre-Post

Traumatic Symptoms and helpful ways of coping with these

reactions to long term suffering.

Focus Two: Provide the Health Care Worker with added skills

on how to support our clients, family members and our

coworkers during this time of multiple and complicated losses.

Focus of the Webinar

"The reality is that you will grieve forever.

You will not 'get over' the loss of a loved one;

you will learn to live with it.

You will heal and you will rebuild yourself

around the loss you have suffered.

You will be whole again

but you will never be the same.

Nor should you be the same

nor would you want to."

Elisabeth Kubler-Ross

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In crisis carewe live with the paradox of

knowing that I am at the same timepart of a great wound

and part of a great healing

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COVID - 19 and Complicated Grief

1. Isolated from loved ones before death.

2. Not being physically present during the last 48 hours.

3. Inability to participate in death bed rituals.

4. Witnessing personal suffering from a distance – helplessness.

5. Restrains of the time = loss of control and hopelessness.

6. Individual, family, cultural, social and faith bound rituals are hampered.

7. Witnessing mass suffering adds to the traumatic nature.

8. Grieving without “my people”.

Depression - Grief

Distinguishing Between Complicated Bereavement and

Post-Traumatic Stress Disorder

Some of the most common symptoms of each disorder include:

Complicated Bereavement:

• Persistent focus on the loss

• Intense, daily longing

• Feeling that life is meaningless

• Replaying aspects of death in mind

• Intense attachment or rejection of reminders

• Bitterness and anger at the world

Post-Traumatic Stress Disorder:

• Intense flashbacks

• Recurring nightmares

• Sensory experiences that trigger trauma

• Unwelcome thoughts

• Paranoia and fear

• Anxiety

• Jumpiness

STUG

A Sudden Temporary Upsurge of Grief (STUG) is intense and unexpected.

What can you do after a STUG? Here are a few suggestions:

1. Identifying the experience for what it is and calling it by name can help you stay in charge, even when feeling out of control.

2. Remember that a STUG is a temporary, transitional experience. No one ever dies from a STUG, though many feel like the experience is deadly. The painful feelings will pass.

3. The most effective strategy in the presence of a STUG is to ride it out. Find a safe place, as private as possible, breathe deeply and lean into it.

4. Allow the pain until it passes. During a STUG, a person’s body goes on hyper-alert, releasing endorphins because of the fight-flight response manifest in the perception of danger.

STUG

A Sudden Temporary Upsurge of Grief (STUG) is intense and unexpected.

What can you do after a STUG? Here are a few suggestions:

5. After the STUG passes, a body needs several hours to absorb the hormones and brain chemicals and return to baseline.

6. Sleep on it. The day following a STUG, cognitive capacities return to normal, allowing more thoughtful consideration of the meaning of what triggered the memory.

7. Take it as a matter of truth that the STUG signaled a reconsideration of a loving experience in the history of the relationship.

The psychological process of coping with a significant loss is called "grief work." Just as the

body heals if certain conditions are met, so will the mind heal.

A bodily wound will heal if:

(1) the foreign material is cleaned out,

(2) the edges of the wound are brought back together, and

(3) the body is given the proper nutrients.

The wound of psychosocial loss will also heal if:

(1) unnecessary contaminants such as unreasonable guilt and resentment can be

worked through;

(2) the individual is prevented from feeling isolated and helped to feel connected to

others and;

(3) the person can be helped to tap into the psychological "nutrients" that come from

helping others.

The Six Needs of Mourning

During our journey through grief and mourning, we all encounter six needs we must meet if we are to heal:

1. Acknowledge the reality of the death.

2. Embrace the pain of the loss.

3. Remember the person who died.

4. Develop a new self-identity.

5. Search for meaning.

6. Receive support from others.

- Dr. Alan Wolfelt

- Dr. Alan Wolfelt

- Dr. Alan Wolfelt

Charting:

- Consider writing your note with your client.

- Write your note as if your client and their insurance company will read it.

- Describe, sleep, eating, energy level, concentration, emotions in each note.

- If anti depressants make your client feel detached and can’t feel emotions or cry – explain that in note.

- Document all the Assessment Scales that you use.

- Use the term “Complicated Grief”

- Educate in your note: Research states that the death of a loved one takes 2 to 3 years to adjust – 3 to 5 years for the death of a child.

Presence

▪ Courage of Presence – I can be with your pain without wanting to hide it, fade it or fix it.

▪ Compassion of Listening – bearing witness, validation.

▪ Humility of Helplessness – Your helplessness frees you to be present.

▪ Confidence of Trust – resiliency

▪ Belief in Hope

▪ Peace of Adequacy

▪ Freedom of Inadequacy

▪ Comfort of Companionship

We in the care partnering communitiesfrequently encounter peoplewith life threatening illness

at a point when they areno longer who they have been and

are not yet reborn into who they will be.We meet them in a place between

“no longer” and “not yet”Joan Borysenko

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NEW COVID-19 RESOURCES

COVID-19 SPECIFIC CONVERSATION GUIDES:

• Proactive Goals of Care (GOC) conversations

• GOC conversations for a person with mild/mod COVID-19

• GOC conversation for a person with severe COVID-19

• Phone conversations with families of a dying person

OTHER COVID RESOURCES:

• Palliative symptom management suggested order set for LTC

• Advance Care Planning guides for patients and SDM

• Sample letter from LTC facilities to families and residents

ALWAYS AVAILABLE:

• Advance Care Planning, Goals of Care and Consent resources for

healthcare providers (conversation guides, e-learning modules)

• Person-Centred Decision-Making Toolkit

https://www.hpco.ca/