Preparing for life apart

Transcription

1 Preparing for life apart Spontaneous public memorials De Vries, B. & Rutherford, J. (2004) OMEGA. 49(1):5-26.

2 Preparing For Life Apart Web memorials De Vries, B. & Rutherford, J. (2004) OMEGA. 49(1):5-26.

3 Persistent Complex Bereavement Disorder A. Death of someone with close relationship B/C. Symptoms to a significant degree on more days than not, with persistence at least 12 months after death of adult or 6 months of child D. Clinically significant distress or impairment in social, occupational, or other important aspects of functioning. E. Reaction out of proportion to or inconsistent with cultural, religious, or age-appropriate normal responses.

4 Complicated grief Risk factors for complicated grief: Sudden/unexpected death Pediatric death Violent/traumatic death Lack of social support Low socioeconomic status/education Underlying anxiety/depression Disenfranchised mourners Meert, KL, et al. (2010) Arch Pediatr Adolesc Med. 164(11):

5 Complicating grief Remember that the role of death rituals is to 1. Provide social support to mourners. 2. Set limits to formal mourning. 3. Outline cultural obligations during mourning. 4. Restore the bereaved to society. Might deritualization lead to insufficient bereavement? Hunter, J. (2008) OMEGA. 56(2): Romanoff, BD & M. Terenzio (1998) Death Studies, 22:

6 Incorporating rituals 1. To include rituals (religious & non-religious) in the medical history. Faith Importance Community Address Borneman, T., et al. (2010) J Pain Symptom Manage. 40(2):

7 Incorporating rituals 2. To explore facility rules in regards to rituals. Ritual bathing Laying of body on the floor Religious ceremonies

8 Incorporating rituals 3. To recognize our unique role in modern biomedical rituals. Ritual of coming to hospital Ritual of CPR Ritual of withdrawal Ritual of pronouncement Mohammed, S & E Peter. (2009) Nurs Ethics. 16(3):

9 Incorporating rituals 4. To know when to ask for help. Pastoral Care Other clergy/religious leaders Family Other clinicians

10 Personal Grief The unexamined life of clinicians: Loneliness Loss of meaning Cynicism Helplessness Hopelessness Frustration Anger Depression Burnout Meier, DE, et al. (2001) JAMA. 286(23):

11 Personal rituals Seek outlets for self-reflection & processing: Praying/meditating Exercising Writing (e.g. journaling, sympathy cards) Calling family members or other clinicians Attending funerals, memorial services Moneymaker, KA & Traeger, J. (2007) J Palliat Med. 10(1):270-1.

12 conclusions We should recognize that rituals help us make sense of death as a society. We should appreciate that all cultures have rich ceremonies for dealing with death & dying. We should consider the role that we play in the death rituals of our patients. We should reflect on the importance of ritual in our own response to death as caregivers.

13 This is my play's last scene; here heavens appoint My pilgrimage's last mile; and my race, Idly, yet quickly run, hath this last pace, My span's last inch, my minute's latest point; And gluttonous death will instantly unjoint My body and my soul, and I shall sleep a space; But my'ever-waking part shall see that face Whose fear already shakes my every joint. Then, as my soul to'heaven, her first seat, takes flight, And earth-born body in the earth shall dwell, So fall my sins, that all may have their right, To where they'are bred, and would press me, to hell. Impute me righteous, thus purg'd of evil, For thus I leave the world, the flesh, the devil. - John Donne ( )

14 References Death Rituals: Hunter, J. Bereavement: An incomplete rite of passage. OMEGA. 2008; 56(2): Mohammed, S & E Peter. Rituals, death and the moral practice of medical futility. Nurs Ethics. 2009; 16(3): Moneymaker, KA & Traeger, J. Creating space and ritual for the time of death. J Palliat Med. 2007; 10(1): Romanoff, BD & M. Terenzio. Rituals and the grieving process. Death Studies. 1998; 22: African American: Collins, WT & A. Doolittle. Personal reflections of funeral rituals and spirituality in a Kentucky African American family. Death Studies. 2006; 30: Barrett, RK & KS Heller. Death and dying in the black experience. J Palliat Med. 2002; 5(5): Bordere, TC. To look at death another way: Black teenage males perspectives on second-line and regular funerals in New Orleans. OMEGA. 2008; 58(3): McIlwain, CD. Death in black and white: A study of family differences in the performance of death rituals. Qual. Res Reports in Comm. 2002; Winter:1-6. Hinduism: Clements, PT, et al. Cultural perspectives of death, grief, and bereavement. J Psychosoc Nurs. 2003; 41(7): Firth, S. End-of-life: A Hindu view. Lancet. 2005; 366: Lobar, SL, et al. Cross-cultural beliefs, ceremonies, and rituals surrounding death of a loved one. Pediatr Nurs. 2006; 32(1):44-50.

15 References Islam: Gatrad, AR. Muslim customs surrounding death, bereavement, postmortem examinations, and organ transplants. BMJ. 1994; 309(6953): Sarhill, N, et al. The terminally ill Muslim: Death and dying from the Muslim perspective. Am J Hospice Palliat Care. 2001; 18: Judaism: Clements, PT, et al. Cultural perspectives of death, grief, and bereavement. J Psychosoc Nurs. 2003; 41(7): Dimond, B. Disposal and preparation of the body: different religious practices. British J Nursing. 2004; 13(9): Gamliel, T. Wailing lore in a Yemenite-Israeli community: Bereavement, expertise, and therapy. Social Sci Med. 2007; 65: Loike, J, et al. The critical role of religion: Caring for the dying patient from an Orthodox Jewish perspective. J Palliat Med. 2010; 13(10): Western/Christian: Davis, C. A funeral liturgy: death rituals as symbolic communication. J Loss Trauma. 2008; 13: De Vries, B. & Rutherford, J. Memorializing loved ones on the world wide web. OMEGA. 2004; 49(1):5-26. Lobar, SL, et al. Cross-cultural beliefs, ceremonies, and rituals surrounding death of a loved one. Pediatr Nurs. 2006; 32(1): Quested, B & T Rudge. Nursing care of dead bodies: A discursive analysis of last offices. J Adv Nursing. 2003; 41(6):