Loss and Maintaining Compassion

Question 1

Describe the legal responsibility of medical practitioners for the bereaved.

Answer 1

Medical certificate of cause of death (how, where, when died)

Question 2

Identify the top 3 causes of death in Scotland.

Answer 2

1) Ischemic Hear Disease
2) Dementia/Alzheimers
3) Lung Cancer

Question 3

What age ranges are mainly affected by death in Scotland ? least affected ?

Answer 3

80+

Least: 15-

Question 4

Does the majority of the Scottish population want to die at home or in hospital ? What proportion of the Scottish population dies in hospital ?

Answer 4

At home

50%

Question 5

Distinguish between death in the 16th, 18th, 20th, and 21st centuries.

Answer 5

16th: Religious event, clear distinction that when Dr. could do no more, priest takes over (ensure person’s soul
was fit and healthy to go to Heaven) .
18th: death is noble (e.g. death of Marat)
20th: end of WWI had an effect on
religious beliefs + on healthcare professionals
(death no longer nice and clean, it is bloody and horrific)
21st: Death has been sterilised (family don’t have to look at the victim during the bereavement process again if don’t want to)

Question 6

Identify the main different kinds of death, timeline-wiwse.

Answer 6

Gradual death ~
- old age, chronic illness

Premature death ~
- ‘sudden, accidents’

Catastrophic death ~
- war, disaster, terrorist attack

Question 7

Describe the main features of Sudden death.

Answer 7

• often untimely (young people)
• May be traumatic (RTA, crime, suicide, violent)
• May be a time lapse between death and family involvement
• It Always involves the Procurator Fiscal and the Police (in Scotland) (Coroner in the rest of the UK)

Question 8

Describe the main theories of grief and bereavement.

Answer 8

Usually a period of disorganisation, followed by extremes, followed by resolution. This can take the form of:

1) Bowlby (1961, 1980) & Parkes (1972)
Shock and numbness (disorganisation)
Searching and yearning (extreme)
Disorientation (extreme)
Reorganisation and resolution (resolution)

2) Kübler-Ross (1969)
Denial (disorganisation) 
Anger (extreme) 
Bargaining (extreme) 
Depression (extreme) (bargaining and depression are equivalent of disorganisation from 3, and disorientation from 1)
Acceptance (resolution) 

3) Grief Education Institute (1986)
Shock (disorganisation) 
Protest (extreme) 
Disorganisation (extreme) 
Re-organisation (resolution)

Question 9

On average, how long does it take for normal life to resume its course after a bereavement ?

Answer 9

2 years

Question 10

Identify examples of normal reactions to death.

Answer 10

• A sense of unreality or helplessness
• Strong emotions: anger, crying, guilt – ‘if only’
• Blame at HCPs
• Blame at other family members

OVERALL, grief is normal, and we need to ‘normalise’ the journey for the bereaved

Question 11

Should you prescribe antidepressants for grief ?

Answer 11

NEVER prescribe antidepressants for grief

Question 12

Identify examples of things patients might say about death.

Answer 12

• I’ve had enough, its time I was gone.
• How much longer do you think I’ve got?
• I wish I could just go now
• Do you think I’ll make Christmas?

Question 13

How should you respond to the following questions/comments about dying by patients, if you are happy to have the conversation ?
“I’ve had enough, its time I was gone”
“How long do you think I’ve got?”

Answer 13

Q: “I’ve had enough, its time I was gone”
A: “That must be a hard place to be, what’s putting that in your mind?”

Q: “How long do you think I’ve got?”
A: “That’s a big questions, what’s put that in your mind?”

Question 14

How should you respond to the following questions/comments about dying by patients, if you don’t want the conversation or don’t have time to deal with it ?

Answer 14

These are hard questions/issues would you like me to get someone to talk about them with you? (can then pass them on to colleague, chaplain social worker?)

Question 15

State the golden rules of talking with the bereaved.

Answer 15

Always use the right words!

• Has he gone? “Yes, he’s died”
• Get used to saying it – it gets easier.

Avoid the platitudes, especially when children are present - She’s gone to a better place (can I go too?)
- He’s at peace now (that may be no comfort)

Hold the space

• Don’t be afraid of emotions (yours or the bereaved)
• Don’t be afraid of silence
• The greatest gift you can give is time and presence

Question 16

Identify key strategies of living and working with grief.

Answer 16

• Self-care
• Understand your feelings
• Consider what you think about dying and death
• Find a safe place & safe people – and USE them
• Clinical supervision
• Reflective practice - Mindfulness and meditation
• Educational programmes

Question 17

Identify a website which helps NHS staff deal with working with death.

Answer 17

Sad.uk.net (support around death)