© 2012, Covenant Hospice, Inc. All rights reserved. Holly Herring, MS, APRN Director, Children and Family Support Services Empowering Bereaved Caregivers

© 2012, Covenant Hospice, Inc. All rights reserved.

Holly Herring, MS, APRNDirector, Children and Family Support Services

Empowering Bereaved

Caregivers to Facilitate the Grief Process with Children

© 2012, Covenant Hospice, Inc. All rights reserved. © 2012, Covenant Hospice, Inc. All rights reserved.

Objectives

At the conclusion of this presentation, participants will be able to:

Describe common grief reactions in children, with special focus on the effects of grief on the family system

Identify three ways in which parents can facilitate the grieving process among all family members

Discuss three interventions for use by parents or professionals working with grieving children


Children and Grief


What Does Grief Look Like in Children?Every child grieves

differently

Individual and cultural factors will influence grief response

Common responses based on age and developmental stage


The Grief Process

Can begin before the death

There is no “getting over” a loss

Not orderly or predictable

Everyone grieves in their own way and in their own time

Some common tasks in grief work

Goal of grief work: integration (living with the loss)


Loss Changes the Family SystemForces the creation

of a “new normal”

Family members must often adopt new roles and assume new responsibilities

“Mobile” as analogy Family system striving

for homeostasis


Siblings: The Voice of the Invisible Perceived their life has changed

Sense the previous family dynamic has been altered

Experience intense feelings

Seek open communication and involvement in care of sick brother or sister

Desire to feel recognizedKreicbergs, U. The Voice of the Invisible – the experience and consequences of having a brother or sister with cancer during childhood.


How Does Grief Differ in Children and Adults?

Grief in Children

Children do not grieve continuously – they take breaks

Grief behaviors may be mixed with play

Understanding of death is limited to their cognitive development

Young children may not retain an image of the deceased

Children are generally dependent upon adults for support, may not be able to articulate their needs

Grief in Adults

Adults grieve fairly constantly and are usually not delayed

Adults typically separate grief from play

Adults are aware of the irreversibility of death.

Adult memory of the deceased is more fully developed

Adults can seek help and are usually able to meet their needs independently.

Jeffreys (2005), p. 96


Parent as Griever,Parent as Facilitator


Modeling Good Grief

Children usually take the lead on grieving from their parents Parents don’t need to

hide their grief Open communication Sharing thoughts and

feelings


Helpful Tips for Parents

Don’t feel that you must have the correct answers.

Invite your children to offer their own musings about their questions.

Don’t be afraid to say, “I don’t know.”

Tedeschi & Calhoun (2004), p. 94


Working with Grieving Families


General Grief Interventions

“Expert companionship” Tedeschi & Calhoun (2004), p. 38

The gift of being present

Active listening, touch, silence, reassurance

Normalize & individualize the grief process

Actualize the loss & facilitate living without the deceased

Identify support systems

Utilize community resources


Grief Interventions for Children

Provide age-appropriate information

Address fears, answer questions

Offer opportunities to grieve Not all children grieve through talking Art, music, play

Listen, validate feelings, and provide reassurance

Include in funeral/memorial to the extent child desires

Continue routines as much as possible Children appreciate consistency – offers safety, return to “normal”


Grief Interventions for Families

Creating a remembrance ritual Each family member

can play a role Can be repeated on

special days

Schedule family time (“Family night”) Time for fun and

relaxation This may take practice


Research and Literature

Research has found that Art as therapy: Can help gain insight, develop creative skills, and

enhance self esteem. Has the potential to be more effective at reducing

stress and anxiety than other methods. Can help “suspend their inner dialogue” and interrupt

the cycle of negative thoughts Can tap “into the unconscious giving concrete form to

feelings of which individuals are usually unaware.” (Devlin, 2006)


Car Toolkit

Crayons and Markers

Paper or Sketch Pad

Scissors

Glue

String

Deck of Cards

Stickers

Play-dough


Blank Paper

Free Drawing Draw a person Draw a bridge Draw a house Draw a person in the rain Draw pain or fear

Safe Place Drawing Draw a place where you feel safe Can be useful for guided imagery and relaxation


Involving Children in Grief Work

Messengers of Hope Bird feeder outside of office

Imagine birds as messengers Balloon message

Prayer or Wish Tree Prayers or wishes written, laminated and tied to a tree

Spiritual Bracelets Choose colors that represent forgiveness, faith,

courage, hope, love or… Choose the values you need or want to develop

Dream Catcher


Art Activities

Mandalas Circular drawing that can be used to

assess or as non-threatening treatment

The circle is thought to represent the wholeness of the person or experience

Useful as a group opening or for closing

Useful tool to distract guarded children during difficult conversations

From Creating Mandalas.comhttp://www.creatingmandalas.com/index.html


In conclusion…

Just as every family is different, each family and family member will grieve differently

Parental grief does not need to be hidden, and can be a useful tool in helping children with their grief

Bereavement professionals can help parents and families navigate through the grief process


Bibliography

Davies, B., Attig, T., & Towne, M. (2006). Bereavement. In A. Goldman, R. Hain, & S. Liben (Eds.), Oxford textbook of pediatric palliative care. New York, NY: Oxford University Press.

Davies, B. & Jin, J. (2006). Grief and bereavement in pediatric palliative care. In B.R. Ferrell, & N. Coyle (Eds.), Textbook of palliative nursing (2nd ed., pp. 975-989). New York, NY: Oxford University Press.

Davies, B., & Orloff, S. (2004). Bereavement issues and staff support. In D. Doyle, G. Hanks, N.I. Cherny, & K. Calman (Eds.), Oxford textbook of palliative medicine (3rd ed., pp. 831-839). Oxford, UK: Oxford University Press.

Gibbons, M.B. (2009). Psychosocial aspects of serious illness in children and their families across settings. In A. Armstrong-Dailey & S. Zarbock (Eds.), Hospice care for children, 3rd edition. New Yor, NY: Oxford University Press.

Jeffreys, J.S. (2005). Helping Grieving People: When tears are not enough. New York, NY: Brunner-Routledge.


Bibliography

Martin, T. & Doka, K.J. (1999). Men Don’t Cry, Women Do: Transcending Gender Stereotypes of Grief. Philadelphia: Taylor & Francis.

Midland, D., Gensch, B., & Rybarik, F. (Eds.). (2004). RTS Bereavement Training in Pregnancy Loss & Newborn Death (6th ed.). La Crosse, WI: Gunderson Lutheran Medical Foundation.

Oliver, L.E. (1999). Effects of a child’s death on the marital relationship: A review. Omega, 39, 197-227.

Parkes, C.M., & Prigerson, H. (2009). Bereavement: Studies of grief in adult life (4th ed.). New York, NY: Routledge.

Silverman, P. R., & Kelly, M. (2009). A Parent’s Guide to Raising Grieving Children. New York, NY: Oxford University Press.

Tedeschi, R. G., & Calhoun, L. G. (2004). Helping Bereaved Parents: A Clinician’s Guide. New York, NY: Brunner-Routledge.

Worden, J.W., & Monahan, J. R. (2009). Caring for bereaved parents. In A. Armstrong-Dailey & S. Zarbock (Eds.), Hospice care for children (3rd ed). New York, NY.: Oxford University Press.


Bibliography

Kreicbergs, U. The voice of the invisible – the experience and consequences of having a brother or sister with cancer during childhood. International Society of Paediatric Oncology. Retrieved on 4/4/2011 from: https://www.cure4kids.org/private/courses_documents/m_382/Voice-Invisible-Brother-Sister-Cancer.pdf

Remke, S. R. (2011). Pediatric Workshop. Children’s Hospitals and Clnics of Minnesota. Pain and Palliative Care.

Roush, K. (2006). I wish I had understood what it meant, leaving you that last time. American Journal of Nursing, 109 (9); 77.

Wolfe J, Hammel JF, Edwards KE, Duncan J, Comeau M, Breyer J, Aldridge S, Grier HE, Berde C, Dussel V, Weeks JC. Easing of Suffering in Children With Cancer at the End of Life: Is Care Changing?. Journal of Clinical Oncology, 2008;26(10):1717-1723.

Documents

© 2012, Covenant Hospice, Inc. All rights reserved. Holly Herring, MS, APRN Director, Children and Family Support Services Empowering Bereaved Caregivers