Term Paper on "Caregiver Grief and Loss Introduction"

Term Paper 6 pages (2321 words) Sources: 1+

[EXCERPT] . . . .

Caregiver Grief and Loss

Introduction- Grief is a part of being human, everyone experiences transformation in many ways; active, passive, pushing and shoving, begrudgingly, etc. Loss and grief, rather than being a tragedy of living, and be an opportunity for transformation and personal growth. In general, grief can help us from seeing ourselves as the center of the universe and seeing the universe as the center of who we are. Grief and loss as are transformation -- as a process to move through. Kubler-Ross, one of the foremost authorities on the subject, is more general in believing that humans will all go through her stages, but at different rates. Grief or loss can cause change -- force evolution, if you will, into the human ability for personal growth and self-actualization. Certainly grief is a human emotion; as much a part of us (Kubler-Ross, 2009). Psychologically, grief is a response to loss -- conventionally emotional, but also having physical, cognitive, social, philosophical, and even behavioral dimensions.

There are numerous theories about grief, some popularized, some scholarly, but all try to explain the "process" humans engender when dealing with loss. Even one of the more popularized, yet useful, theories, Kubler-Ross, though, states that the grief stages, "have evolved since their introduction, and they have been very misunderstood over the past three decades. They were never meant to tuck messy emotions into neat packages. They are responses to loss that many people have, but there is not a typical response to loss. There is no typical loss. Our grief is as individual as our lives" (Kubler-Ross, On Grief and Grieving, 2007, 1).

Too, grief can be extermely complicated -- there is no "single" or even "archetypal" form. Since individuals are so different, and we all experience emotions in different ways, the robustness or quality of grief is often interdependent on numerous outside factors. These include: the surprise, or timing of the death; the presence of violence, degree of attachment, and the way others play into the paradigm of the person's life and death. Interestingly enough, though, the literature also tells us that there is a clinical problem of becoming "identified" with grief and loss, particularly if one deals with it on a regular basis (care givers, medical personnel, etc.). In fact, the psychological research suggests that complicated grief tends to activate neurons in the brain's reward centers, possible enhancing memories with addiction-like properties and heightening the acivity in the nucleus accumbens, a region of the brain associated with rewards (O'Connor, Wellisch, Standon, et al., 2008).

The Role of a Caregiver- The term caregiver has a number of meanings in contemporary medical jargon. It can be the unpaid family member of someone requiring acute care, it can be a certified medical worker, or it can be someone in the social services field that either supervises care or is actually hands on. The person receiving care may be in the hospital, hospice, a nursing facility, or even at home. The quality and quantity of care changes, too, based on the circumstances of the individual. Most caregivers in the United States tend to be female (60-75%), and there are about 50 million people directly involved in the field, with 30% aged 65 of older. It is also interesting to note that "free" caregiving services provide over $300 billion in aid, more than twice as much as is actually spent on homecare and nursing home services in total (Aliiance, 2010l; Caregiving Statistics, 2010). With such a large population of those under care, however, there are a number of issues that caregivers face, in general. Many caregivers find that their own health deteriorates from overwork and stress involving the emotionality of care; many find that they neglect their own psychological and physical health in favor of those under care, often exacerbating a number of chronic conditions. However, it is the emotional toll of grief for the caregiver that often takes a serious toll on caregivers. By the very nature, caregivers know that the person they are caring for is seriously ill, many on the final stages of their life. Nevertheless, the grief experienced at the demise of a patient, loved-one, or even client is palpable for a caregiver, often moreso because it happens on a fairly regular basis (Davidson, 2002).

Literature Review- There is certainly a growing body of research that suggests that caregivers experience normal "anticipatory" grief while working in the caregiving process, and even has a psycho-social term, "caregiver grief." This affliction has intellectual and even existential elements of the changing dynamics of care, varies in intensity, duration, and expression, and tends to involve distinct dynamics (e.g. caregivers of people with dementia experience different anticipatory grief than cancer patients). The grief experience, then, is certainly multifaceted, and includes such heighted responses as anxiety, depression, nervousness, trouble concentrating, and lack of impetus to perform normal tasks. Caregivers seem to feel a combination of helplessness and anger; and often a feeling that they should have been more responsive, or that they could have done more for the patient during the last moments. Following the actual death, caregiver grief usually becomes sustained -- overall distress is often diminished, but symptoms continue long beyond what pscyhologists see as normal griefing time. The caregiver had been so used to almost a 24-7 model that they, themselves felt that they no longer had a purpose (Waldrop, 2007).

Caregivers, as we have seen, are well aware that the person to whom they are giving care is often in a terminal stage of illness. Most have accepted this mentally, long before any end-stage of life issues occur. However, despite accepting the nature of the terminal nature of the illness menatlly, there is still a psychological shock when the caregiver is confronted with traumatic grief. Despite this trauma, most caregivers perceive that they are coping fairly well- under the circumstances. There does seem, however, to be a significant correlation between the quality of information and support services extended to the carefiver prior to and after the demise of the patient, and the caregiver's ability to process the grief and move on with their own lives (Hudson, 2006).

Much attention has been given to the robustness of caregiver grief, but now we see that bereaved caregivers have been somewhat neglected in the delivery of true pallative care services after a death. Research finds that it is imperative that berevement support is integral to service, yet it remains one of the most marginalized elements of modern care. Nurses have a significant role in berevement care, and the entire context of care model should include a significant level of not only grief counseling, but true berevement therapy and support (Holtslander, 2008). This idea of berevement care can be as simple as cognitive therapy, but findings show that preloss caregiving therapy has higher levels of benefit towards any postloss symptomology. It eases the burden of loss, places more contex in the process, and has a number of positive outcomes for those associated with loss (Boerner, Schulz and Horowitz, 2004).

Again and again, several common themes emerge from qualitative research with caregivers in various stages of the berevement process: 1) The consistent lack of treatment options for both patients and caregivers, often prompting both to consider alternative end of life issues; 2) The ability to change and adapt preferences at the end of an illness; 3) The variability of information that is available to patients and caregivers about the patient's illness, options, and caregiver support; and, 4) Continual difficulties and misunderstandings with patient-caregiver communications. This research also shows that it is vital to find a way to support a broader level of information care procedures prior to serious times; to provide support and, above all, information to assure caregivers they will also have support (Fried and O'Leary, 2008).

How might healthcare and social work professionals predict the manner in which grief might become a problem for certain caregivers? Are there experiences that are common enough within the population to engender similar behaviors? The literature shows us that predictors of complicated grief prior to the death include previous loss, exposure to trauma, a previous psychiatric history, attachment style, and the relationship to the deceased. Some of the factors associated with the death include violent or unexpected demise, the quality of the caregiving or dying experience (sharing, length of time, etc.), close kinship relationships, marital closeness and dependency, and lack of and psychological or psycho-social preparation for the death. The level of cognitive dissonance increases in certain cases, in fact. We can think of it as a two way continuum -- the stronger the circumstances regarding the death coupled with the lack of preparation for the death, the stronger the complicated grief symptoms will be. Further, while there are some inconsistencies present on the definition and robust nature of complicated grief, there is a direct relationship to the internal manifestation of symptoms and those that are clinically interdependent (Lobb, Kristjanson, Aoun, Monterosso, Halkett and Davies, 2010). This is a major… READ MORE

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