preparing for life apart

Preparing For Life ApartWeb memorials

www.eforever.com www.ilasting.com www.imorial.com www.remembered.com

De Vries, B. & Rutherford, J. (2004) OMEGA. 49(1):5-26.

Complicated grief

Formal criteria proposed for DSM-V:

Prolonged (>6 months) acute mourning. Intense longing & yearning for the deceased. Recurrent intrusive & distressing thoughts. Inability to concentrate, engage in activities, or form

new relationships.

Schulz, R., et al. (2008) Geriatrics. 63(1):20-2.

Complicating griefRemember 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):153-73.Romanoff, BD & M. Terenzio (1998) Death Studies, 22:697-711.

Complicated griefRisk 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):1045-51.

Complicating griefRemember 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):153-73.Romanoff, BD & M. Terenzio (1998) Death Studies, 22:697-711.

Incorporating rituals1. 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):163-73.

Incorporating rituals2. To explore facility rules in regards to rituals.

Ritual bathing Laying of body on the floor Religious ceremonies

Incorporating rituals3. 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):292-302.

Incorporating rituals4. To know when to ask for help.

Pastoral Care Other clergy/religious leaders Family Other clinicians

Personal GriefThe “unexamined” life of clinicians:

Professional loneliness Loss of professional

meaning Cynicism Helplessness

Hopelessness Frustration Anger Depression Burnout

Meier, DE, et al. (2001) JAMA. 286(23):3007-14.

Personal ritualsSeek 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.

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 & dying as caregivers.

ReferencesDeath Rituals:

Hunter, J. Bereavement: An incomplete rite of passage. OMEGA. 2008; 56(2):153-73.Mohammed, S & E Peter. Rituals, death and the moral practice of medical futility. Nurs Ethics. 2009; 16(3):292-302.Moneymaker, KA & Traeger, J. Creating space and ritual for the time of death. J Palliat Med. 2007; 10(1):270-1.Romanoff, BD & M. Terenzio. Rituals and the grieving process. Death Studies. 1998; 22:697-711.

African American:Collins, WT & A. Doolittle. Personal reflections of funeral rituals and spirituality in a Kentucky African American

family. Death Studies. 2006; 30:957-69.Barrett, RK & KS Heller. Death and dying in the black experience. J Palliat Med. 2002; 5(5):793-800.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):213-32.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):18-26.Firth, S. End-of-life: A Hindu view. Lancet. 2005; 366:682-6.Lobar, SL, et al. Cross-cultural beliefs, ceremonies, and rituals surrounding death of a loved one. Pediatr Nurs.

2006; 32(1):44-50.

ReferencesIslam:

Gatrad, AR. Muslim customs surrounding death, bereavement, postmortem examinations, and organ transplants. BMJ. 1994; 309(6953):521-3.

Sarhill, N, et al. The terminally ill Muslim: Death and dying from the Muslim perspective. Am J Hospice Palliat Care. 2001; 18:251-5.

Judaism:Clements, PT, et al. Cultural perspectives of death, grief, and bereavement. J Psychosoc Nurs. 2003; 41(7):18-26.Dimond, B. Disposal and preparation of the body: different religious practices. British J Nursing. 2004; 13(9):547-9.Gamliel, T. “Wailing lore” in a Yemenite-Israeli community: Bereavement, expertise, and therapy. Social Sci Med.

2007; 65:1501–11.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):1267-71.

Western/Christian:Davis, C. A funeral liturgy: death rituals as symbolic communication. J Loss Trauma. 2008; 13:406-21.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):44-50.Quested, B & T Rudge. Nursing care of dead bodies: A discursive analysis of last offices. J Adv Nursing. 2003;

41(6):553–60.

This is my play's last scene; here heavens appointMy 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 unjointMy body and my soul, and I shall sleep a space;But my'ever-waking part shall see that faceWhose 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 (1572–1631)