| Coming to Terms With Grief | https://www.providermagazine.com/Articles/Pages/Coming-to-Terms-With-Grief.aspx | Coming to Terms With Grief | <p>Grief is a complex issue. It doesn’t follow a straight trajectory or timeline, and people don’t all grieve in the same way or for the same losses. The key is to understand the big picture of grief, determine how to create an organizational culture that honors and supports those who are grieving, and plan how to help people as individuals through their grief.<br></p><p>Start by understanding that there are many misperceptions about grief. For instance, Trish Childress, LCSW-S, ACHP-SW, a long term care social worker and director of supportive services, says, “People sometimes think that if they talk about someone’s loss, it will only make them sadder. I hear this a lot.” However, she says, “In reality, they are already sad. We need to give them an opportunity to talk about their loss if they want to.”<br></p><p>Another myth is that grief is the same for everyone—that there is a set timeline for grieving or that people go through predetermined <a href="/Articles/Pages/Stages-of-Grief.aspx" target="_blank" title="Stages of Grief">stages of grief</a> and then are “done grieving.”<br></p><p>Paige Hector, LMSW, national speaker and clinical educator, says, “People tend to think that grief is something we should experience briefly and move on.” This “just get over it” mentality, she says, is common in health care.<br></p><p>“We don’t allow people the time to reflect and experience all of their emotions,” she says. “As a result, they get bottled up inside, and [it affects their] entire being.”<br></p><p>People often think that grief is only an emotional experience. However, Hector notes, “Grief is a whole-body issue. We experience grief in all sorts of ways, and our bodies aren’t hardwired to get over it quickly. It’s about building capacity around grief and mourning, instead of getting around it.”</p><h2>COVID Grief Looks Different</h2><p>“The landscape of grief looks different in the COVID world,” Childress observes. For one thing, people are grieving many losses beyond deaths. They are suffering from the loss of social norms, activities, interactions with families and friends, traditions, and more. People may not even realize they are grieving these losses until something triggers a reaction.<br></p><p>For instance, says Childress, “A colleague told me how, in the middle of the pandemic, she broke a dog food dish she had bought for her first dog 20-some years ago. She said she sobbed for an hour and thought something was wrong with her. In fact, the dish actually represented all of the losses she had experienced—lost work, lost connections with friends and family, lost holidays—and she was grieving for all of those things.”<br></p><p>Once the colleague understood this, she was able to acknowledge her grief and begin to deal with it.<br>Many healing traditions, such as viewings or memorial services, have had to be skipped or postponed during the pandemic. People even had to forgo simple gestures such as bringing someone a meal or a gift. “These are important rituals and gestures for many people, and not being able to participate in them has delayed the grief process for some,” Childress says.<br></p><p>The pandemic took everyone off guard, and “none of us was completely prepared to deal with the amount of loss and level of grief we’ve experienced,” says James Wright, MD, CMD, a multifacility medical director in Virginia. “I think we’re actually still gritting our teeth. We’re imagining the light is at the end of the tunnel and figuring we’ll grieve when we get there.”<br></p><p>In the meantime, he suggests, everyone is still putting one foot in front of the other to make it through. However, it still is important to take the time to stop and grieve, he says.</p><h2>Daunted by Discomfort</h2><p>Even when they have the best of intentions, some people don’t know how to help someone who is grieving or even how to address their own grief. “In general, we have a dislike or fear around vulnerability,” Hector says. “We have this idea that vulnerability isn’t acceptable or worry that we’ll get stuck if we let ourselves be vulnerable.”<br></p><p>People may hesitate to reach out when they are grieving because they don’t want to bother others, she suggests. “We need to help people understand that part of being human is to grieve and mourn when you experience a loss.”<br></p><p>When people don’t know how to help others who are grieving, they may just avoid them. “People in my [grief support] groups say that it’s so lonely, that others are avoiding them ‘like the plague,’” Childress observes. Those feelings of isolation are one reason such support groups are so important.<br></p><p>“I think grief groups are the best thing anyone ever came up with,” says Judi Crick, a family caregiver who has lost three close relatives in the past year. “You come together with others who are grieving, and you start to share your feelings. Before long, you realize you’re not alone, that you’re okay,” she says. Someone will tell a funny story about a loved one and “you find yourself laughing and that it’s okay.” <br></p><p>In truth, just reaching out and expressing a willingness to be there for the person can be helpful. Childress suggests offering something specific, such as bringing the person dinner, taking their dog for a walk or their kids to a movie. </p><h2>Take Time for Tears</h2><p>“When someone is in grief, create a safe place for them to express their feelings,” says Hector. This means, for example, letting people cry, instead of saying, “Please don’t cry. Don’t be sad. Everything is going to be okay.” Shedding tears is a perfectly normal human reaction and can provide much-needed release.<br></p><p>“Take your cues from the person,” Hector says. “Don’t jump in, offer advice, reassurance, or consolation. Instead, offer an empathic presence, which may include warm silence as the individual experiences their emotions.”<br></p><p>An empathic presence conveys a message of caring, listening, and spaciousness, not problem-solving, she says. “If you sense an urge to say something, keep it simple and focused on the other person: ‘This really hurts,’ or ‘I hear you and will stay with you as long as you’d like.’”<br></p><p>When people cry, she adds, “It’s often a knee-jerk reaction to give them a tissue. But this can look like you’re encouraging them to stop crying.” Instead, wait for them to look around for a tissue or ask for one.</p><h2>Some Steps Toward Healing</h2><p>There is no panacea for grief, but there is much facility leaders can do to help residents, families, and staff who are grieving. <br></p><p>For instance, Childress says, “We do a 12-minute virtual memorial online every month, and we encourage people to take the time to feel and acknowledge their emotions. They can take a minute to think about people they’ve lost, reflect, and smile at a happy memory.”<br></p><p>Wright stresses the importance of openness. “We need to recognize loss, not cover it up or ignore it. At one of my facilities, we had a memorial service at the end of the January 2020 outbreak that was attended by family and staff. It brought us together respectfully,” he says.<br></p><p>“There was a recognition that we were going through something that was unprecedented. Our chaplain was very involved, and we offered grief counseling and opportunities to vent and be there for each other.”</p><h2>A Long Road to Healing</h2><p>Addressing grief isn’t one and done. Childress suggests, “Make sure your Human Resources department is putting out tips and tools all year long to help people deal with grief. For instance, have teaching sheets to put out in monthly newsletters or promote local bereavement groups they can participate in.” <br></p><p>It’s not just enough to say that the company supports efforts to grieve and mourn. “Even when facilities say it’s okay to grieve, staff may not feel that it’s safe to express their feelings if there are no formal processes or structure for them,” Hector says. “Everyone needs to know where they can turn if they want counseling or other help.”<br></p><p>Judi Crick and her husband Rob suggest a few ways staff can help families with grief. Judi says, “When my mother was dying, I didn’t know what to expect. The facility staff were so good about telling me what was happening with her physically; they walked me through the dying process. This helped me to have feelings of peace when she passed away.”<br></p><p>Rob recommends that staff keep the rooms of residents who are in the dying process as neat and free of clutter as is possible. “Creating a comfortable environment to spend time with a loved one really helps, and it demonstrates for family members how much respect the facility has for the resident and those who love them.”<br></p><p>It’s important to remember that grief is unpredictable and can pop up unexpectedly long after the loss. When this happens, Childress offers, “Think about the basics. Is the person safe? If not, how can I get them to a safe space? What was the trigger?” She adds, “It’s best to just sit with them and encourage them to talk if they want to. You don’t have to know what to say or ask a lot of questions,” she says. “The best gift is to be present.” <br><br><em>Joanne Kaldy is a freelance writer and communications consultant based in Harrisburg, Pa.</em></p> | Grief is a complex issue. It doesn’t follow a straight trajectory or timeline, and people don’t all grieve in the same way or for the same losses. | 2021-12-01T05:00:00Z | <img alt="" src="/Articles/PublishingImages/2021/1221/CF2-Grief.jpg" style="BORDER:0px solid;" /> | Caregiving;Mental Health | Cover Feature | Joanne Kaldy | 48 | 12 |
| Facing COVID With Creativity, Connections, and Resilience | https://www.providermagazine.com/Articles/Pages/Facing-COVID-With-Creativity,- Connections,-and-Resilience.aspx | Facing COVID With Creativity, Connections, and Resilience | <p>After a devastating storm, the signs of life—children going to school, lights coming on after days of power outages, neighbors talking and laughing—are powerful reminders of people’s resilience and the importance of their connections to each other. Even though the pandemic isn’t completely over, it has led to some changes, innovations, and inspiring stories that should be embraced and remembered moving forward. <br></p><p>One impact of COVID-19 has been a bit of a double-edged sword. The pandemic has shown a spotlight on nursing homes and other long term care facilities. While this has brought some negative and often unfair media coverage, it also presents opportunities.<br></p><p>As James Wright, MD, CMD, a multifacility medical director in Virginia, says, “For a brief period of time, the public was more interested than ever in what goes on in nursing homes, especially with staffing. If we take this interest and harness it into legislative and regulatory changes, we can translate this into better funding and staffing.” </p><h2>The Temporary, the Timely, and the Timeless</h2><p>“The past 18 months were the time of the activities department,” Wright says. “They came in and turned visiting rooms into something beautiful, they devised ways for residents to connect, interact, play, laugh, and have fun without leaving their rooms.” <br></p><p>Facilities not only made creative use of their indoor spaces but the great outdoors as well. Wright says, “Last November one of our facilities had a Thanksgiving meal outside. The temperature was a little cool, but we had an open tent with heaters. Seating was socially distanced, and tables were beautifully set with decorations and plants.” It gave residents, families, and staff a safe opportunity to get together and, given the circumstances, truly appreciate the day of giving, he says.<br></p><p>“We have celebrations of life,” says Trish Childress, LCSW-S, ACHP-SW, a social worker and director of supportive services. For instance, one man was able to see his family for the first time in 15 months after losing his wife. Some people were afraid it would make him sad, but Childress says, “He was excited to have this opportunity to celebrate her life with his loved ones.”</p><h2>Supporting One Another</h2><p>Elsewhere, Childress says, “We run a pet loss support group, and we usually only have one or two members a month. But during COVID, people’s grief at the loss of their pets was so profound that we now have five to six people in the group each week.” This demonstrates how important pets are to people, especially during a crisis like a pandemic, she says, and recognizing and honoring the loss of a pet can be very healing and help people bond over shared losses.<br></p><p>“Most of what was put in place was temporary, but many good things should—and will—continue,” says Wright. “As a result, we will be so much better for the immediate future, at least, in preventing the spread of communicable disease and avoiding isolation when quarantines are necessary. Flu season won’t be as dangerous, thanks to all of our efforts during COVID, and we can possibly keep other infections out as well.”</p><h2>Leaning on Each Other </h2><p><img src="/Articles/PublishingImages/2021/1221/JasmineWadkins.jpg" alt="Jasmine Wadkins" class="ms-rtePosition-1" style="margin:5px;" />“One blessing from the pandemic was that we were able to lean on each other,” says Jasmine Wadkins, LCSW, CDP, BF-CMT, CCTP, CEA, director of behavioral health services operations and education at Signature HealthCARE. “We’ve focused on cross-training, and people aren’t operating as much in specific roles. Instead, they’ve been growing and stretching beyond traditional roles and responsibilities.”<br></p><p>Barbara Resnick, PhD, CRNP, professor at the University of Maryland School of Nursing, says they were able to engage the whole team in care plan meetings. “I also think COVID raised awareness of some aspects of end-of-life planning and decisions about going out to the hospital,” she says. “We also had more of an opportunity to talk about other end-of-life decisions, things like nutrition and hydration and what to do if someone won’t or can’t eat or drink.” <br></p><p>The pandemic also gave organizations a chance to remind staff that they are cared for and supported. For instance, Signature created a food bank that employees, their family members, and other stakeholders could access. “Our leadership wanted to make sure that no one went hungry because they couldn’t afford food or get out to shop for groceries,” Wadkins says.</p><h2>Finding and Sharing Joy</h2><p>Even in the midst of the pandemic, Wadkins suggests, it is important for people to find joy and laughter. “We made sure residents were safe, but we had to find ways to have fun and give them a sense of meaning and purpose.” For instance, she says that the company holds senior Olympics every year, and starting last year, instead of cancelling the events they’ve held them virtually. <br></p><p>Creative thinking and finding new sources of entertainment were common themes at facilities nationwide. For example, at Westminster in Austin, Texas, residents became interested in watching construction teams work on a nearby building. <br></p><p>Staff set up chairs at the third floor window so residents could oversee the action and enjoy a unique connection with the outside world during the isolation of the pandemic. Residents, who called themselves the “third-floor admirers,” even exchanged dozens of letters and even some gifts with the construction workers.<br></p><p>Last Christmas, country singer J.D. Shelburne livestreamed an exclusive concert for Signature residents and staff. Even those who aren’t fans of the music genre found the event enjoyable. <br></p><p>“To have something done just for us was so special, and music is always an important part of holiday celebrations,” Wadkins says. </p><h2>Telehealth: Here to Stay?</h2><p>There have been a lot of positives in terms of opportunities for telehealth, Resnick says. “For one, it provided more timely access and the ability to address problems quicker,” she says.<br></p><p>While most people would agree that telehealth was essential and a godsend during the pandemic, some offer caution about its use moving forward. For instance, Wright says, “The older people get and the more cognitive issues they have, the less effective this technology is.”<br></p><p>Of course, telehealth visits weren’t the only use of technology to touch lives. <br></p><p>“One woman became very tearful on the phone. She hadn’t seen her husband in months, and they were preparing to celebrate their anniversary,” Childress says. <br></p><p>“We were able to walk her through turning on her phone’s camera so that she could have a video call with her husband. It was so meaningful and comforting for her to see her husband after so long.”<br></p><p>She adds, “There are probably a million of those remarkable stories of people digging into problems and finding solutions.” <br></p> | After a devastating storm, the signs of life are powerful reminders of people’s resilience and the importance of their connections to each other. | 2021-12-01T05:00:00Z | <img alt="" src="/Articles/PublishingImages/2021/1221/CF3-Covid-Impact.jpg" style="BORDER:0px solid;" /> | Caregiving | Cover Feature | Joanne Kaldy | 48 | 12 |
| Picking Up the Pieces Post-Trauma | https://www.providermagazine.com/Articles/Pages/Picking-Up-the-Pieces-Post-Trauma.aspx | Picking Up the Pieces Post-Trauma | <p>In many ways, trauma is like snowflakes. It looks different for each person, and everyone experiences it in their own unique way. How someone responds to a traumatic event—such as a pandemic—depends on their history, beliefs, values, and other factors. Addressing trauma may seem like reconstructing a shattered vase, but putting the pieces together, even when it doesn’t look perfect, can result in something strong and beautiful.<br></p><p>The American Psychological Association (APA) defines trauma as an emotional response to an accident or natural disaster. Immediately after the event, APA says, shock and denial are typical. Longer-term reactions include “unpredictable emotions, flashbacks, strained relationships, and even physical symptoms like headaches or nausea.”</p><h2>Identify, Acknowledge Trauma</h2><p>While trauma and grief are different, they are intertwined. As Trish Childress, LCSW-S, ACHP-SW, a long term care social worker and director of supportive services, says, “Grief is a natural emotional process we go through after a loss, whereas trauma is an emotional response after a horrific event. But grief can be impacted by trauma, and trauma can be complicated by grief.”<br></p><p>Identifying trauma can be challenging, as people can respond in different ways. But there are signs to watch for, such as someone who was always a pleasant, cheerful person is now angry and short-tempered, or someone becomes preoccupied with death. <br></p><p>As with grief, ignoring signs of trauma isn’t healthy. Instead, Childress suggests, “Try to identify where the person is. Acknowledge that their mood, attitude, approach, etc. has changed, and support them through it.” She stresses that a person can’t receive information about someone’s trauma and just do nothing.<br></p><p>“If you open the box, you have a responsibility to help, and that can be challenging; knowing your boundaries and professional limits with co-workers is important,” she says. An option could be referring them to the Employee Assistance Program. “We don’t want to be passive, but we don’t want to be intrusive either,” she says.</p><h2>Check in With Co-workers</h2><p>After a situation such as a pandemic, natural disaster, or violent event, Childress says, “It is important to check in with team members and co-workers. HR [Human Resources] or other leaders can meet with team members and talk to staff. They can watch for shifts in attitudes, behaviors, or company culture and simply ask people if there is anything they need to do their jobs.” </p><h2>The Role of Control</h2><p>“Two of the greatest predictors of trauma are whether we feel like we had adequate support and how well we were able to take action on our own behalf after the traumatic experience,” says Carla Cheatham, MA, PhD, founder of the Carla Cheatham Consulting Group.<br></p><p>“I know of nurse leaders who when the pandemic began had team members who were terrified, and understandably so,” she says. “They were struggling with lack of information, understanding, and support. I suggested: Go be present with them; walk them through it.” <br></p><p>These leaders were concerned about their teams and took actions such as providing detailed written instruction on how to put on, take off, and dispose of Personal Protective Equipment, how to wash up, and how to protect their families when they went home. However, Cheatham observes, “Their presence gave their teams comfort that written memos and training programs couldn’t. This took time, but the impact was tremendous. It bonded teams and reassured frontline workers that they were cared for.<br></p><p>“Leaders who turn off their phones and listen to their people will build brand loyalty and connections and, ultimately, save much time, money, and energy in the long run.”</p><h2>Offer Options, Be There</h2><p>Giving people the option of initiating outreach for help is important as well. “We set up a call line where residents and employees could talk about their losses and their feelings,” says Jasmine Wadkins, LCSW, CDP, BF-CMT, CCTP, CEA, director of behavioral health services operations and education at Signature HealthCARE.<br></p><p>At the same time, it is important to realize that some people may not be willing or able to take that first step, she says. “If someone acknowledges feelings of trauma, you can say, ‘Would you like me to help you get assistance?’ or, ‘Can I make a call for you?’”<br></p><p>The personal touch is essential. For instance, instead of having corporate HR handle everything, Signature has HR people who deal with just a few buildings so they can get to know staff and communicate with them one-on-one. “We promote the Employee Assistance Program and do many referrals. We connect with area clergy and form other partnerships. As a result, we are able to make sure that employees get what they need.”<br></p><p>Encouraging self-care is important, especially after people have experienced a trauma or crisis. However, Cheatham stresses the need to realize that this isn’t a panacea. “We can’t tell people to exercise, eat right, take a vacation, or something else and expect everything to be okay. We need to look at what aspects of the workplace contribute to or trigger trauma and address them head on,” she says.</p><h2>Trauma Beyond Disease and Death</h2><p>There is no doubt that COVID has been responsible for much trauma, but there are issues beyond the illness that have negatively impacted many in long term care. The battles and controversies about vaccinations and masking, as well as conspiracy theories about the virus itself, have affected many people at all levels.<br></p><p>“When what we believe about the world gets smacked by reality, we hit an existential crisis,” Cheatham says. To let go of the belief that people will stop doing something that will hurt others when you find that this isn’t necessarily true, you first have to grieve, she says. “Once you do that, you can find a new place to come to. You can accept the reality of the world while understanding that when people are afraid, they’re not always their best selves.” </p><h2>Post-Trauma: PTSD</h2><p>With post-traumatic stress disorder (PTSD), which is not uncommon for people who have experienced traumas, specific triggers (such as loud noises) take them back to the event and make them feel fear, terror, or helplessness. Symptoms may include flashbacks, recurring dreams or nightmares, feelings of detachment, problems sleeping, and/or an exaggerated startle response.<br></p><p>Researchers have found that PTSD affects many COVID survivors, as well as those who have been impacted by the virus in some way. One contributor to this is economic stress, something that many people—including a number of frontline workers—experienced during the pandemic. <br></p><p>COVID-related PTSD can be challenging to treat. In “COVID-Related Post Traumatic Stress Disorder: What It Is and What To Do About It,” William Haseltine, PhD, said, “Building resilience is an important part of overcoming trauma, yet the ambiguity surrounding it makes it more difficult to build resilience. People can’t always resort to typical methods such as goal setting and shifting the focus away from the trauma and toward the future.”</p><h2>So Many Starfish</h2><p>It may be tempting to assume that once the worst of COVID is over, trauma will ease. However, this isn’t likely to be the case.<br></p><p>“When people have time to come up for air and reflect on what they’ve been through, we can anticipate that burnout and trauma rates will go up,” Cheatham cautions. In addition to trauma, there may be widespread compassion fatigue, the physical and emotional exhaustion that leads to diminished ability to empathize or feel compassion, and moral distress, which results when people are prevented from taking or are unable to take the correct response to a situation.<br></p><p>Even the best, most caring, and conscientious of leaders and organizations are likely to see these kinds of issues arise. In addition to dealing with the Delta variant and new outbreaks and infections, says Cheatham, many staff members are confronted by pushback on vaccinations and masking, as well denials of COVID’s existence or severity. <br></p><p>“When there are that many starfish on the beach, you can only pick up so many,” she says. “It will take time, effort, and patience to deal with the traumas resulting from the pandemic and other crises we’ve faced in the past few years.”</p><h2>Person-Centered Care for Staff, Too</h2><p>“We pride ourselves as an industry for doing person-centered care, but it’s not enough to do it for residents. We need to take what we do for our residents, like trauma-informed care, and do it for our staff as well,” says Cheatham, adding, “The best leaders I’ve seen understand this.”<br></p><p>Paige Hector, LMSW, national speaker and clinical educator, suggests encouraging staff to have an “empathy buddy.” An empathy buddy can be a colleague or co-worker or someone outside of the work setting. Engaging with an empathy buddy is an intentional practice that is different from usual conversation, one in which the individuals can share their feelings and explore underlying needs.<br></p><p>“This doesn’t have to be a formal arrangement or involve structured meetings,” Hector says. It could mean a "check-in," where each person has the opportunity to share while the other person listens deeply instead of typical back-and-forth talking or problem solving. It can be helpful to agree upon a set time, for example, five minutes each (or longer if the situation allows). <br></p><p>“It lays a foundation to help people understand and practice empathy, and it encourages mutually supportive relationships,” Hector says. Of course, she notes, “Participating in this type of practice is voluntary, and some staff may choose to not participate.”<br></p><p>It’s important for leaders to create a culture where everyone understands that trauma is an injury, and not a weakness, illness, or character flaw, says Hector.<br></p><p>“Few of us will get though life without being traumatized by something at some point," she says. “Infusing trauma-informed care in the facility fabric of daily interactions is the beautiful opportunity we all have to support each other in healing.” <br><br><em>Joanne Kaldy is a freelance writer and communications consultant based in Harrisburg, Pa.</em></p> | Identifying trauma can be challenging, as people can respond in different ways. But there are signs to watch for. | 2021-12-01T05:00:00Z | <img alt="" src="/Articles/PublishingImages/2021/1221/CF1-Truama.jpg" style="BORDER:0px solid;" /> | Caregiving;Behavioral Health | Cover Feature | Joanne Kaldy | 48 | 12 |