emotional losses in the elderly for the learner top-notch cnas, one inservice at a time the five...

We hope you enjoy this

inservice, prepared by

registered nurses

especially

for nursing assistants

like you!

After finishing this inservice, you will

be able to:

Describe the five basic stages of the grieving

process.

List at least five physical symptoms of grief.

List at least five emotional symptoms of grief.

Describe at least three different types of emotional

losses experienced by elderly people.

Demonstrate your understanding of this inservice in your daily communications with

elderly clients.

If you are studying the inservice on your own, please do the following:

Read through all the material. You may find it useful to have a highlighting marker nearby as you read. Highlight any information that is new to you or that you feel is especially important.

If you have questions about anything you read, please ask _________________________.

Take the quiz. Think about each statement and pick the best answer.

Check with your supervisor for the right answers. You need 8 correct to pass!

Print your name, write in the date, and then sign your name.

Keep the inservice information for yourself and turn in the quiz page to _____________________________ no later than _______________. Show your Inservice Club Membership Card to ___________________ so that it can be initialed.

Email In the Know at [email protected] with your comments and/or suggestions for improving this inservice.

THANK YOU!

Instructions for the Learner

A Communication Skills Module:

EMOTIONAL LOSSES IN THE ELDERLY

Developing Top-Notch CNAs, One Inservice at a Time

A Communication Skills Module:

Emotional Losses in the Elderly

A GRUMPY, FORGETFUL WOMAN?

Inside This Inservice:

© 2013 In the Know, Inc. www.knowingmore.com

May be copied for use within each physical location that

purchases this inservice from In the Know. All other

copying or distribution is strictly prohibited.


The Five Stages of Grief 2

Loss of Youth 4

Loss of Family and Friends

5

Loss of Work 6

Loss of Spouse 7

Loss of Health 8

Loss of Independence 9

Communicating with Care and Concern

10

Handling Spiritual Doubt 10

Final Tips! 11

Symptoms of Grief 3

At age 65, Sarah Smith retires from her job. Even though this gives her more free time, she misses the daily contact with her former coworkers.

A year later, Sarah’s husband dies. His sudden death leaves her emotionally devastated, and in some financial trouble.

During that same time, Sarah is diagnosed with both diabetes and hypertension. She also develops chronic back pain.

On her 67th birthday, Sarah receives word that her sister has passed away. Three months later, Sarah’s best friend dies from cancer.

Six months later, her son decides that she should no longer live alone. He helps Sarah sell her house and moves her into an assisted living facility.

To the staff at the facility, Sarah seems like a grumpy, forgetful woman who keeps to herself and seems impossible to please. No one is very fond of her.

But look at things from Sarah’s point of view:

Within two short years, she has lost:

Her work,

Her friends,

Her health,

Her husband, and

Her home.

Is it any wonder that she tends to be grumpy and withdrawn?

Keep reading to learn more about:

The losses people face as they age.

The different ways these losses can affect people.

What you can do to help.

Most people think that “grief” and “grieving” only happen after the death of a family member or friend. But, people can go through the stages of grief for many types of significant losses.

There is no right or wrong way to grieve. Each person does it in his or her own way. However, there are five basic stages of grief:

1. DENIAL: “This can’t be happening to me.”

During this stage, a person may deny or even ignore that the loss has occurred. You may hear things like, "I'm going to wake up tomorrow and this will all be a dream." You may see you client withdrawal to avoid facing the truth or regress into child-like behavior, needing constant reassurance that "everything is going to be okay."

2. ANGER: “Why me?”

When denial wears off and reality sets in . . . anger emerges. Most people will have some anger about their loss. And, anger can be misdirected toward other family members, friends, doctors, nurses and even toward you!

It’s important to understand that anger is a critical stage of grief. It helps give the grieving person a focus. The only way to move through the stage of anger is to feel it. So, don't deny your clients this emotion. If your client is angry, listen. Be present. Never tell someone the feeling is wrong.

THE FIVE STAGES OF GRIEF

A Communications Skills Module: Emotional Losses in the Elderly © 2013 In the Know, Inc. Page 2

3. BARGAINING: “If I do this, things will change.”

This is the internal struggle—usually between the grieving person and God. "Please God . . . I will do anything you ask . . . just bring back my beloved husband."

Bargaining usually arises from guilt. People often feel there must be something (anything) they can do to change the reality of the situation.

4. DEPRESSION: “This really happened to me.”

When bargaining fails, depression takes over. Depression and withdrawal are normal in the grieving process. Depression occurs when the sadness becomes so overwhelming, the person finally surrenders to the grief.

You may see the grieving person experience uncontrollable spells of crying, long periods of silence, deep thinking or reflection, hopelessness, and even self blame.

5. ACCEPTANCE: “This is what happened to me.”

Acceptance occurs when the grieving person comes to terms with the reality of the situation. At this stage, the person is aware of the loss, understands the impact of the loss and is able to talk about what happened openly. The person will begin to believe that life can be adjusted or adapted to the loss.

Grab your favorite highlighter! As you read through this inservice, highlight five things you learn that you didn’t know before. Share this new information with your supervisor and co-workers!

© 2013 In the Know, Inc. Page 3 A Communications Skills Module: Emotional Losses in the Elderly

People who are dealing with an emotional loss may experience physical as well as emotional symptoms.

THE PHYSICAL SYMPTOMS OF GRIEF INCLUDE:

THE EMOTIONAL SYMPTOMS OF GRIEF INCLUDE:

THE SYMPTOMS OF GRIEF

Changes in appetite.

A lump in the throat.

A knot in the stomach.

Frequent sighing.

Shortness of breath.

Tightness in the chest.

Fatigue (that doesn’t get better with sleep).

Headaches.

Muscle weakness.

Dry mouth.

Nausea, indigestion or diarrhea.

Feeling faint or lightheaded.

Aching all over.

Problems sleeping.

Feeling “empty.”

Anxiety or panic.

Anger.

Guilt.

Depression.

Helplessness.

Fear.

Jealousy of other people who have not experienced the same loss.

Loneliness.

Indifference.

Betrayal.

While working through the grieving process, people may:

Deny that the loss has actually happened.

Be unable to concentrate.

Experience confusion.

Be preoccupied with what or who they

have lost.

Talk a lot about how things used to be.

Show their anger towards God for letting

the loss happen.

Say that life has no meaning.

Feel that they have no reason to keep on living.

Spend a lot of time crying.

Talk about ending their own lives.

COULD YOUR CLIENT BE DEPRESSED OR EVEN SUICIDAL?

Each day, the U.S. loses 14 senior citizens through suicide. In fact, people who are 75 and older have the highest rate of suicide.

For every 100 elderly home health clients, at least 14 are depressed.

Some symptoms of depression: Feeling sad or tearful.

No interest in doing anything.

Having feelings of worthlessness.

Being agitated easily.

Thoughts about suicide.

Some warning signs for suicide: Severe depression. Talking about suicide. Seeking out the means to carry

out a suicide (pills, gun). Feelings of loneliness,

helplessness, hopelessness. Anxiety or panic. Saying goodbye to people—as

if they may never see them again.

Sudden sense of calm after being extremely depressed.

Report any symptoms of depression or suicide to your

supervisor right away!


In some ways, the idea of “youth” is really just an attitude. For example, some people feel young throughout their whole lives. Others start to complain about feeling old before they turn forty.

However, there are undeniable physical changes associated with aging. The loss of a youthful body begins gradually and then seems to speed up in the later years.

Some of the obvious physical signs that a person may no longer be young include:

In addition, there are physical changes taking place inside the body. Here are just two examples:

The digestive system may become more sensitive. (Older people can no longer chow down on half a pizza without suffering the consequences.)

It takes longer for older people to recover from an illness or to heal from an injury.

As people lose their youth, they may start to realize that their days on earth are growing short.

Some people react to this by considering every day to be precious. They work hard to live each day to the fullest.

Others react by becoming depressed and by giving up their youthful hopes and dreams.

LOSS OF YOUTH

Emotional losses are tough to deal with for elderly clients—especially when the loss includes the death of a best friend or spouse.

The best way to help a client who is suffering from emotional loss is to TALK ABOUT IT!

Follow these easy guidelines when discussing emotional losses with clients.

Remember, you are NOT a counselor or a psychologist. Do not attempt to give advice or try to “fix” the problem yourself.

You are there to listen. Your main job is to be someone who cares! Listen and do your best to understand what your client says.

Give your client hope. Having a friend is often all it takes to help someone through a tough period of emotional loss. Be a friend!

COMMUNICATION SKILLS:

Relax and listen very carefully.

Make a special time for talking.

Express your natural compassion.

Focus on your client’s feelings.

HOW NOT TO COMMUNICATE:

Do NOT interrupt.

Do not talk about your own feelings.

Hair loss. Grey hair. A thicker waistline. Wrinkles. Sagging skin.

“Age spots” on the skin. Stiff muscles. Arthritic joints. Reading glasses. A hearing aid.

If you have negative feelings about getting older, don’t let them show during your work with your clients.

Help your clients focus on the things they are still able to do, rather than dwelling on the things they can’t do anymore.

Talk to your clients about current events, such as politics, music and movies. Keeping up with the times helps people stay “young at heart.”

Share funny stories or jokes with your clients to keep them laughing!

WHAT CAN YOU DO TO HELP?

Being 70 years young is better than to being

40 years old!

©2013 In the Know, Inc. Page 5 A Communications Skills Module: Emotional Losses in the Elderly

LOSS OF FAMILY AND FRIENDS

Most people spend their middle years building deep emotional attachments with other people. These close relationships make life special and worthwhile.

As people age, it’s common for them to lose a number of loved ones. They must face the deaths of their parents, their siblings and their friends.

These deaths may occur one right after another—making it difficult for elderly people to complete the grieving process.

These losses may cause older people to focus on their own mortality. Your elderly clients may be thinking, “Will I be the next one to die?”

It’s not always death that takes away family and friends. Longtime friends may move away—to retirement homes or nursing facilities. Children and grandchildren may also move. But no matter what the cause, the result is the same: older people feel they have lost their loved ones.

All these losses cause an elderly person to have fewer social contacts. This can lead to a downward spiral: your clients have fewer people to talk to, so they become withdrawn and quiet. The less they talk, the fewer social connections they make . . . and so on.

People who have lost friends and/or family members may feel unloved and unappreciated. They are at risk for depression.

GO BEYOND THE OBVIOUS!

Look at the sections titled, “What Can You Do To Help” on pages 4 through 9 and think about what’s missing.

Get creative and think up a few more ways you can help your clients handle the following:

Loss of Youth:

____________________________

____________________________

____________________________

Loss of Work:

____________________________

____________________________

____________________________

Loss of Independence:

____________________________

____________________________

____________________________

Share your ideas with your co-workers and supervisor!

Ask them how they help clients deal with emotional losses!

Don’t dismiss the grief that older people feel when they lose their parents. For example, if your 75-year-old client loses her 95-year-old mother, her grief may run very deep. Encourage her to talk about her feelings and reminisce about her childhood.

Remember that social connections are important for seniors. You can help by encouraging them to talk or write to friends and family members on a regular basis. And remember . . . it’s never too late to make new friends.


Elderly people who keep in touch with friends

have fewer illnesses and less depression.


LOSS OF WORK

Some people look forward to retiring at age 65. Others keep on working well past retirement age. However, even people who are looking forward to retirement feel some grief over the loss of work.

Older people may feel pain over losing their daily schedule. They miss having someplace to go every day.

Many people take pleasure in being productive. A large part of their identity comes from their work—whether they are paid for it or not. If they lose the ability to be productive, they may feel worthless. They may start to think, “I am no good to anybody...I’m just taking up space.”

Many people build close friendships with their coworkers. When they retire, they lose not only their work—but also the daily social contact with their friends at work.

Some people feel a loss of “status” or “identity” upon retirement. When asked, “What do you do?”, they can no longer answer, “I’m a lawyer.” or “I own my own business.” Now, they say, “I’m retired.” This may make them feel less valuable to society.

Many people lose financial benefits when they retire. They must learn to live on a fixed income and may find themselves worrying about money more than before.

Women who have always taken care of their families and homes may experience a loss of work when they no longer have a household to manage.

A GOOD LAUGH MAY BE JUST WHAT’S NEEDED!

Did you know that laughter can help ward off the blues and even make people healthier? It’s true!

As Bill Cosby says, "If you can laugh at it, you can survive it."

LAUGHTER CAN:

Boost Immunity: Laughter creates a stronger immune system and guards against the physical effects of stress.

Be a Workout: Laughter often leads to a physical and emotional release and can cause a cleansing feeling of relief.

Provide Distraction: Laughter can divert a clients attention away from sadness and grief. It’s impossible to feel sad while laughing!

Create or strengthen friendships: Laughter connects people . . . and it’s contagious! The more your client can laugh, the more friends he or she will have. And, more friends means less sadness and grief!

To learn more about the benefits of laughter, ask about our inservice on

“The Role of Humor in Healing.”

Remember that the goal for most seniors is to fill their time in a rewarding way—rather than to have each day drag on with no purpose. So, help your clients find a variety of interesting and fun ways to pass their time.

Help your clients feel valuable by recognizing the knowledge and wisdom they have gained through the years. For example, ask for their opinion on a current event or on an issue such as how to invest money or discipline a child.


You are never too old to set another goal or to dream a

new dream!


LOSS OF SPOUSE

Working with clients in the home often requires coming up with creative

solutions to uncommon problems.

THE PROBLEM: You are caring for Mary, a 78 year old woman who has lived alone since her husband died six months ago.

Her health has severely declined and her daughter keeps talking about the need for assisted living.

However, Mary refuses to leave the house because her husband built it with his own hands and they lived in it together for over 50 years.

WHAT YOU KNOW: You know it’s time for Mary to have assistance around the clock, but you also understand why she is emotionally attached to her home.

GET CREATIVE: Think of 3 creative solutions you might suggest to Mary and her daughter so Mary can be safe and get the care she needs without feeling like she is losing the precious home her husband built.

TALK ABOUT IT: Share your ideas with your co-workers and supervisor and find out how they would solve the problem.

As married couples age, they usually hope to grow old together, but death often interrupts these plans. Most people live out their final years alone—especially women. (Among senior citizens, over half the women are widows. Only 13% of men have lost their wives.)

Losing a spouse, especially after a long term marriage, can be especially devastating.

With the death of a spouse, many people lose their best friend, their confidante and their sexual partner. Every area of life is affected.

In addition to the severe emotional loss, the death of a spouse can change a person’s everyday life. For example, Mr. Smith’s wife always did the cooking and the housework. When she died, Mr. Smith had no idea how to fix himself a meal or wash his own clothes.

The most difficult way to lose a spouse may be from a sudden death. When this happens, people tend to focus on their last moments with their spouse—especially if those moments were negative. For example, Mrs. Brown says, “The last words I said to my husband were in anger . . . over some stupid little fight we were having!” Mrs. Brown is tormented by guilt, even though she and her husband spent many happy years together.

The loss of a spouse may occur because of divorce—even among the elderly. People who divorce must also go through the grieving process in order to heal.

Encourage your client to share some special memories of their spouse with you.

Encourage your widowed clients to do as much as possible for themselves so they learn that they can be independent—even if it’s in little ways.

Ask your supervisor if there is a support group that might help your grieving client.


Losing a spouse turns a “we” into an “I”. It

can be a very difficult transition.


LOSS OF HEALTH

Think about a client you have cared for who has suffered from one or more emotional losses.

What loss or losses did your client experience?

_____________________________

_____________________________

How did your client react to the loss? Sadness, depression, withdrawal?

_____________________________

_____________________________

What did you do to help your client?

_____________________________

_____________________________

What could you have done differently?

_____________________________

_____________________________

_____________________________

What will you do differently now, after reading this inservice?

_____________________________

_____________________________

_____________________________

When people are young, their health problems tend to be temporary. They get sick . . . then they get well. They break an arm . . . and the bone heals. However, the health problems in later life tend to be permanent. This can cause elderly people to grieve over the loss of good health they had in their youth.

In some cases, loss of health is a gradual process—a slow loss of eyesight, hearing, muscle strength or memory. People might deny these gradual losses at first, but, eventually, they have a significant impact on an elderly person’s daily life.

For others, the loss of health can be a dramatic process—a sudden heart attack, stroke or tumor. These sudden losses tend to get people’s attention fast!

Some people react to a loss of health by denying that they have any problems. They continue with unhealthy habits such as eating too much, drinking too much and smoking cigarettes. Their attitude is, “Well, I’m going to die anyway . . . might as well do what I want.”

Other people react to a loss of health by getting angry. They feel betrayed by their bodies and “cheated” out of a healthy future.

Still others react by focusing on every little ache and pain. Their reaction is based on fear. They anxiously wait for the next health problem to appear—and they look for death around every corner.

Encourage clients to stay healthy by eating a healthy diet, quitting smoking and avoiding too much alcohol.

Because chronic pain can be a problem in the elderly, learn all you can about pain management.

Be patient. It may sound like some clients are constantly complaining about their health, but would you trade places with them . . . even for just one day?

Encourage your clients to do some kind of regular exercise—even if they aren’t up to aerobics classes anymore!


Encourage clients to do whatever exercise they can—it doesn’t

have to be an aerobics class!


LOSS OF INDEPENDENCE

IF YOU COULD PREPARE FOR LOSS, WHAT WOULD YOU PLAN?

IMAGINE THIS: One week from today, you will wake up to learn that you are no longer able to speak, walk or feed yourself.

You will lose your job because you are unable to work. You will be at risk of losing your home because you can’t make the payments.

You won’t be able to care for your family. In fact, you will be completely dependent upon family members (and strangers hired by your family) to care for you.

Your condition may last one day, one year or the rest of your life. No one knows for sure. The good news is . . . you have one week to make a plan.

What things are most important to you? Would you make arrangements to have your children cared for? Maybe you would try to sell your house to make money to live on while you are ill?

Share your thoughts with your co-workers and discuss how it must feel for clients to suffer many losses without the opportunity to plan ahead.

Many elderly people can still function on their own—they just take longer! Others may only need help for certain tasks like shopping for groceries or balancing their checkbooks.

Many seniors first begin to lose their independence when they can no longer drive a car. Losing the ability to come and go as they please can be very hard for elderly people.

Some seniors need help with basic everyday activities, such as bathing, grooming and dressing. Losing the ability to perform their own personal care can make your clients feel like children again. This can be difficult for many people to accept.

To stay safe, many people who need daily help must move in with family members or become residents at nursing facilities. So, losing their independence means losing their homes.

Giving up a home can mean losing familiar surroundings, possessions, neighborhood friends and a local place of worship.

People who feel as if they have no control over their own lives may lose self-esteem. They may also become depressed and uninterested in doing anything for themselves.

Senior citizens who try to cling to their independence may be putting themselves in danger. For example, they may insist on living alone—even though they fall down frequently and forget to take their medications.

Allow your elderly clients to make as many of their own decisions as possible. This allows them to feel “in control” and may keep them from becoming more and more dependent on you.

Enhance your clients’ sense of purpose by giving them a “job” to do: caring for a potted plant, straightening their room or folding their laundry.

Above all, treat your clients with respect and dignity!


“Purpose is what gives

life meaning.” ~ Charles Perkhurst


COMMUNICATING WITH CLIENTS AFTER A LOSS

1. People can go through the five stages of grief for many types of significant losses, including loss of youth, health, independence, friends and loss of spouse.

2. Grief can cause physical symptoms, like headaches and nausea as well as emotional symptoms, like anxiety and depression.

3. Most people have a lack of practice talking about loss and grief . . . but as a nursing assistant, it is important for you to know how to talk to a person who is grieving in a meaningful and honest way.

4. Grieving the emotional losses discussed in this inservice is a normal part of life for aging adults. Listen carefully, be a friend, and give your client the time and space needed to grieve naturally.

5. Be prepared to report and seek help for clients who become withdrawn, severely depressed, suicidal or those who are abusing substances like drugs or alcohol.

It's easy to stop by any grocery store or pharmacy and pick up a Hallmark® card to let someone know you care. But, being able to truly express heartfelt care and concern for someone after a loss is much more difficult.

Most people lack practice talking about loss and grief. But as a nursing assistant, it is important for you to know how to talk in a meaningful and honest way to a person who is grieving . Here are a few Do’s and Don’ts:

DO SAY . . . NEVER SAY . . .

"You are in my thoughts and prayers." This is okay to say if it is true and if you are sincere.

"I know how you feel." Even if you have suffered a similar loss, grief is felt differently by each person.

"He was such a caring / creative / loving person, and I am so sorry he died." Pointing out a specific quality of a person who died shows you valued that person.

"He's at peace now." or “She’s in a better place.” These are clichés that are often used but not very genuine and do not provide any real comfort.

"How are you feeling today?." and “What can I do to help?" Ask a grieving person how he or she feels and be sincere in your offer to help.

"It's part of God's plan," or "Everything happens for a reason." People may fail to find comfort in a God that leaves them feeling so sad and lost.

UNDERSTANDING SPIRITUAL DOUBT

Emotional loss can lead even the most faithful to doubt or question their belief in God. You may hear things like, "What kind of God would allow this to happen?" Or, "Why is God punishing me?"

Spiritual doubt is a normal reaction to loss or grief. In fact, many great spiritual leaders have asked the exact questions when feeling abandoned or cheated by God.

In 1979, Mother Teresa wrote, "Jesus has a very special love for you. As for me, the silence and the emptiness is so great that I look and do not see, listen and do not hear."

Surprisingly, doubting the existence or motivations of God often leads the person to a place of spiritual growth.

Offer to contact your client's minister or request a visit from clergy if you feel your client is experiencing spiritual doubt.


TIPS FOR HELPING CLIENTS COPE WITH LOSS

Now that you‘ve read this inservice on emotional losses, take a moment to jot

down a couple of things you learned that you didn’t know before.

The past is a source of strength for many elderly people. Talking about “the old days” can bring them a sense of security and self-esteem. It can also help them cope with grief. You can help your clients reminisce by asking them questions about their life. For example, “What was it like to grow up on a farm?” or “What was it like to teach in a one-room schoolhouse?” or “How did you meet your husband?” or “Who taught you to knit?”

Try playing some music for your clients. They may enjoy hearing a soothing melody or a popular tune from the past.

Let your words and actions show that you care. If your client is comfortable with physical contact, try giving a hug or holding a hand.

Remember that everyone grieves in his or her own way. For example, avoid judging a grieving person because he doesn’t cry or because he cries too much.

Watch out for signs of substance abuse. People who are grieving are at risk for using alcohol and/or drugs to ease their emotional pain.

Remember that holidays may be difficult for people who are coping with a loss. Be sensitive to their feelings and needs.

Avoid telling your clients that “you know how they feel.” It’s impossible for you to know exactly what it’s like to walk in their shoes. Instead, let them know that you care and that you want to help if they need you.

Learn to recognize the symptoms of depression. These include: Weight changes.

Loss of interest in everyday activities.

Sleeping too much...or having trouble getting to sleep.

Problems paying attention.

Confusion.

Irritability (especially in elderly males).

Keep in mind that some elderly people may be suffering from depression even though they don’t seem particularly sad.

Be sure to report any signs of depression to your supervisor right away.

Are you “In the Know” about emotional losses? Circle the best choice or fill in your answer. Then check your answers with your supervisor!

1. All of the following are normal stages of grieving, EXCEPT:

A. Depression C. Anger B. Suicide D. Bargaining

2. Your client recently lost her spouse. They had been married 50 years. A helpful way to express your care and concern is to say:

A. “I know how you feel.“ C. “I’m keeping you in my prayers.” B. “He’s in a better place now.” D. “It’s part of God’s plan.”

3. Which of the following is a sign that a client may be thinking about suicide?

A. She denies that a loss actually happened. B. She talks a lot about how things used to be. C. She has a sudden sense of calm after a period of deep depression. D. She expresses feeling anger towards God for allowing bad things to happen.

4. A good way to help your elderly client cope with his loss of independence is to: A. Give him a “job” to do. C. Let him live alone. B. Limit activities to avoid injury. D. Place personal care items just out of reach.

5. True or False

A client with a poor appetite may be suffering from depression.

6. True or False

Talking to clients about current events, music or movies can help them stay “young at heart.”

7. True or False

Clients who are angry should be left alone to think about their behavior.

8. True or False

Spiritual doubt should be discouraged as it often leads to suicidal thoughts.

9. True or False

Using the phrase, “everything happens for a reason,” is a cliché and not very comforting to a grieving person.

10. Fill in the Blank

The stage of grief when the grieving person comes to terms and is at peace with the

reality of the situation is known as ________________________.

Inservice Credit:

Self Study 1 hour

Group Study 1 hour

File completed test in employee’s personnel file.

EMPLOYEE NAME (Please print):

________________________

DATE: __________________

I understand the information presented in this inservice.

I have completed this inservice and answered at least eight of the test questions correctly.

EMPLOYEE SIGNATURE:

________________________

SUPERVISOR SIGNATURE:

________________________

An Communication Skills Module: Emotional Losses in the Elderly


emotional losses in the elderly for the learner top-notch cnas, one inservice at a time the five...

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