In The Name of GodIn The Name of God

Cognition vs EmotionCognition vs Emotion

How to tell the bad news How to tell the bad news

Setting up

• Arrange for privacy• Involve significant others• Sit down and appear un-hurried• Make an emotional connection• Make arrangements to avoid interruptions

- eg. Hand off your pager if possible

Perceptions

• Use open ended questions to assess the patient and their families perception of the medical situation.

• Careful not to talk down or above • What is your understanding of your …• What have you been told so far?

Invitation

• Explore if the patient wants all the facts or (as you know in some cultures) they may say my daughter or son will take care of everything.

• How would you like me to give the information about test results?

Knowledge

• A brief warning shot may help• Warning that bad news is coming may

help lessen the shock.• Unfortunately I have some bad news to

share then say it clear and concisely.• Avoid medical jargon:

- say “spread” instead of metastasis

The Patient’s Emotions

• Expect anything:- silence- disbelief- crying- denial- anger- shock

Your Emotions

• Sit and listen, connect with your eyes, hold their hand - whatever is natural

• I wish the news were different

• Can empathy be learned?

Grief• The pain, discomfort, mental and

physical feeling that most people feel following the death of a loved one.

• People suffer grief at the loss of anything. It doesn’t just have to be death.

Grieving Process

Denial

Denial• In this stage we refuse to believe what has

happened. We try in our mind to tell ourselves that life is as it was before our loss.

• We can even make believe to an extent by re enacting rituals that we used to go through

with our loved one.

• We set an extra plate at the table.• We expect them to be there when we

get home.• We flash back to memories and

conversations.• These are all part of this stage.

Anger

Anger• We get angry.

• The anger can manifest itself in many ways.• We blame others for our loss.

• We become easily agitated having emotional outbursts.

• We can even become angry at ourselves.

• Care must be taken here not to turn the anger inwards.

• Release of this anger is essential!

Bargaining

Bargaining• Bargaining can be with ourselves or if you are religious

with your god.• Often we will offer something to try to take away the

reality of what really happened.• We may try to make a deal, to have our loved one back

as they were before the tragic event occurred.• It is only human to want things back as they were before.

Depression

Depression• Depression is a very likely outcome for all

people that grieve for a loss.• This is the most difficult of the stages to deal

with.• There can be a feeling of listness and tiredness.

• Outbursts of tears may occur.

• You may feel like there is no purpose to your life anymore.

• You may feel like you are being punished.• Pleasure and joy may be difficult to

express.• There may even be thoughts of suicide. • If you at any time in this stage, feel like

doing yourself harm, professional counseling should be sought.

Acceptance

Acceptance• This is the final stage of grief.

• It happens when you know that you have to go on.

• You can accept your loss and now be able to regain your energy and goals for the future.

• It may take some time to get to this stage..but you will get there!

Coping with Crisis

Physical Reactions

Numbness

Unfeeling

PainTired

Can’t Sleep

Tightness in

Throat

Disinterest in

Eating

Emotional Reactions

Stabbing Pain

Sudden Anger

Sense of Unfairnes

sFeeling of Relief

Anger

GuiltHostility

Anxiety

Gladness

Fear

Mourning Process

Resolution• One starts living a

regular life.

Anticipatory Grief• The mourning process

that occurs prior to death in cases of terminal illnesses.

11. Four Basic Needs of the Bereaved

Companionship

Ventilation of Feelings

TIME

Time Alone

12. What are some appropriate things to say to the bereaved?

• "IT'S OKAY TO CRY," • "I JUST WANTED YOU TO KNOW I AM

THINKING ABOUT YOU."

13. What should you avoid saying to the bereaved?

• "CHEER UP,“• " TIME WILL HEAL ALL WOUNDS,"

• "HE/SHE IS BETTER OFF," • "IT WAS GOD'S WILL,"

• "CALL ME IF YOU NEED ME."