Vous êtes sur la page 1sur 68

INTRODUCTION: What is bereavement? Bereavement, or grief, is defined as a set of reactions to a significant loss.

While bereavement usually refers to the loss of a loved one, it may also refer to the loss of employment, a physical ability, possessions, or other events. Bereavement is a word used to denote grief, pain and sadness following the loss of a loved one. Even though death is an inevitable part of life, the finality and irrevocability of death lends a lethal blow, making it unacceptable for those left behind. It is truly one of lifes most stressful periods, with nothing to match the intensity of sorrow e perienced during this time. Bereavement is a comple process that is considered normal and may be accompanied by a variety of emotional reactions, behavioral responses, and thoughts. !or e ample, in the course of bereavement you may e perience sadness, anger, or relief. "ou may also feel the urge to withdraw from other people or to seek out social support. Bereavement that is prolonged, overwhelming, or seriously impairing may be considered #complicated bereavement,# a condition that may re$uire intervention. Bereavement is also a time of overwhelming and conflicting emotions. What may begin as shock and disbelief may give way to reflection, reali%ation and acceptance as time passes by. &hysical signs of bereavement may be portrayed as crying, e pressing anger, loss of appetite, dip in energy levels and even sleeplessness. &sychological signs could be depression, feeling lost, being aloof or withdrawn, guilt and even anger. !re$uently reported symptoms in the first year of bereavement were sleep problems, nervous tension, depression, loss of appetite and pain. 'ental health status and caregivers relational status were strong predictors of poor ad(ustment in early bereavement. )ther risk factors included female gender, older age, grief in the past and emotional burden. *nderstand that other family members may not feel these mi ed emotions that you harbor. +o not use the immediate death or funeral to speak unkindly of him or her. )thers might be grieving grandparents intensely and your negative words will not be taken well. ,et the time of death and months afterward be a time for mourning even if you cannot participate. If your unresolved issues you hold continue to bother you, do not hesitate to

seek the counsel of a therapist or clergy member. -alking about these issues and dealing with them may be (ust what you need for healing. In an ideal world, every death is a sad one and longing for and missing the deceased is a constant. .owever, in a realist world, sometimes there have been problems with your loved ones and their death may complicate feelings or issues you held. &erhaps your relationship with the deceased was not a happy one. /uestions went unanswered or there was a sticky situation regarding the Will. 0t the time of the death of your grandparent, respect who he or she was as much as you can. 1upport from loved ones, caring, talking ones grief out and even seeking professional help are ways to cope with the bereavement. 1everal studies indicate that the ma(ority of caregivers ad(ust reasonably well after the death of the person they cared for. 1tudies indicate that caregivers report a range of feelings in bereavement including loneliness, sadness, apathy, relief and overwhelming feelings of being back in the situation. Definition Bereavement refers to the period of mourning and grief following the death of a beloved person or animal. -he English word bereavement comes from an ancient 2ermanic root word meaning #to rob# or #to sei%e by violence.# Mourning is the word that is used to describe the public rituals or symbols of bereavement, such as holding funeral services, wearing black clothing, closing a place of business temporarily, or lowering a flag to half mast. Grief refers to one3s personal e perience of loss4 it includes physical symptoms as well as emotional and spiritual reactions to the loss. While public e pressions of mourning are usually time5limited, grief is a process that takes most people several months or years to work through. Causes of Bereavements -he immediate cause of bereavement is usually the death of a loved friend or relative. -here are a number of situations, however, which can affect or prolong the grief process6 -he relationship with the dead person was a source of pain rather than love and support. E amples would include an abusive parent or spouse. -he person died in military service or in a natural, transportation, or workplace disaster. Bereavement in these cases is often made more difficult by intrusive news reporters as well as an iety over the loved one3s possible physical or mental suffering prior to death.

-he person was murdered. 1urvivors of homicide victims often find the criminal (ustice system as well as the media frustrating and upsetting. -he person is missing and presumed dead but their death has not been verified. 0s a result, friends and relatives may alternate between grief and hope that the person is still alive. -he person committed suicide. 1urvivors may feel guilt over their inability to foresee or prevent the suicide, shame that the death was self5inflicted, or anger at the person who committed suicide. -he relationship with the dead person cannot be openly acknowledged. -his situation often leads to what is called disenfranchised grief. -he most common instances are homose ual or e tramarital se ual relationships that have been kept secret for the sake of spouses or other family members. -he loved one was an animal rather than a human being. Western societies are only beginning to accept that adults as well as children can grieve for a dead animal4 many adults still feel that there is #something wrong# about grieving for their pet. -he $uestion of euthanasia may be an additional source of sorrow4 even when the pet is terminally ill, many people are very uneasy about making the decision to end its life.

Symptoms of Bereavement Bereavement typically affects a person3s physical well5being as well as emotions. 7ommon symptoms of grief include changes in appetite and weight, fatigue, insomnia and other sleep disturbances, loss of interest in se , low energy levels, nausea and vomiting, chest or throat pain, and headache. &eople who have lost a loved one in traumatic circumstances may have such symptoms of post5traumatic stress disorder as an e aggerated startle response, visual or auditory hallucinations, or high levels of muscular tension.

&hysical pain 5 tightness in the body, breathlessness, lack of energy 7onfusion, hallucinations, disbelief )bsession with the deceased, sleeplessness, lack of appetite

+octors and other counselors have identified four stages or phases in uncomplicated bereavement6

1hock, disbelief, feelings of numbness. -his initial phase lasts about two weeks, during which the bereaved person finally accepts the reality of the loved one3s death. 1uffering the pain of grief. -his phase typically lasts for several months. 1ome people undergo a mild temporary depression about si months after the loved one3s death. 0d(usting to life without the loved one. In this phase of bereavement, survivors may find themselves taking on the loved one3s roles and responsibilities as well as redefining their own identities.

'oving forward with life, forming new relation5ships, and having positive e pectations of the future. 'ost people reach this stage within one to two years after the loved one3s death. What issues can Bereavement Counse in! a""ress?

It can offer an understanding of the mourning process -o e plore areas which might restrict moving on such as child abuse .elp resolve areas of conflict still remaining .elp to ad(ust to a new sense of self 7onsider if the mourning has turned to depression

-alking about the loss is usually helpful and allows a person to ad(ust to their new life with all its changes, good and bad. 8eeping things bottled up, or denying the sadness can prolong the pain. 0ny loss has to be acknowledged for us to move forward. Bereavement means finding a suitable place for the lost person to allow life to continue with adaptation and change, not forgetting or wiping out the memory. Description : Bereavement is a highly individual as well as a comple e perience. It is increasingly recogni%ed that no two people respond the same way to the losses associated with the death of a loved one. &eople3s reactions to a death are influenced by such factors as ethnic or religious traditions4 personal beliefs about life after death4 the type of relationship ended by death 9relative, friend, colleague, etc.:4 the cause of death4 the person3s age at death4 whether the death was sudden or e pected4 and many others. In addition, the death of a loved one inevitably confronts adults 9and older adolescents: with the fact that they too will die. 0s a result of this variety and emotional comple ity, most

doctors and other counselors advise people to trust their own feelings about bereavement, ; and grieve in the way that seems most helpful to them. It is also increasingly understood in the early <;;;s that people can e perience bereavement with regard to other losses. 1ome e amples of these so5called #silent losses# include miscarriages in early pregnancy, the death of a child in the womb shortly before birth, or the news that a loved one has 0l%heimer3s disease or another illness that slowly destroys their personality. In addition, many counselors recogni%e that bereavement has two dimensions, the actual loss and the symbolic losses. !or e ample, a person whose teenage son or daughter is killed in an accident suffers a series of symbolic losses= knowing that their child will never graduate from high school, get married, or have children=as well as the actual loss of the adolescent to death. Copin! With #oss Bereavement, or grief, is defined as a set of reactions to a significant loss. While bereavement usually refers to the loss of a loved one, it may also refer to the loss of employment, a physical ability, possessions, or other events. -he loss of a loved one is lifes most stressful event and can cause a ma(or emotional crisis. 0fter the death of someone you love, you e perience bereavement, which literally means >to be deprived by death.? Bereavement $ Conse%uences When a death takes place, you may e perience a wide range of emotions, even when the death is e pected. 'any people report feeling an initial stage of numbness after first learning of a death, but there is no real order to the grieving process. 1ome emotions you may e perience include6

+enial +isbelief 7onfusion 1hock 1adness "earning 0nger .umiliation +espair 2uilt

-hese feelings are normal and common reactions to loss. "ou may not be prepared for the intensity and duration of your emotions or how swiftly your moods may change. "ou may even begin to doubt the stability of your mental health. But be assured that these feelings are healthy and appropriate and will help you come to terms with your loss. 'ourning 0 ,oved )ne It is not easy to cope after a loved one dies. "ou will mourn and grieve. 'ourning is the natural process you go through to accept a ma(or loss. 'ourning may include religious traditions honoring the dead or gathering with friends and family to share your loss. 'ourning is personal and may last months or years. 2rieving is the outward e pression of your loss. "our grief is likely to be e pressed physically, emotionally, and psychologically. !or instance, crying is a physical e pression, while depression is a psychological e pression. It is very important to allow yourself to e press these feelings. )ften, death is a sub(ect that is avoided, ignored or denied. 0t first it may seem helpful to separate yourself from the pain, but you cannot avoid grieving forever. 1omeday those feelings will need to be resolved or they may cause physical or emotional illness. 'any people report physical symptoms that accompany grief. 1tomach pain, loss of appetite, intestinal upsets, sleep disturbances and loss of energy are all common symptoms of acute grief. )f all lifes stresses, mourning can seriously test your natural defense systems. E isting illnesses may worsen or new conditions may develop. &rofound emotional reactions may occur. -hese reactions include an iety attacks, chronic fatigue, depression and thoughts of suicide. 0n obsession with the deceased is also a common reaction to death. Dea in! &ith a 'a(or #oss of Bereavement -he death of a loved one is always difficult. "our reactions are influenced by the circumstances of a death, particularly when it is sudden or accidental. "our reactions are also influenced by your relationship with the person who died. ) chi "*s "eath arouses an overwhelming sense of in(ustice = for lost potential, unfulfilled dreams and senseless suffering. &arents may feel responsible for the childs

death, no matter how irrational that may seem. &arents may also feel that they have lost a vital part of their own identity. ) spouse*s "eath is very traumatic. In addition to the severe emotional shock, the death may cause a potential financial crisis if the spouse was the familys main income source. -he death may necessitate ma(or social ad(ustments re$uiring the surviving spouse to parent alone, ad(ust to single life and maybe even return to work. + "er y peop e may be especially vulnerable when they lose a spouse because it means losing a lifetime of shared e periences. 0t this time, feelings of loneliness may be compounded by the death of close friends. ) oss "ue to suici"e can be among the most difficult losses to bear. -hey may leave the survivors with a tremendous burden of guilt, anger and shame. 1urvivors may even feel responsible for the death. 1eeking counseling during the first weeks after the suicide is particularly beneficial and advisable. ,o& to cope up &ith Bereavement ? 7oping with death is vital to your mental health. It is only natural to e perience grief when a loved one dies. -he best thing you can do is allow yourself to grieve. -here are many ways to cope effectively with your pain.

See- out carin! peop e. !ind relatives and friends who can understand your feelings of loss. @oin support groups with others who are e periencing similar losses. +.press your fee in!s. -ell others how you are feeling4 it will help you to work through the grieving process. Ta-e care of your hea th. 'aintain regular contact with your family physician and be sure to eat well and get plenty of rest. Be aware of the danger of developing a dependence on medication or alcohol to deal with your grief. )ccept that ife is for the ivin!. It takes effort to begin to live again in the present and not dwell on the past. /ostpone ma(or ife chan!es. -ry to hold off on making any ma(or changes, such as moving, remarrying, changing (obs or having another child. "ou should give yourself time to ad(ust to your loss. Be patient. It can take months or even years to absorb a ma(or loss and accept your changed life. See- outsi"e he p &hen necessary . If your grief seems like it is too much to bear, seek professional assistance to help work through your grief. Its a sign of strength, not weakness, to seek help.

,e pin! Others 0rieve If someone you care about has lost a loved one, you can help them through the grieving process.

Share the sorro&. 0llow them = even encourage them = to talk about their feelings of loss and share memories of the deceased. Don*t offer fa se comfort. It doesnt help the grieving person when you say >it was for the best? or >youll get over it in time.? Instead, offer a simple e pression of sorrow and take time to listen. Offer practica he p. Baby5sitting, cooking and running errands are all ways to help someone who is in the midst of grieving. Be patient. Aemember that it can take a long time to recover from a ma(or loss. 'ake yourself available to talk. +ncoura!e professiona he p &hen necessary. +ont hesitate to recommend professional help when you feel someone is e periencing too much pain to cope alone.

,e pin! Chi "ren 0rieve 7hildren who e perience a ma(or loss may grieve differently than adults. 0 parents death can be particularly difficult for small children, affecting their sense of security or survival. )ften, they are confused about the changes they see taking place around them, particularly if well5meaning adults try to protect them from the truth or from their surviving parents display of grief. ,imited understanding and an inability to e press feelings puts very young children at a special disadvantage. "oung children may revert to earlier behaviors 9such as bed5 wetting:, ask $uestions about the deceased that seem insensitive, invent games about dying or pretend that the death never happened. 7oping with a childs grief puts added strain on a bereaved parent. .owever, angry outbursts or criticism only deepen a childs an iety and delays recovery. Instead, talk honestly with children, in terms they can understand. -ake e tra time to talk with them about death and the person who has died. .elp them work through their feelings and remember that they are looking to adults for suitable behavior.

Support for the primary care!iver an" fami y &. .udson and &ayne 9<;;Bb: have outlined several reasons why governments and health and social care agencies should offer support to family caregivers6 caregivers are profoundly affected by the patients terminal illness caregivers are responsible for numerous tasks caregivers are prone to physical and psychological morbidity caregivers are financially disadvantaged caregivers have limited e posure to death and dying caregivers are pivotal in achieving Csuccessful home care caregivers are often e cluded from information and care planning caregivers can become socially isolated caregivers commonly report unmet needs. -he World .ealth )rgani%ation 9W.): advocates that palliative care should improve the $uality of life of patients and their families facing problems associated with terminal illness 9World .ealth )rgani%ation, <;;<:. &alliative care services are ideally placed to provide support to caregivers and family members of terminally ill patients. 1ervice providers are often in close contact with families and have the opportunity to build rapport and trust over a period of time. -he potential benefit of obtaining support from a specialist palliative care program was shown in a *1 cohort study whereby D;,EDE elderly couples were retrospectively matched on the basis of whether or not the decedent was the recipient of hospice care. !indings showed that the surviving spouse of decedents who received hospice care were less likely to fall ill and die during bereavement than spouses of decedents who did not receive hospice care 97hristakis F Iwashyna, <;;D:. Within 0ustralian health policy standards it is e plicitly acknowledged that the needs of primary caregivers and family members should be considered as an integral component in the provision of specialist palliative care services 9&. .udson F &ayne,

<;;Bb:. !urthermore, it is deemed best practice for this duty of care to e tend into the phases of post5patient death and bereavement 9&alliative 7are 0ustralia, <;;G4 Aelf, 'achin, F 0rcher, <;;E:. In recent years, the importance of developing and identifying support interventions for caregivers involved in terminal care has been recognised by a number of health care agencies and research bodies 97andy, et al., <;;B4 Eagar et al., <;;H4 &alliative 7are 0ustralia, <;;I:. +espite the evidence of caregiver burden, there are minimal evidence based strategies or interventions to ensure effective delivery of support to caregivers and families of palliative care patients. While the national standards for palliative care services endorse this principle in many countries 9Aelf, et al., <;;E:, it is not always feasible to provide care for all family members of a palliative care patient. In an effort to set realistic ob(ectives in the provision of palliative care, it has been recommended that support should focus on the needs of primary caregiver9s: in the first instance and where resources allow, the entire family 9&. .udson F &ayne, <;;Bb4 Aelf, et al., <;;E:. &rimary caregivers: usually provide primary support for the patient at all levels of need. -hey may be the patients spouse, child, another family member or a friend. 0lthough the primary caregiver may be supported by other caregivers, they generally assume primary responsibility for the co5ordination and provision of care and support to the patient 9&alliative 7are 0ustralia, <;;G: Ways to Cope &ith the #oss of a #ove" One Aelationship with the dead person and manner of death can also influence the grieving process. Even if the death was e pected as in cases of terminal illnesses where families may have undergone anticipatory grief and are supposedly prepared for the loss, facing the reality of death can still be traumatic. -he suffering undergone before death also increases the pain and sorrow of the bereaved. The oss of a spouse can be e tremely traumatic. !or some, it can be life5changing, especially if the spouse was the sole breadwinner, which can bring both emotional as well as financial stress on the bereaved spouse. The oss of a chi " is by far the worst form of grief. It can send parents into a state of deep shock and denial. 2rief over the loss of a child is also accompanied by guilt, a sense of in(ustice and anger, and also wishes of what could have been if the death was averted. 'emories of the precious one could haunt ceaselessly, making it one of the toughest bereavements to cope with.

Une.pecte" "eaths due to accidents or suicide, or even a sudden illness can also be very difficult to cope with. -he bereaved e perience e treme guilt, and may blame themselves for the situation especially in cases of death by suicide where they feel the death could have been prevented. 0ccepting the loss of a loved one in such cases may take longer. 'u tip e "eaths within a family can also e acerbate grief making it very tough for those left behind. 0n acute sense of shock envelops the aggrieved, who could go through stress, trauma, an iety and depression. &rofessional help and counseling may be the best way to deal with such trauma. Ris- 1actors for Comp icate" 0rief an" Other Ne!ative Bereavement Outcomes )ne study of <IE caregivers of terminally ill cancer patients investigated the presence of pre5death complicated grief and its correlates. Aesults revealed the following variables associated with higher levels of pre5death complicated grief6

0ge younger than J; years. ,ack of perceived available social support. .istory of depression and current depression. ,ower income. &essimistic thinking. 1everity of stressful life events.

)f these correlates, pessimistic thinking and severity of stressful life events were independent predictors of pre death complicated grief. )ther research has focused on predictors of outcomes such as symptoms of depression and overall negative health conse$uences. -hree categories of variables have been investigated6

1ituational 9e.g., circumstances of the death:. &ersonal 9e.g., personality characteristics, gender:. Interpersonal conte t 9e.g., social support, kinship:.

'ost research has focused on spousalKpartner loss and is not uni$uely focused on death via cancer. Situationa : +.pecte" or Une.pecte" Death 0lthough theory suggests that a sudden, une pected loss should lead to more difficult grief, empirical findings have been mi ed. -he impact of an une pected loss

seems to be moderated by self5esteem and perceived control6 Bereaved persons with low self5esteem andKor a sense that life is uncontrollable seem to suffer more depression and somatic complaints after an une pected death than do bereaved persons with higher self5 esteem andKor a sense of control. /ersona : /ersona ity Characteristics 0ttachment theory has suggested that the nature of ones earliest attachments 9typically with parents: predicts how one would react to loss. Bereaved persons with secure attachment styles would be least likely to e perience complicated grief, while those with either insecure styles or an ious5ambivalent styles would be most likely to e perience negative outcomes. In a study of GB caregivers of terminally ill spouses, the nature of their attachment styles and marital $uality were evaluated. Aesults showed that caregivers with insecure attachment styles or in marriages that were #security5increasing# were more likely to e perience symptoms of complicated grief. &ersons with a tendency toward #ruminative coping,# a pattern of e cessively focusing on ones symptoms of distress, have also been shown to e perience e tended depression after a loss. /ersona : Re i!ious Be iefs -heory has proposed that strong religious beliefs and participation in religious activities could provide a buffer to the distress of loss, via two different mechanisms6

0 belief system that helps one cope with death. 0 network of social support that comes with religious participation.

.owever, empirical results about the benefits of religion in coping with death tend to be mi ed, some showing positive benefit and others showing no benefit or even greater distress among the religious. 1tudies that show a positive benefit of religion tend to measure religious participation as regular church attendance and find that the benefit of participation tends to be associated with an increased level of social support. -hus it appears that religious participation via regular church attendance and the resulting increase in social support may be the mechanisms by which religion is associated with positive grief outcomes. /ersona : 0en"er In general, men e perience more negative conse$uences than women do after losing a spouse. 'ortality rates of bereaved men and women are higher for both men and

women compared to no bereaved people4 however, the relative increase in mortality is higher for men than for women. 'en also tend to e perience greater degrees of depression and greater degrees of overall negative health conse$uences than do women after a spouses death. 1ome researchers have suggested that the mechanism for this difference is the lower level of social support provided to bereaved men than that provided to bereaved women. /ersona : )!e In general, younger bereaved persons e perience more difficulties after a loss than do older bereaved persons. -hese difficulties include more severe health conse$uences, grief symptoms, and psychological and physical symptoms. -he reason for this age5 related difference may be the fact that younger bereaved persons are more likely to have e perienced une pected and sudden loss. .owever, it is also thought that younger bereaved persons may e perience more difficulties during the initial period after the loss but may recover more $uickly because they have more access to various types of resources 9e.g., social support: than do older bereaved persons. Interpersona Conte.t: Socia Support 1ocial support is a highly comple construct, consisting of a variety of components 9perceived availability, social networks, supportive climateKenvironment, support seeking: and measured in a variety of ways. .owever, as mentioned above, lack of social support is a risk factor for negative bereavement outcomes6 It is both a general risk factor for negative health outcomes and a bereavement5specific risk factor for negative outcomes after loss. !or e ample, after the death of a close family member 9e.g., spouse:, many persons report a number of related losses 9often unanticipated: such as the loss of income, lifestyle, and daily routine=all important aspects of social support. R+2I+W O1 #ITR+TUR+: 34 Ro"ie )-erman an" (une stataham 567338 -his rapid review has considered evidence for the impact of childhood bereavement on educational and psychological outcomes for children, and the effectiveness of services to support bereaved children. 'ost children do e perience some negative impact on psychological wellbeing in the short term 9up to a year: from bereavement of a parent or sibling, but for the ma(ority of

children these difficulties do not persist or re$uire specialist intervention. Evidence of impact on educational attainment is generally lacking. -here is also little hard data on long5term outcomes from parental bereavement in childhood, although a new analysis of the LBH; birth cohort study suggests that there may be some impact, particularly for women, on outcomes at age D; such as having any $ualification, being employed, having symptoms of depression or being a smoker.

64 St4 9oseph*s ,ospice: ,ac-ney; St4 Christopher*s ,ospice: Sy"enham: U< 567338

'uch of the writing on the sub(ect of bereavement during the first three $uarters of the twentieth century were written from the point of view of western psychiatrists. 0s such it presented a reasonably consistent view but one limited by a frame of reference which has been primarily concerned to identify risks to mental health and prevent psychiatric problems. 'ore recently psychologists, sociologists, anthropologists, clergy and non5psychiatric health care staff have carried out their own studies and developed their own theories. 'any of these will be found in the papers published in 'ortality since its inception in 'arch LBBJ, they include some of the most influential voices in current European thanatology. Each of them has made their own uni$ue contribution to our understanding of the wide topic of bereavement. -he multiplicity of view points and the natural tendency for writers to see their own perspective as superior to that of others, may create confusion and I would like to take this opportunity to attempt a synthesis of views which I regard as complementing more often than undermining each other.

=4 Dr Chery Reme"ios: Dr <ristina Thomas an" /rofessor /eter ,u"son567338

7aregivers of palliative care patients face comple and challenging tasks including physical, medical, financial, legal and emotional aspects of care giving. While many caregivers report that care giving provides positive and valuable e periences, a high proportion of caregivers report considerable burden on their own physical health, psychological well5being, financial welfare and social life. It is recommended that the assessment of caregivers needs and well5being become routine in palliative care. 2reater recognition of the factors that increase or decrease caregivers vulnerability for burden is advocated. Aisk factors for psychological burden include sleeplessness, higher levels of caregiver esteem, financial difficulties, greater impact on schedules, greater impact on health and pessimistic thinking. &rotective factors that decrease caregivers vulnerability for burden include involvement in previous commitments, setting limits and boundaries, ade$uate personal and professional support, participation in valued activities and an optimistic outlook on life.

>4 #or" 1reu" 567338

Initial findings indicate that6 for most people, regardless of household income or whether or not they are in work, the death of a working age spouse or civil partner has a significant financial impact, which is particularly acute in the few months following bereavement4 longer term financial impacts were more varied, with an apparent correlation between being outside the labour market and having significant ongoing financial needs4 and decision making can be very difficult in this period. 'ost people found bereavement benefits e tremely valuable, but some felt they could be enhanced by greater interaction from government throughout the payment period, to provide sensitive employment support and reiterate practical information about the benefit at a time when it can be more easily absorbed. Aespondents who were less positive about bereavement benefits had often received other state benefits at the time of bereavement and noted that bereavement benefits caused these other payments to be reduced.

?4 #ouise Casey CB 567338

!or most families the criminal (ustice process is unknown and their state of vulnerability makes it difficult and unreasonable for them to negotiate this themselves. Because there are a series of competing interests within that (ustice process, the rights of bereaved families can be overlooked. -hose working with bereaved families who are not part of the criminal (ustice process M including the national homicide service caseworkers, volunteers and peer support groups M should know what families are entitled to e pect and to challenge shortcomings. -he system needs some challenge to ensure that it is taking account of the families reasonable and legitimate needs @4 Susan ) en /rofessor Stephen Bro&n 5Chair8 567338

1*+E& is when a person with epilepsy dies suddenly and no other cause of death is found. -here are over L;;; epilepsy5related deaths each year in the *8, of which over G;; are attributed to 1*+E&. >It is a privilege to be working with such a strong and necessary charity. !or many years hundreds of people were dying of une plained death related to epilepsy and it took effort and courage to bring this into national focus. 0s a result we now more fully understand the problem and the impact and I am sure that the scientific basis of this work will save many lives in the future as the wonderful support for families tries to reduce the pain of bereavement?.

A4 'onica 1 e.hau!: BSc: ',S +r"em BaC!ano! u: 'D: '): ',Sc 5677D8

'ost of the above tools were developed to be applied in clinical assessment, and in a clinical environment, and most have been used with general bereaved populations. -hese tools have not been tested for implementation in a community environment through lay facilitators. !urthermore, the capability of the community organi%ations to analy%e this data and apply it in decision making and service improvements may be limited. 0mong the grief instruments, the 2rief E perience /uestionnaire is the one most suited to identify grief e periences of suicide survivors. 0lthough this instrument shows the ability to separate the grief e periences of survivors from other forms of grief, the ability of the tool to show differences between test5retest have not been assessed. -herefore, it was not recommended to be used in clinical applications.

E4 's 9o"ie Cro.a F Dr Sarah ,i coat$Na etamby4 I)00 5677D48

&reliminary analysis suggests that socia iso ation and one iness are particularly dominant concerns amongst older bereaved people. Socia chan!e 9e.g. increasing divorce, women in work etc: affects the availability of informal support. older people interviewed felt that they have particular unmet nee"s for support following bereavement, especially with practica matters 9such as paperwork, funeral arrangements:4 functiona support 9such as transport, shopping, cleaning:4 emotiona support4 9companionship4 somebody to talk to: and empathetic support 9shared bereavement e periences:

D4 9anet #ec-ey 5677E8

7ruse Bereavement 7are in Northern Ireland is part of a national organisation which promotes the well5being of bereaved people and to enable anyone bereaved by death to understand their grief and cope with their loss. 7ruse has <I years e perience of providing bereavement support in Northern Ireland and the wide range of services are provided free of charge. -he services are available to adults

and children aged I M LE years, delivered by trained volunteers to respond to all causes of bereavement. 7urrently there are over G;; volunteers involved in activities including management committee membership, supervision, administration, fundraising training and vital face to face support and counselling.

374By ,e en +4 Bene"ict: /hD: R/T$S 5677E8

-here are two ma(or categories of death e periences6 uncomplicated and complicated bereavement. 7omplicated bereavement can be further divided into death complicated by stigma and traumatic death. *ncomplicated bereavement is defined as the normal grieving process when one e periences the loss of an important relationship. It is noteworthy that with uncomplicated bereavement, children who are ade$uately parented following the death do not appear to be at risk of later mental illness. In both types of complicated bereavement, especially traumatic grief including &-1+, there is heightened risk for later development of significant psychopathology

334)ber"een 5677A8

-he ma(ority of materials in this section are observational studies or opinion pieces 9evidence ratings are predominantly in the D5I level: that seek to establish distinctions between complicated grief and other diagnoses. &resently, it would appear that, there is no accepted diagnosis of complicated grief unless it is related to other mental health diagnoses. -herefore, those who are bereaved with signs and symptoms of complicated grief are often diagnosed with an iety and depression or &ost -raumatic 1tress +isorder 9&-1+:, which may, or may not, be appropriate.

364Sharon Be! ey 5677A8

In recent years there has been considerable interest in the effectiveness of psychotherapies including grief counseling and therapy. With regard to the impact of mental health treatment for grief, two issues have come to the forefront6 the efficacy of grief counseling and a claim that grief counseling can actually be harmful. -he 0ssociation for +eath Education and 7ounseling 90+E7: sees the $uestion of efficacy as a significant research challenge, made more comple by variations in methodologies, analytic stances, and preferred approaches toward the vulnerable population of mourners. It is important to note that the $uestion of harm is an ancillary issue within an investigation of overall efficacy.

3=4/a iative 'e"icine 677A

1till, there is conflicting evidence as to whether religion helps in the process of coping with loss. Aesearch has demonstrated many positive attributes of religion at the end of life and during stressful life events. -he causes of death were also various, including death of illness 9especially cancer:, suicide, homicide, stillbirth, neonatal death, violent deaths and accidents. Aange of time since death of the deceased was between L month and IL years.

3>4,eather 0aines ,ar"ison: Robert )4 Neimeyer: an" <enneth #4 #ichstein 5677?8

Insomnia has been commonly associated with bereavement. -hus, on the one hand, bereavement researchers have reported that grief is linked to impairments in sleep 9&rigerson, !rank, et al., LBBG:, and on the other hand, sleep researchers list bereavement among the common causes of insomnia 9,ichstein F Aeidel, LBBI:. +espite this recognition of the mutual relevance of sleep and bereavement studies, the relation between sleep disturbance and grief symptomatology has received

surprisingly little systematic attention. -he goals of this study were to establish the fre$uency of insomnia and associated sleep behaviors among a large cohort of bereaved young adults and to investigate their relation to complicated grief symptomatology.

3?4,anne ore &ass 9ane +4 'yers 5677?8

+eath is inescapable fact of life that touches everyone at sometime. 1o all counselors regardless of their work setting will be faced with mindset to help someone ad(ust to death, whether their own or a death of a parent, spouse, child or friend. .elp older persons cope with death may be made easier for those counselors who are familiar with the known psychosocial aspect of death among elderly.

3@49oseph '4 Currier: 9ason '4 ,o an": an" Robert )4 Neimeyer 5677?84

-he overall results do not support the assumption that the bereavement interventions with children have a significant influence on ad(ustment. )n average, the treated child did not appear to be better than bereaved children who did not participate in grief therapy. -he results of our review lead to the same general conclusion, namely that the interventions with bereaved children do not appear to produce the outcomes that are e pected from professional psychotherapeutic interventions.

3A4'ary 'cC ain: RN: 'S 9oan )rno ": RN: /hD +ve yne #on!champ: RN: ') 9o"i Shaefer: RN: /hD5677>8

8ey to the development of effective skill as a bereavement counselor is the willingness to seek personal insight and gain ob(ectivity about ones motivation to do this work. Every person has a history of loss, and has processed loss in uni$ue ways influenced by the nature of his or her relationships, family dynamics and cultural conte t. -he history and processing of loss provide a foundation of e perience, and issues emanating from personal e periences of loss tend to be played out in the helping conte t. It is imperative, therefore, that the bereavement counselor seeks insight and gains ob(ectivity about personal e periences of loss in order to achieve ob(ectivity in the therapeutic relationship with bereaved parents and others.

3E4/a iative 'e"icine 5677=8

-he death of a loved person is a normal part of life, one that at first sight may not be an obvious topic for scientific investigation. Is it not enough to rely on human insight and clinical e perience to provide the right sort of support for bereaved people and to understand grief and grievingO In fact, there are a variety of arguments that can be given in support of an empirical, scientific approach, from both societal and theoretical points of view, but let us instead take an apparently simple e ample that turns out to be more comple than e pected.

3D4Boston: ')5677=8

If the family is resistant to the idea of autopsy, the physician or nurse may be able to alleviate an iety associated with this procedure. !irst, it is helpful to e plain to parents that an autopsy is a medical procedure similar to surgery or an #operation#. 0 speciali%ed physician or pathologist performs this operation in a respectful manner. 1econd, besides ruling out in(ury, an autopsy will eliminate or confirm any unsuspected illness or congenital anomaly as the cause of death.

-hird, in almost all cases in which autopsies are not performed, the family may have lingering doubts as to the cause of death.

674The Community )"visory /ane 5C)/8567768

-he bereavement process is very individual. 0s such the needs of relatives will differ on a case5by5case basis. It is noted that the needs will also be affected by how sudden or e pected the death of the patient was.

In general, the 70& were very satisfied that the bereavement process is organised and fit5for5purpose. It should be noted that only the API and !reeman sites were considered. 0 number of observations and suggestions for improvements are made. Both the bereavement offices and mortuary viewing facilities were felt to be accessible to users, though the approach to the viewing facility at the !reeman is far from ideal 9in the basement, on a noisy service corridor which can be dark due to the movement sensitive lighting:.

634'ar!aret Stroebe: ,en- Schut: Wo f!an! Stroebe567768 &eople who have been bereaved are more likely to have physical health problems, particularly those who have been bereaved recently. Bereaved individuals also have higher rates of disability, medication use, and hospitali%ation than non5bereaved counterparts. 0lthough widowed people in general consult with doctors more fre$uently, most likely because of symptoms of an iety and tension,DG findings suggest that many of those with intense grief might fail to consult with doctors when they need to.

6649ennifer ,o i"ay 567768

In many cases, there is no evidence of significant increases in psychological morbidity associated with sibling bereavement. .owever, both internali%ing and e ternali%ing problems may emerge in situations where6 traumatic death has occurred the family has difficulty ad(usting predisposing factors such as previous depression are present -he secondary effects of sibling bereavement may have a more profound impact on the surviving child. 1uch as6 loss of the sibling relationship change to the role the sibling plays within the family

6=4+ iCabeth Temp eton 567778

-eachers are in an ideal situation, without the personal burden of the childs loss, to help grieving students feel safe, acknowledge that their loss is real, provide an environment for sharing feelings and structure learning e periences to deal with grief and loss circumstances 97harkow, LBBE:. With specialist training, school counselors are able to provide additional support for grieving students through individual and or group therapy, family intervention and development of identification and referral processes and school grief and loss programs

6>4St4 9oseph*s ,ospice: ,ac-ney; St4 Christopher*s ,ospice: Sy"enham 567778

0ll in all it would appear that we now have a great deal of knowledge about the nature of bereavement and its conse$uences. If there were ever counsellors who confined themselves to aiding in the e pression of emotions 9as Walter maintains but 1troebe, 'c,aren and !ootman disagree:, this can no longer be the case. -here seems to be general agreement that bereaved people need to talk there way through

grief. 0s Walter puts it, the helper can share in the never5ending and refle ive conversation with self and others through which the late5modern person makes sense of their e istence. It is time to put aside minor academic differences and get on with the (ob of caring.

6?49ohn ,inton 567778

&repare for the death of someone you are close to. It is important emotionally and practically to talk things over. If you are preparing for the death of your partner, discuss with them the (obs your partner used to do, sort out finances. 1ay all the things you would want to say. 7arefully consider whether you want to see the body of the dead person. 1ome people may feel this is too distressing but can regret it later on if they have not done this. !ollow your own feelings. -here is no right or wrong thing to do, but do think it out. !uneral arrangements should be considered carefully. -ry to have someone with you. +ont feel pressured into a funeral that is too e pensive for your budget. -ry and think about what you really want.

R+S+)RC, '+T,ODO#O0B
Intro"uction Aesearch is common terms refer to the research for knowledge. )ne can also define research as a scientific and systematic search for information on a specific topic. In fact research is an art of scientific investigation. Aoadmann and 'orry 9LB<D: defined research as a systematic effort to gain knowledge. It is the pursuit of truth with a help on

study, observation, comparision and e periment through ob(ective and systematic methods of finding solution to a problem. Aesearch is, thus an original contribution to the e isting stock of knowledge making for its advancement. Aesearch is defined as >a systemati%ed effort to gain new knowledge?. -he word research itself gives the meaning as re5searching, searching for more relevant facts from the e isting facts. It refers to the systematic method consisting of enunciating problem, formulating hypothesis, collecting facts and reaching certain conclusion, either in the form of solution towards the concerned problem or in central generali%ation for the same theoretical formation. It can be defined as a careful critical in$uiry or e amination in seeking facts or principles and to design investigation in order to ascertain something. Aesearch methodology prepares the investigator to adopt techni$ues and tools to neutrali%e the effect of hurdles. It is description, e planation and (ustification of various methods of continuing research. Aesearch methodology is an important part of a specific study. Every researcher should have a well5defined methodology, which states the relevance of the study. 1ormu ation of research prob em 0fter reviewing a number of articles and literatures, the researcher was able to understand that many study were conducted to measure the level of bereavement among childrens, spouse etc,. -here is very little research study in this area, so the researcher was interested in carrying out a study on the level of bereavement among care givers of hospice patient.

Nee": 7aregivers are facing lots of problems like sorrow, grief, pain, suicidal tendency with bereavement. Especially care givers of hospice patients have more pain after the loss of their loved one, so there is a need to study about the bereavement among the care givers of hospice patients.

Scope:

&eople cope with the loss of a loved one in many different ways. !or some, the e perience may lead to personal growth, even though it is a difficult and trying time. -here is no right or wrong way to cope with the passing of a loved one. -he way a person grieves depends on the personality of that person and the relationship with the person who has died. .ow a person copes with grief is affected by many factors6 the person3s e perience with the illness, the way the disease progressed, the person3s cultural and religious background, his or her coping skills and mental history, e isting support systems and the person3s social and financial status. 1o there is more scope to study about the bereavement of a care givers of hospice patients.

/retest
-he pretest was conducted preliminary step to test the feasibility of the study. !ind the e tend of the cooperation of the respondents. +ecide on the procedures and tools of data collection. 0s the pretest proved to be successful the researcher decided to go ahead with data collection.

)im an" ob(ective5s8:


)im: -o measure the level of bereavement among caregivers of hospice patients Ob(ective: -o know how much the care givers have affected after the loss of their loved ones -o know how much the care givers have distressed after the loss of their loved ones -o know how much they missing them and how they coping their sorrow level.

,ypothesis:

-here is no significant difference with age of the care giver with regard to the level of bereavement -here is no significant difference with se of the care giver with regard to the level of bereavement -here is no significant difference with 'arital status of the care giver with regard to the level of bereavement -here is no significant difference with Aesidence of the care giver with regard to the level of bereavement -here is no significant difference with domicile of the care giver with regard to the level of bereavement -here is no significant difference with )ccupation of the care giver with regard to the level of bereavement -here is no significant difference with -ype of family of the care giver with regard to the level of bereavement -here is no significant difference with Aeligion of the care giver with regard to the level of bereavement

Operationa "efinition:
Bereavement Bereavement is the level of psychological pain caregiver is having after the death of the hospice patient. Care!iver 7are giver is the person who has taken care of hospice patients during hospitali%ation Desi!n of the stu"y: -he research design is a plan of action indicating the specific steps that are necessary to provide answers to those $uestions, test the hypotheses, and thereby achieve

the research purpose that helps choose among the decision alternatives to solve the management problem or capitali%e on the market opportunity -he researcher has used Diagnostic research design to find how much care givers are affected after the death of the hospice patient

)bout the Universe:


-he researcher has selected 7'1 &ushpalaya charitable trust, Nellikkampoil for the research study. -he universe consists of 677 caregivers of hospices

Inc usion criteria:


)nly .ospice patients alone included in this study.

Samp in! proce"ure:


Aesearcher has used convenient samp in!

'etho" of "ata co ection:


-he researcher has used Guestionnaire metho"

Too s of "ata co ection:


-he researcher has adopted > Bereavement 1cale 9Burnett: /au C 53DDA8?. Bereavement scale is having DG $uestions with I point and G point scale. !irst D< $uestions will be having I point scale and rest of the D scales will be having G point scale. /retest 1tandardi%ed scale and socio demographic profile was pretested with G respondents Statistica ana ysis -he researcher has used t test and 0N)P0 to find the difference between age, se , marital status, Aeligion, Aesidence, )ccupation, -ype of family and domicile with the level of bereavement among caregivers of hospice patients.

Difficu ties face" by the Researcher -he researcher faced some difficulty obtaining permission from the 7haritable trust. -he researcher has to visit the 7haritable trust fre$uently to get information since the respondents were busy with their own works. -he researcher faced the difficulty in communicating to the care givers as they are very much sad in the loss of their loved ones. 1ome of the care givers stopped in half way while filling up the $uestionnaire as they go back to the memories about their loved ones. #imitations of the stu"y -he study is conducted only in 7'1 &ushpalaya 7haritable trust, Nellikkampoil, so it cannot be generali%ed.

ChapteriCation

Chapter I /art ) -his chapter contains the introduction of Bereavement /art B -his chapter contains the views of various different scholars and authors on Bereavement and related aspects, as a whole it is summed up as review of literature. Chapter II -his chapter contains the research methodology of the pro(ect Chapter III -his chapter contains the analysis and interpretation of the collected data. Chapter I2 -his contains the findings, suggestion, conclusion, bibliography and appendi of the pro(ect.

Data ana ysis an" interpretation

Distribution of the respon"ents by their a!e S4No L < D I )!e <G 5 DG DG 5 IG IG 5 GG 0bove GG Tota 1re%uency G LE LL <G @7 /ercenta!e E.D D;.; LE.D ID.; 377

-able L indicates the distribution of respondents by their age. It can be observed that among the total respondents E.D belongs to age of <G M DG , D;.;Q belongs to age of DG M IG, LE.D Qbelongs to age of IG M GG, ID.;Q belongs to above GG.

Distribution of the respon"ents by their a!e

Distribution of the respon"ents by their se. S4No Se. 1re%uency /ercenta!e

L <

'ale !emale Tota

L; G; @7

LJ.H ED.D 37747

-he above table reveals those ma(orities IEQ of the respondents belong to the age group of <J to DD years,DDQ of the respondents belongs to the age group of LE to <G years,L;Q of the respondents belong to DI to IL years, JQ of the respondents belong to I< to IB years, DQ of the respondents are above G; years.

Distribution of the respon"ents by their se.

Distribution of the respon"ents by their 'arita Status

S4No L <

'arita Status 'arried *nmarried Tota

1re%uency G.H D @7

/ercenta!e BG.; G.; 37747

-able D indicates the distribution of respondents by their marital status. BG.; Q of them are married, G.; Q of them are unmarried.

Distribution of the respon"ents by their 'arita Status

Distribution of the respon"ents by their 'arita Status

S4 No L < D

Re i!ion .indu 7hristian 'uslim Tota

1re%uency D; <D H @7

/ercenta!e G;.; DE.D LL.H 37747

-able I shows the distribution of respondents by their religion. G;.; Q of them are .indus, DE.D Q are 7hristians and LL.H Q of them are 'uslims.

Distribution of the respon"ents by their 'arita Status

Distribution of the respon"ents by their Occupation

S4No L <

Occupation !arming )thers Tota

1re%uency <D DH @7

/ercenta!e DE.D JL.H 37747

-able G indicates the distribution of respondents by their type occupation. DE.D Q of them are farmers and rests of them are not farmers.

Distribution of the respon"ents by their Occupation

Distribution of the respon"ents by their Domici e

S4No L <

Domici e Aural *rban Tota

1re%uency GD H @7

/ercenta!e EE.D LL.H 377

-able J depicts the distribution of respondents by their domicile. It can be observed that among the total respondents EE.DQ are belongs to rural domicile and LL.HQ are belongs to urban

Distribution of the respon"ents by their Domici e

Distribution of the respon"ents by their Resi"ence

Resi"ence 1re%uency )wn Aental Tota DH <D @7

/ercenta!e JL.H DE.D 37747

-able H indicates that whether the respondent having an owned or rental residence. JL.HQ of them are having own houses and the rest are having rent houses.

Distribution of the respon"ents by their Resi"ence

Berevement

Frequen Percen Valid ,evel cy t Percent Valid 1 2 3 6 27 27 10.0 45.0 45.0 100.0 10.0 45.0 45.0 100.0

Cumulative Percent 10.0 55.0 100.0

Total 60

-he above table reveals that IGQ of the respondents are having moderate level of bereavement, IGQ of the respondents having .igh level of bereavement and L;Q of the respondents having low level of bereavement. .

Bereavement

Distribution of the respon"ents by their Type of fami y S4No L < Type of 1ami y @oint !amily Nuclear !amily Tota 1re%uency IE L< @7 /ercenta!e E; <; 37747

-able E shows the distribution among respondents based on their type of family. In that E;Q of them are belongs to (oint family and <;Q of them are belongs to nuclear family.

Distribution of the respon"ents by their Type of fami y

One$&ay )na ysis of variance amon! the a!e of the respon"ents &ith re!ar" to their eve of bereavement

Mean

um o! #F "quare

Mean o! F quare

tati"tica l in!erence

$et%een &rou'"

&1(2.60 &2(2.2) &3(2.36 .40* &4(2.35 &5(2.35

.136

.302

P(.)24

+it,in &rou'" 25.241 56 .451

&R. ;G No significan ce

03H 6? to =?I 06H=? to >?I 0=H>? to ??I 0>H above ?? ,ypothesis: 3 -here is no significant difference between 0ge of the respondents with regard to their ,evel of Bereavement It is inferred from the above table that there is no significant difference between the 0ge of the respondents with regard to their score in Bereavement. -he calculated ! value is 9;.E<I:, which is significant at ;.;G levels. ,ence the hypothesis 3 is accepte"4 -here is no significant difference between the mean score 9<.J;: indicates that the above <G to DG 0ge group respondents have more Bereavement.

Stu"ent*s t$test bet&een the Se. of the respon"ents &ith re!ar" to their eve of Bereavement 1e 'ale !emale ,ypothesis: 6 -here is no significant difference between 0ge of the respondents with regard to their ,evel of Bereavement It is inferred from the above table that there is no significant difference between the 0ge of the respondents with regard to their score in Bereavement. -he calculated ! value is 9;.E<I:, which is significant at ;.;G levels. ,ence the hypothesis 6 is accepte"4 -here is no significant difference between the mean score 9<.J;: indicates that the above 'ale respondents have more Bereavement. N L; G; 'ean <.J; <.D; 1td. +eviation ;.GLJ ;.JHE t5value -S .LDD & R .;G No significance

Stu"ent*s t$test bet&een the 'arita Status of the respon"ents &ith re!ar" to their eve of Bereavement 'arital 1tatus 'arried *n married ,ypothesis: = -here is no significant difference between 'arital 1tatus of the respondents with regard to their ,evel of Bereavement It is inferred from the above table that there is no significant difference between the 'arital 1tatus of the respondents with regard to their score in Bereavement. -he calculated ! value is 9;.I<I:, which is significant at ;.;G levels. ,ence the hypothesis = is accepte"4 -here is no significant difference between the mean score 9<.JH: indicates that the above *n married respondents have more Bereavement. N GH D 'ean <.DD <.JH 1td. +eviation ;.JJI ;.GHH t5value -S .I<I & R .;G No significance

One$&ay )na ysis of variance amon! the Re i!ion of the respon"ents &ith re!ar" to their eve of bereavement4

Mean

um o! #F "quare

Mean o! F quare

tati"tica l in!erence

$et%een &rou'"

&1(2..37 &2(2.30 &3(2.43 0.0**

.050

.111

P(.)*5

+it,in &rou'" 25.551 57 .44)

&R. ;G No significan ce

03H ,in"uI 06HChristianI 0=H'us im ,ypothesis: > -here is no significant difference between Aeligion of the respondents with regard to their ,evel of Bereavement It is inferred from the above table that there is no significant difference between the Aeligion of the respondents with regard to their score in Bereavement. -he calculated ! value is 9;.EBG:, which is significant at ;.;G levels. ,ence the hypothesis > is accepte"4 -here is no significant difference between the mean score 9<.ID: indicates that the above 'uslim respondents have more Bereavement.

Stu"ent*s t$test bet&een the Occupation of the respon"ents &ith re!ar" to their eve of Bereavement )ccupation !arming )thers ,ypothesis: ? -here is no significant difference between Aeligion of the respondents with regard to their ,evel of Bereavement It is inferred from the above table that there is no significant difference between the Aeligion of the respondents with regard to their score in Bereavement. -he calculated ! value is 9;.BEI:, which is significant at ;.;G levels. ,ence the hypothesis ? is accepte"4 -here is no significant difference between the mean score 9<.DG: indicates that the above !arming and other occupation respondents have more Bereavement. N <D DH 'ean <.DG <.DG 1td. +eviation ;.JIH ;.JHJ t5value -S ;.BEI & R .;G No significance

Stu"ent*s t$test bet&een the Domci e of the respon"ents &ith re!ar" to their eve of Bereavement +omicile Aural *rban ,ypothesis: @ -here is no significant difference between Aeligion of the respondents with regard to their ,evel of Bereavement It is inferred from the above table that there is no significant difference between the Aeligion of the respondents with regard to their score in Bereavement. -he calculated ! value is 9;.;;J:, which is significant at ;.;G levels. ,ence the hypothesis @ is accepte"4 -here is no significant difference between the mean score 9<.EJ: indicates that the above urban respondents and other occupation have more Bereavement. N GD H 'ean <.<E <.EJ 1td. +eviation ;.JJ< ;.DHE t5value -S ;.;;J & R .;G No significance

Stu"ent*s t$test bet&een the Type of fami y of the respon"ents &ith re!ar" to their eve of Bereavement -ype of family @oint family Nuclear family ,ypothesis: A -here is no significant difference between Aeligion of the respondents with regard to their ,evel of Bereavement It is inferred from the above table that there is no significant difference between the Aeligion of the respondents with regard to their score in Bereavement. -he calculated ! value is 9;.D<E:, which is significant at ;.;G levels. ,ence the hypothesis A is accepte"4 -here is no significant difference between the mean score 9<.I;: indicates that the above @oint family respondents have more Bereavement. N IE L< 'ean <.I; <.LH 1td. +eviation ;.JII ;.HLE t5value -S ;.D<E & R .;G No significance

Stu"ent*s t$test bet&een the Resi"ence of the respon"ents &ith re!ar" to their eve of Bereavement Aesidence )wn Aental ,ypothesis: E -here is no significant difference between Aesidence of the respondents with regard to their ,evel of Bereavement It is inferred from the above table that there is no significant difference between the Aesidence of the respondents with regard to their score in Bereavement. -he calculated ! value is 9;.BEI:, which is significant at ;.;G levels. ,ence the hypothesis E is accepte"4 -here is no significant difference between the mean score 9<.DG: indicates that the above )wn and Aental Aesidence respondents have more Bereavement. N DH <D 'ean <.DG <.DG 1td. +eviation ;.JIH ;.JHJ t5value -S ;.BEI & R .;G No significance

1in"in!s )!e It is inferred from the above table that there is no significant difference between the 0ge of the respondents with regard to their score in Bereavement. -he calculated ! value is 9;.E<I:, which is significant at ;.;G levels. ,ence the hypothesis 3 is accepte"4 -here is no significant difference between the mean score 9<.J;: indicates that the above <G to DG 0ge group respondents have more Bereavement. Se. It is inferred from the above table that there is no significant difference between the 0ge of the respondents with regard to their score in Bereavement. -he calculated ! value is 9;.E<I:, which is significant at ;.;G levels. 'arita status It is inferred from the above table that there is no significant difference between the 0ge of the respondents with regard to their score in Bereavement. -he calculated ! value is 9;.E<I:, which is significant at ;.;G levels. Occupation It is inferred from the above table that there is no significant difference between the 0ge of the respondents with regard to their score in Bereavement. -he calculated ! value is 9;.E<I:, which is significant at ;.;G levels. Resi"ence It is inferred from the above table that there is no significant difference between the 0ge of the respondents with regard to their score in Bereavement. -he calculated ! value is 9;.E<I:, which is significant at ;.;G levels. Re i!ion

It is inferred from the above table that there is no significant difference between the 0ge of the respondents with regard to their score in Bereavement. -he calculated ! value is 9;.E<I:, which is significant at ;.;G levels Domici e It is inferred from the above table that there is no significant difference between the 0ge of the respondents with regard to their score in Bereavement. -he calculated ! value is 9;.E<I:, which is significant at ;.;G levels Type of 1ami y It is inferred from the above table that there is no significant difference between the 0ge of the respondents with regard to their score in Bereavement. -he calculated ! value is 9;.E<I:, which is significant at ;.;G levels.

Conc usion :

In the current world that is materialistic in all sense, bereavement has many levels of meanings. 0 scenario where people tend to be interdependent emotionally, physically F socially, bereavement has a very significant role in the day to day life. -his study itself is a proof that being intimate, any human being can develop emotional dependency towards each other. Being a social animal, man always has a tendency for mutual sharing and bereavement again is an outcome of this social characteristics. Su!!estions : L. Each and every family members should give support to the hospices <. &arents should teach children about how to behave to the hospices if they are in family. D. 2overnment must establish certain policies regarding their upliftment. I. 0ll the hospitals taken care of hospices especially, nurses and other care givers try to give them to mental moral support. G. 1ociety should accept the hospices. If the hospices need any help the society should try provide it. J. 'oral support to the care givers in whatever ways possible. H. 1pecial training programs to overcome the bereavement. E. Aemember, with support, patience and effort, you will survive grief. 1ome day the pain will lessen, leaving you with cherished memories of your loved one.

SC)#+S :B+R+)2+'+NT /,+NO'+NO#O0B SC)#+


Burnett: /au C 53DDA8 -his is a scale which measures a variety of attitudes feelings and behaviors among care givers of hospice patients. 1o please try very hard to completely honest in your answers. Aesults are confidential. Aead each $uestions and place an 9T: under the column which applies best for you. &lease read each $uestion carefully. -hank you.

/+RSON)# /RO1I#+
Name 0ge 1e UUUUUUUUUUUU UUUUUUUUUUUU UUUUUUUUUUUU9'ale K !emale: +ate UUUUUU.

'arital 1tatus UUUUUUUUUUUU91ingle K 'arried: Aeligion )ccupation +omicile UUUUUUUUUUUU97hristian K .indu K 'uslim K )thers: UUUUUUUUUUUU9!armers K Business K )thers: UUUUUUUUUUUU9*rban K Aural:

-ype of !amilyUUUUUUUUUUUU9Nuclear K @oint:

-hese $uestions ask about your e perience in relation to the recent loss of your loved ones, whose name in these $uestions will be signified by the symbol T. L. +o you e perience image of the events surroundings Ts death O V 7ontinuously V /uite a bit of time V 0 little bit of time V Never

<. +o thoughts of T come in to your mind whether you wish it or not O V 7ontinuously V /uite a bit of time V 0 little bit of time V Never D. +o thoughts of T make you feel distressed O V 0lways V /uite a bit of time V 0 little bit of time V Never I. +o you think about T O V 7ontinuously V /uite a bit of time V 0 little bit of time V Never G. +o images of T make you feel distressed O V 0lways V /uite a bit of time V 0 little bit of time V Never J. +o you find yourself preoccupied with images or memories of T O V 7ontinuously V /uite a bit of time V 0 little bit of time V Never H. +o you find yourself thinking of reunion with T O V 0lways V /uite a bit of time V 0 little bit of time V Never E. +o you feel as though T is present O V 0 lot of time V /uite a bit of time V 0 little bit of time V Never B. +o you at times feel as though you have seen T O V 0 lot of time V /uite a bit of time V 0 little bit of time V Never L;.+o you feel at times as though T has touched you O V 0 lot of time V /uite a bit of time V 0 little bit of time V Never LL.+o you at time as though you have heard T O V 0 lot of time V /uite a bit of time V 0 little bit of time V Never L<.When you dream about T does it feel as though T is still alive O V 0lways V /uite a bit of time V 0 little bit of time V Never LD.+o you currently recall dreaming about T O

V 0 lot of time V /uite a bit of time V 0 little bit of time V Never LI.+o you feel as though dreaming about T is helping you to cope with the loss O V 0lways V /uite a bit of time V 0 little bit of time V Never

LG.+o you find yourself missing T O V 0 lot of time V /uite a bit of time V 0 little bit of time V Never LJ.0re you reminded by familiar ob(ects 9photos, possessions, rooms etc.,: of T O V 0 lot of time V /uite a bit of time V 0 little bit of time V Never LH.+o you find yourself pining for K yearning for T O V 0 lot of time V /uite a bit of time V 0 little bit of time V Never LE.+o you find yourself looking for T in familiar places O V 0 lot of time V /uite a bit of time V 0 little bit of time V Never LB.+o you feel distressed K pain if for any reason you are confronted with the reality that T is not coming back O V 0 lot of time V /uite a bit of time V 0 little bit of time V Never <;.+o reminders of T such as photos, situations , music, places..you to feel longing for T O V 0 lot of time V /uite a bit of time V 0 little bit of time V Never <L.+o reminders of T such as photos, situations , music, places..you to feel loneliness O V 0 lot of time V /uite a bit of time V 0 little bit of time V Never <<.+o reminders of such as photos, situations, music, places etc., cause you to cry about T O V 0 lot of time V /uite a bit of time V 0 little bit of time V Never

<D.+o reminders of such as photos, situations, music, places etc., cause you to feel sadness O V 0 lot of time V /uite a bit of time V 0 little bit of time V Never <I.+o reminders of such as photos, situations, music, places etc., cause you to feel loss of en(oyment O V 0 lot of time V /uite a bit of time V 0 little bit of time V Never <G.+o reminders of such as photos, situations, music, places etc., cause you to feel dread O V 0 lot of time V /uite a bit of time V 0 little bit of time V Never <J.+o reminders of such as photos, situations, music, places etc., cause you to feel unreality O V 0 lot of time V /uite a bit of time V 0 little bit of time V Never <H.+o reminders of such as photos, situations, music, places etc., cause you to feel an iety O V 0 lot of time V /uite a bit of time V 0 little bit of time V Never

<E.+o reminders of such as photos, situations, music, places etc., cause you to feel numbness O V 0 lot of time V /uite a bit of time V 0 little bit of time V Never <B.+o reminders of such as photos, situations, music, places etc., cause you to feel guilt O V 0 lot of time V /uite a bit of time V 0 little bit of time V Never D;.+o reminders of such as photos, situations, music, places etc., cause you to feel anger O V 0 lot of time V /uite a bit of time V 0 little bit of time V Never

DL.1ince Ts death how able are you to organi%e your life O V Never V 0 little bit of time V /uite a bit of time V 0 lot of time D<.+o you find you are able to organi%e life to your satisfaction O V 0 lot of time V /uite a bit of time V 0 little bit of time V Never DD.0t the present time, do you feel able to assist others following Ts death O V 0 lot less able to V 0 bit less able to V No change V0 bit more able to V 0 lot better able to DI.0t the present time how do you feel having gone through the e perience of Ts death O V0 lot weaker V0 bit weaker VNo change V0 bit stronger V0 lot stronger DG.0t the present time do you feel able to understand yourself following Ts death O V 0 lot less able to V 0 bit less able to V No change V0 bit more able to V 0 lot better able to WWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWW

BIB#IO0R)/,B
Bereavement6 studies of grief in adult life

7olin 'urray &arkes, .olly 2. &rigerson 5 <;L; 5 DG; pages 5 &review ,ong recognised as the most authoritative work of its kind, this new edition is revised to take into account recent findings in the *1 and *8.
Bereavement6 reactions, conse$uences, and care

'arian )sterweis, !redric 1olomon, 'orris 2reen 5 LBEI 5 DL< pages 5 &review -hey looked at rates of death and disease among bereaved persons4 then they compared these rates with those for persons who had not lost a family member through death. What they learned generally lent scientific credence to what poets, ...
Bereavement

+ee &ilgrim 5 <;;J 5 HD pages 5 &review -he guides are presented in a clear andaccessible manner and will help the reader to understandthe issue that they might be encountering and willprovide tips on how they can deal with it.
Bereavement6 Words of 7omfort in -imes of 1orrow

@ames 1erafina 5 <;;E 5 GE pages 5 &review Bereavement. Words of 7omfort in -imes of 1orrow is a book that offers support for the dying and those around them.
+ying, +eath, and Bereavement

,ewis A. 0iken 5 <;;L 5 DBE pages 5 &review -his book is a brief but comprehensive survey of research, writings, and professionalpractices concerned with death and dying.
+eath and bereavement across cultures

7olin 'urray &arkes, &ittu ,aungani, Bill "oung 5 LBBH 5 <JL pages 5 &review -his book e plores the richness of mourning traditions around the world with the aim of increasing the sensitivity and understanding which we all bring to the issue of death. Bereavement6 client adaptation and hospice services Bereavement 7ounseling6 &astoral 7are for 7omplicated 2rieving
)n bereavement6 the culture of grief

-ony Walter 5 LBBB 5 <D< pages 5 1nippet view -his ground5breaking book looks at the social position of the bereaved.
7ounselling for 2rief and Bereavement

2eraldine '. .umphrey, +avid 2. Ximpfer 5 <;;H 5 LHE pages 5 &review In 7ounselling for 2rief and Bereavement, 1econd Edition 2eraldine .umphrey and +avid Ximpfer take readers step5by5step through the skills needed to facilitate the process of grief, initiate healing, and promote a sense of growth
Bereavement6 7ounseling the 2rieving -hroughout the ,ife 7ycle

+avid 0. 7renshaw, William Pan )rnum 5 <;;< 5 LEL pages 5 No preview


-he 0natomy of Bereavement6 0 .andbook for the 7aring &rofessions

Beverley Aaphael 5 LBEG 5 IGJ pages 5 &review Bereavement is a painful and inevitable e perience. -his book shares the e perience of many bereavements, how they are dealt with, understood, and eventually adapted to in the ongoing framework of human life.
+ying, +eath, and Bereavement6 0 7hallenge for ,iving

Inge B. 7orless, Barbara B. 2ermino, 'ary 0. &ittman, +r&. 5 <;;J 5 DE< pages In this updated edition, the authors e amine the issues of death and dying as a continuum, from death education and care of the dying to grief and bereavement.
0dolescent encounters with death, bereavement, and coping

+avid E. Balk, 7harles 0. 7orr 5 <;;B 5 DB; pages 5 &review # -his new book, #0dolescent Encounters With +eath, Bereavement, and 7oping, # analy%es the challenges faced by adolescents coping with death, dying, and bereavement, and e amines the new, uni$ue circumstances and advances that have ...
7hildhood bereavement6 developing the curriculum and pastoral support

Nina @ob, 2ill !rances 5 <;;I 5 H; pages 5 &review -his booklet aims to help teachers and those working in schools to support bereaved children and young people, and to communicate with all children and young people about death and dying.
.andbook of Bereavement6 -heory, Aesearch, and Intervention

'argaret 1. 1troebe, Wolfgang 1troebe, Aobert ). .ansson 5 LBBD 5 GIJ pages 5 -he .andbook of Bereavement constitutes a comprehensive review of scientific knowledge on the conse$uences of losing a loved person through death.
7hildren3s encounters with death, bereavement, and coping

7harles 0. 7orr, +avid E. Balk 5 <;L; 5 IEE pages 5 &review #Y!Zor the resource that offers one of the best bibliographies and guides to resources, for the book that contains theory, definitions, treatment modalities, helps, warnings, integration of people and programs, culural diversity...when it ...
Bereavement6 reactions, conse$uences, and care 6 site visit case ...

Institute of 'edicine 9*.1.:. 7ommittee on the .ealth 7onse$uences of the 1tress of Bereavement, National 0cademy of 1ciences 9*.1.: 5 LBEI 5 GG pages

Bereavement narratives6 continuing bonds in the twenty5first century

7hristine Palentine 5 <;;E 5 LBD pages 5 &review .owever, this empirically5grounded study argues that this is not always the best or only way to help the bereaved. in a radical departure, it emphasises normality and social and cultural diversity in grieving.
,oss and bereavement6 managing change

Aos Weston, -erry 'artin, "vonne 0nderson 5 LBBE 5 <JE pages 5 &review -his book encourages the use of range of skills while bringing a critical yet reflective dimension to this caring work. -he te t considers the work, school, family and social environments.

http6KKwww.nhpco.orgKfilesKpublicKInsightsIssue<W<;;D1ocialWWorkerWppE5B.pdf http6KKwww.nhpco.orgKiIaKpagesKinde .cfmOpageidSD<EL http6KKwww.swlda.orgK1ummit.htm http6KKwww.swlda.orgK1ummit.htm http6KKwww.who.intKcancerKpalliativeKdefinitionKenK http6KKwww.nhpco.orgKfilesKpublicKInsightsIssue<W<;;D1ocialWWorkerWppE5B.pdf http6KKwww.nhpco.orgKiIaKpagesKinde .cfmOpageidSD<EL http6KKwww.swlda.orgK1ummit.htm http6KKwww.swlda.orgK1ummit.htm http6KKwww.who.intKcancerKpalliativeKdefinitionKenK

1ocial workers respect and integrate knowledge about how individuals and families are influenced by their ethnicity, culture, values, religion5 and health5related beliefs, and economic situations. 1ocial workers should understand systems of oppression and how these systems affect client access to, and utili%ation of, palliative and end of life care. 'any cultures maintain their own values and traditions in the areas of palliative and end of life care. 7ulture influences individuals3 and families3 e perience as well as the e perience of the practitioner and institution. 1ocial workers should consider culture in practice settings involving palliative and end of life care. Each cultural group has its own views about palliative and end of life practices and these need to be understood as they affect individuals3 response to dying, death, illness, loss, and pain. 1ocial workers who understand how culture affects the illness and end of life e perience of an individual and family will be better able to individuali%e care and intervene in the psychosocial impact of illness, pain, dying, and death. -herefore, social workers should be familiar with the practices and beliefs of the cultural groups with whom they practice to deliver culturally sensitive services.