Background

Coping with death and dying is often challenging.  Although death has been noted to be the one great certainty of life, the dying process is replete with uncertainty, and this dichotomy can be stressful – for the individual facing death, their family members, and those who care for them.  As a topic which most people do not discuss frequently, the impending death of someone with whom we have a connection both forces us to examine our own views about death and dying and to navigate the discordance that may exist between our views and those of others. Doing this in our role as healthcare providers requires thoughtfulness, self-awareness,  and skill in order to ensure that our patients’ needs, and those of their families remain our focus during these times.

It its important that we recognize that although military healthcare providers encounter death and dying more frequently than most, the impact of these experiences on our lives is no less profound.  Indeed, these experiences, and our reactions to them, have significant implications for how we treat our patients.

At its core, the experience of Death and Dying, for those who remain alive, includes a sense of loss. How we cope with the dying process, the death of others, and our sense of loss has significant implications for our care of patients and their families.

Objectives:

1. Identify your initial reaction to death. Recognize differences depending on the age of a patient, whether it is anticipated or unexpected, the location where a patient dies (Home vs. hospital, stateside vs. deployed)
2. Explore the source(s) of those reactions, including:
3. Analyze how their reactions to death and dying may influence, both positively and negatively their care of a patient and their family prior to their death (when death is anticipated) and after their death
4. Develop a plan (not a goal) to mitigate the negative and enhance the positive implications identified.

Assignment
Prior to the session,  review 1-2 of the provided videos/articles, reflect on your conception of death and your past experiences with loss – including those involving the death of friends and family as well as patients, if you have had such experiences. Reflect on your perspective on death of people at various ages, including children; concerns about your own competence when caring for a patient who dies; thoughts about your own mortality and fears about death; and your views on end of life care.

Identify your thoughts and reactions, and come prepared to discuss:

• your perceptions of how loss in general and death in particular were/are viewed in your family of origin, faith group, community, and among your peers (both growing up and now)
• your experiences to date with loss in general and death in particular
• your perceptions of how loss and death are viewed in the military and medical communities
  • one’s experiences with death and dying growing up
  • one’s views on advance directives and end of life care (to include Hospice)
  • one’s religious views
  • advance directives, etc.

Implications: Keeping in mind what your reactions and the sources of those reactions reveal about your perspective on loss and the death of your patient, analyze both the positive and negative implications of this perspective for how you might care for patients in the future.

Plan: Develop a realistic and specific plan (NOT A GOAL) to mitigate the negative and enhance the positive implications described in your Implications section.