Reflective Practice 401 – Session 2.4:
Loss

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.  It is also important to recognize that among learners in this curriculum, there is a wide range of experience with death and dying.  In past years, some students struggled to identify their personal context as it relates to Death and Dying, noting that they had no personal experience with the death and/or dying of someone with whom they had a relationship. For those of you who fall into this category, I think you will find, as have students in the past, that thinking about your perceptions of the way your family of origin and the community/ies of which you have been a member (geographical, religious, organizational, or otherwise) dealt with death and dying, including avoiding its discussion, will help you to quite readily identify the sources of your reactions to Death and Dying.

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.  With this in mind, I welcome you to join us in our exploration of this important topic.

Assignment

Preparation for the small group
Please take some time and watch, read and listen to the included resources exploring death and dying.

Reflective Essay (R.S.I.P. format)
Reaction: Identify your thoughts and reactions, including each of the following:

1. Your thoughts and feelings about being responsible for the care of someone whose decision to pursue or decline life-prolonging treatment differs from what you feel is best
2. Your reactions to when the death is that of a yet to be born child or includes termination of a pregnancy, paying special attention to your own beliefs.

Sources/Your Story: Explore the sources of these thoughts, feelings, and reactions. Your sources will likely include one or more of the following:

• 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 perceptions of how loss and death are addressed by your faith group
• 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.

 Objectives

By the end of the RP101 session on Loss, through written and verbal expression, students will demonstrate the ability to:

1. Identify their conception of death, their “gut reaction” to the thought of their patient’s death, and their concerns about their patient’s death to include:
   1. The personal loss entailed in the death
   2. The sense of betrayal of a personal trust
   3. Thoughts about their own mortality
   4. Their faith and spiritual beliefs
   5. Concerns about their own competence
   6. Concerns about how they might appear to their patients’ family, colleagues, others with whom they work, family and friends, and perhaps most importantly, themselves.
2. Explore the source(s) of those reactions, including:
   1. Their experiences with death at different points in your life
   2. How they perceive death to be viewed by:
      1. the family/community in which they were raised
      2. their current family/community
      3. the medical community
      4. the military community
      5. Their thoughts and feelings about death depending on:
      6. the age of a patient
      7. whether it is anticipated or unexpected
      8. the location where a patient dies (Home vs. hospital, stateside vs. deployed)
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