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Death. Many people cringe at the word, but one fact I have learned is that if you live, you will die. Death is a very discerning event that affects the life of a dying individual and the lives of their family. Once an individual has died, or even when they are approaching death, those close to them experience grief, which is transferred into a process. The grieving process is a long process and does not end when funeral services are complete. It may take an entire lifetime for a person to go through the grieving process. Sometimes, individuals do not know exactly how they will be affected by the death of a loved one, therefore the extent of their grieving process is unknown (Bolden, 2007). To address grief, we will explore a model of grief, apply this model to working with families in a hospice environment, identify components of the model that will be difficult to apply to social work and identify strategies of self-care for a social worker.
One model of the grieving process is the Kübler-Ross model of grief (Bolden, 2007). In this model, Elisabeth Kübler-Ross identifies five stages of grief regarding death: denial, anger, bargaining, depression and acceptance (Bolden). In the first stage, denial, an individual does not want to accept the fact of death. According to Zastrow and Kirst-Ashman (2013), denial is functional, because it helps to make the loss less difficult. In the second stage, the anger is usually directed at the individual's spiritual superior or God (Zastrow and Kirst-Ashman). A common question that is usually asked in this stage is, "Why me? This isn't fair!" (Zastrow and Kirst-Ashman p. 663) In the third stage, bargaining occurs, whereas individuals attempt to make a deal with their God in an attempt to regain someone who has died (Zastrow and Kirst-Ashman). In the fourth stage, depression, the individual who has experienced a death begins to feel sad (Zastrow and Kirst-Ashman). This is a stage whereas they sort of accept the death
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occurred and are experiencing sad feelings as a result of it. In the final stage of Kübler-Ross' model of grief, acceptance is experienced (Zastrow and Kirst-Ashman). In this stage, an individual fully accepts the death of a loved one.
As a social worker, Kübler-Ross' model of grief can be applied to families in a hospice environment. The goal of hospice care is to provide the most comfortable living environment for an individual who is near death (Zastrow and Kirst-Ashman, 2013). Hospice provides services for families; such has education courses and completing paperwork (Zastrow and Kirst-Ashman). Imagine the grief an individual encounters knowing their loved one is near death. The decision to accept hospice services is a difficult one. To apply the Kübler-Ross model to families in a hospice environment, a social worker should let them grieve at their own pace. A social worker should have a full understanding of the model of grief and have the ability to recognize when members of the family are experiencing these stages. A social worker must also understand that an individual may not experience these stages in this order (HDSA, 2014). Knowing this, as well will assure a social worker can provide the most effective services to individuals. Grief counseling and therapy are good resources for individuals experiencing the grief process.
One component of Kübler-Ross' model of grief that will be difficult to apply to social work practice is the anger phase. During this stage, individuals are angry and sometimes target their anger at God. This challenge is anticipated because personally it is difficult for me to feel as though an individual is upset with me. As social workers, we have to distinguish when a person is angry at us or they are experiencing this stage of grief. In my practice this may be difficult to differentiate, but with practice this should become easier.
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Another stage of the Kübler-Ross model of grief that will be difficult is the bargaining stage. When an individual attempts to bargain with God, it will be difficult to provide coping methods to help them understand the bargaining is ineffective. For example, therapy and counseling can help individuals in the depression stage, but there are few methods to help an individual in the bargaining phase.
In previous work, I addressed methods to deal with the effects of social workers dealing with death repeatedly. In a study conducted by Chow (2013), it indicated three domains which provide psychological support for social workers: environmental alteration, physical exercise and time management and personal aspects. A study conducted by Sheir and Graham (2011), suggests mindfulness improves quality of life. These two studies are similar in that if one is familiar with the domains of Chow's study; they are also mindful and self-aware, thus improving their well-being.
A strategy to use in self-care as a social worker dealing with grief is to maintain a balance with work and personal life (Sheir and Graham, 2011). A social worker should not become so encompassed in their work, that they do not give attention to their personal life. For example, on my job as a social services case manager, we are now required to work a minimum of eight hours of overtime. In order to balance my work and personal life, I made the decision to complete my eight hours during weekdays, giving me the ability to give attention to my family on the weekends. This balance is especially important for individuals working with grieving families. This can be a difficult field to work in, as many times families may be unhappy most of the time, making it a gloomy environment to work in. A social worker must have a comfortable environment in which they are capable of ensuring a positive well being.
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Social workers practice in a variety of environments and a hospice environment is one that social workers can have a tremendous impact. Helping individuals cope with grief means having an understanding of the process of grief. Again, the stages of Kübler-Ross' model of grief don't always occur in a particular order, nor does an individual always experience every stage (HDSA, 2014). As a social worker, the goal for the individual should be working towards the stage of acceptance.