The most recent focus of our reading covered the subjects of dying, death, and grief. In conjunction with my recent volunteer training at Hospice and the reading for this week, the focus of this blog will be the areas of grief and mourning. As the authors, Wedding and Stuber state, grief and mourning are natural emotional healing mechanisms (p. 85) that promote a return to normal living after a person experiences the loss of a loved one.
This section was of particular interest because I have just completed 11-1/2 hours of Hospice training for helping terminally ill patients and their families deal with the process of grief and mourning. Last night there were five volunteers who have each worked for Hospice for 20-35 years. Hoppice offers bereavement counseling to the care givers and families of their patients.Their accounts and memories of the patients that have touched them and who in turn they were blessed to have known, was moving beyond explanation with words. In line with our text the processes they described were the initial or acute grief and intense emotional distress, followed by the three stages of mourning that take place after the acute grief. The three stages of mourning as described by John Bowlby are: protest, despair and finally detachment.
The initial phase of protest is a normal, expected, and spontaneous reaction of disbelief. The second phase of despair is the realization that their loved one is indeed gone, which may lead to floating anxiety and depression. It is believed that this step is necessary for the stage that will lead to resolution of their loss. The final stage of mourning is a time when the mourner reorients his/her focus from the lost loved one to other people and activities until they reach a point of acceptance of the loss and resume normal function. Bowlby summarizes that the process usually takes from three to 12 months. As the experienced volunteers pointed out last night, this varies from person to person taking into account different situations. An example mentioned was one patient who lost her husband and son within a few hours of one another. When the families are able to witness and accept death as a normal part of life and the patient is treated with dignity and respect during their transition from life to death, the progression of grief and mourning can be very healthy, so much so that many have described it as a time of intense spirituality and closness with the patient and with God.
Friday, January 30, 2009
Sunday, January 25, 2009
Middle years are not marked by illness
In a study done by Verbrugge (1986), the symptoms requiring rest, work absences, self-medication, M.D. office visits, or hospitalization were not higher when compared to the same variables in younger people. This finding is contrary to what many would expect (Wedding & Stuber, p. 54).
It is common for many people who are are approaching middle age or who are in the midst of these years to experience worry and concern due to the physical changes and possibility of physical decline they witness in themselves. The realization of eminent mortality faces this age group. As a provider it is necessary to understand and sympathize with patients who may be overly concerned or preoccupied with the changes in their appearance, bodily functions, and sensations. These concerns are normal and valid; a supportive and sympathetic provider can make a tremendous contribution to the progress their middle aged patients might make when they begin lifestyle modification programs to improve their newly diagnosed health problems.
Chronic illness often presents during this cycle of life, yet if it is managed successfully the middle aged person will better cope, tolerate, and accept the illness and undertake the adaptations necessary to maintain their self-image and satisfaction with life. This period is also a time of evaluation of personal worth, values, and new goals (career, relationships, and lifestyle change). The above mentioned study found that 78% of middle -aged women and 79% of middle-aged men noted their overall health as good or excellent.
It is common for many people who are are approaching middle age or who are in the midst of these years to experience worry and concern due to the physical changes and possibility of physical decline they witness in themselves. The realization of eminent mortality faces this age group. As a provider it is necessary to understand and sympathize with patients who may be overly concerned or preoccupied with the changes in their appearance, bodily functions, and sensations. These concerns are normal and valid; a supportive and sympathetic provider can make a tremendous contribution to the progress their middle aged patients might make when they begin lifestyle modification programs to improve their newly diagnosed health problems.
Chronic illness often presents during this cycle of life, yet if it is managed successfully the middle aged person will better cope, tolerate, and accept the illness and undertake the adaptations necessary to maintain their self-image and satisfaction with life. This period is also a time of evaluation of personal worth, values, and new goals (career, relationships, and lifestyle change). The above mentioned study found that 78% of middle -aged women and 79% of middle-aged men noted their overall health as good or excellent.
Saturday, January 24, 2009
Semi-empty nest syndrome
Our text (Wedding & Stuber, p. 40), defines "empty nest syndrome" as a personal crisis marked by depression and loss of identity, and further suggests that this phenomena affects some women more than it does men. This time of change that occurs within the family dynamics is usually resultant of the transition of children physically moving out of the home. Though this is by some parents, is a perceived time of welcomed relief, it can be a time of awareness of one's own inevitable change in lifestyle.
All situations are unique and it is without doubt that parents experience a variety of emotions, realizations, and periods or readjustment. Such is the case within our home. Depression and loss of identity aren't factors in my personal situation; however I absolutely and without question have been in the process of adjusting to the changes as a result of my eldest moving into a house with her roommate while she is in college. In my situation there is no other adult within our home, to communicate these transitions with. So many years were joyfully spent within the role as "housewife". Never was there a stagnant (or dull) moment. I have full recognition of this process and the thoughts that accompany the transition are understood, yet some of you may perceive this as melancholy; it is more the sorting through of what must be done from here --forward (introspection), and the conscious energy it takes in order to place more focus on the future of self, rather than my girls (one of which is still at home-thus the reason for my title: semi-empty next syndrome). The normal excitement that couples anticipate once they are on their own again doesn't exist. For me, it is the hope and promise of what is unknown that can be a bit frightening at times and at others, thrilling.
It was very important to me to be provide security, basic needs, and availability to the girls; not just because I was a parent and it was natural, but because they had to endure divorce, and I was especially sensitive of their needs and emotions. As my eldest grew into early adulthood and my younger daughter is rapidly approaching the same, the transition was/is gradual, as they had to be very independent when I returned to college. The text narrows this section (understandably) and suggests a very limited perspective, probably because there is only so much information they can put into 350 pages. If I were to chart the progress of the transition process, with I as a separate category (divorced empty nest syndrome), it would constitute a chapter or three....better stop here.
All situations are unique and it is without doubt that parents experience a variety of emotions, realizations, and periods or readjustment. Such is the case within our home. Depression and loss of identity aren't factors in my personal situation; however I absolutely and without question have been in the process of adjusting to the changes as a result of my eldest moving into a house with her roommate while she is in college. In my situation there is no other adult within our home, to communicate these transitions with. So many years were joyfully spent within the role as "housewife". Never was there a stagnant (or dull) moment. I have full recognition of this process and the thoughts that accompany the transition are understood, yet some of you may perceive this as melancholy; it is more the sorting through of what must be done from here --forward (introspection), and the conscious energy it takes in order to place more focus on the future of self, rather than my girls (one of which is still at home-thus the reason for my title: semi-empty next syndrome). The normal excitement that couples anticipate once they are on their own again doesn't exist. For me, it is the hope and promise of what is unknown that can be a bit frightening at times and at others, thrilling.
It was very important to me to be provide security, basic needs, and availability to the girls; not just because I was a parent and it was natural, but because they had to endure divorce, and I was especially sensitive of their needs and emotions. As my eldest grew into early adulthood and my younger daughter is rapidly approaching the same, the transition was/is gradual, as they had to be very independent when I returned to college. The text narrows this section (understandably) and suggests a very limited perspective, probably because there is only so much information they can put into 350 pages. If I were to chart the progress of the transition process, with I as a separate category (divorced empty nest syndrome), it would constitute a chapter or three....better stop here.
Friday, January 23, 2009
Challenges that face single women
According to Blumstein and Schwartz (1983), a displaced homemaker is one who is suddenly made vulnerable by divorce or widowhood and found herself unprepared to provide for her income. In addition, some women postpone marriage to complete their education and focus on their careers, and when they approach their 30's experience the "ticking of the biological clock", and find that there are few single men available to become possible marriage partner (Wedding & Stuber, p.52).
Interestingly, both of these scenarios are all to familiar. Not only have several friends fit into both of these categories, yet I too would qualify. Though I was married, it wasn't until age 29 that I gave birth to my first child. This was not out of the norm, as many of my colleagues choose the same path. One person in particular comes to mind as I recall our conversations of her frustration because most of the men her age were married.
After working for many years in my given profession, my spouse and I agreed that it would be in the best interests of the family that I give up my position and career advancement opportunities so that he could take a ex-patriot offer from his employer. Our family (two children 8 and 11 at the time), moved overseas, and subsequently made several moves all for the purpose of his career advancement. Due to my strong beliefs and faith in our marriage this was an easy choice. After 12 years together and divorce lurking around the corner (never imagined possible), the displaced homemaker title befell me, as it had been several years since I worked outside the home (with the exception of volunteering and a few business ventures). Upon my return to the workforce, it was evident that with childcare costs, low salary, no retirement, and no parents (both deceased at that time) or siblings nearby to help with the children, it was without question that it was a necessity to further my education and focus on my career. That was in 2003....and today I am still on the path of the goal that was set then. Age and lack of available time contribute to the sense of discouragement I experience about dating and the possibility of marriage in my future. Though this is something I would like, the statistics alone are less than encouraging. Perhaps the right person, the right age :), at the right time....God only knows.
Interestingly, both of these scenarios are all to familiar. Not only have several friends fit into both of these categories, yet I too would qualify. Though I was married, it wasn't until age 29 that I gave birth to my first child. This was not out of the norm, as many of my colleagues choose the same path. One person in particular comes to mind as I recall our conversations of her frustration because most of the men her age were married.
After working for many years in my given profession, my spouse and I agreed that it would be in the best interests of the family that I give up my position and career advancement opportunities so that he could take a ex-patriot offer from his employer. Our family (two children 8 and 11 at the time), moved overseas, and subsequently made several moves all for the purpose of his career advancement. Due to my strong beliefs and faith in our marriage this was an easy choice. After 12 years together and divorce lurking around the corner (never imagined possible), the displaced homemaker title befell me, as it had been several years since I worked outside the home (with the exception of volunteering and a few business ventures). Upon my return to the workforce, it was evident that with childcare costs, low salary, no retirement, and no parents (both deceased at that time) or siblings nearby to help with the children, it was without question that it was a necessity to further my education and focus on my career. That was in 2003....and today I am still on the path of the goal that was set then. Age and lack of available time contribute to the sense of discouragement I experience about dating and the possibility of marriage in my future. Though this is something I would like, the statistics alone are less than encouraging. Perhaps the right person, the right age :), at the right time....God only knows.
Saturday, January 17, 2009
Changes in Family and Community over the Past Fifty Years
During the past 50 years the dynamics of the family unit have changed considerably (Wedding & Stuber, p. 21). First, the average family size has decreased, with just over two children being the median norm. Secondly, due to divorce and less young people partaking in marriage, the two-parent family is no longer prominent. Lastly, many extended families are displaced because one or more family members' jobs require them to move to other cities, states, or countries.
Both sets of my grandparents moved to the United States with their parents as young children, making me a second generation American. They grew up in areas of the city where most all of the immigrants from European countries lived and had businesses. The social network was vast and everyone seemed to know one another and share in community activities and celebrations as a unit. Weddings were considered a significant event and it wasn't unusual to attend a wedding with a completely filled church and 300 to 500 people in attendance at the reception. The receptions consisted of full course meals, live music, and dancing; a joyous time of celebration with friends and relatives that generally went on until late into the evening and early morning hours.
The impact of these social networks was significant in my life and I must say that I really miss that sense of community. The number of aunts, uncles, and cousins alone would constitute filling an entire church. On the maternal side; my mother was one of five siblings. On the paternal side; my father was one of nine children. I myself, was born into a family of five children. All of my aunts and uncles had large families, so you can imagine the shear numbers of cousins and second cousins. Into my adulthood, with the advances in technology and an the expanding job market many of the younger people were moving away from their extended families and their birthplaces. Such was the case with me. Within my lifetime I have not only witnessed, yet have experienced many changes within the nuclear and extended family, neighborhood, and workplace.
Both sets of my grandparents moved to the United States with their parents as young children, making me a second generation American. They grew up in areas of the city where most all of the immigrants from European countries lived and had businesses. The social network was vast and everyone seemed to know one another and share in community activities and celebrations as a unit. Weddings were considered a significant event and it wasn't unusual to attend a wedding with a completely filled church and 300 to 500 people in attendance at the reception. The receptions consisted of full course meals, live music, and dancing; a joyous time of celebration with friends and relatives that generally went on until late into the evening and early morning hours.
The impact of these social networks was significant in my life and I must say that I really miss that sense of community. The number of aunts, uncles, and cousins alone would constitute filling an entire church. On the maternal side; my mother was one of five siblings. On the paternal side; my father was one of nine children. I myself, was born into a family of five children. All of my aunts and uncles had large families, so you can imagine the shear numbers of cousins and second cousins. Into my adulthood, with the advances in technology and an the expanding job market many of the younger people were moving away from their extended families and their birthplaces. Such was the case with me. Within my lifetime I have not only witnessed, yet have experienced many changes within the nuclear and extended family, neighborhood, and workplace.
Friday, January 16, 2009
Geriatricians, the patient, and the social network
Physicians are advised to not treat patients in isolation from their families and community. A wise doctor knows when and how to work with the beliefs and social support to provide the best medical care possible. Geriatricians and pediatricians alike, are careful to assess the support network of their patients as part of the activities of daily living (Wedding & Stuber, p.28). Often an older person's or adolescent's- parents , spouse, adult children, siblings, or even neighbors, and grandchildren might be helpful in providing pertinent information. Yet, the provider must be extremely discerning when making this decision, for on occasion it has turned out that the alternative source was out of touch, uninvolved or misinformed regarding the patients life, medications, and activities. The person who appears to be an alternative source of information my have only seen the person twice in three years or less than a decade, and live across the country. Ultimately it is the patients choice who they would like to have share information that the physician relays. If the patient is cognisant, an authorization to share medical information, then a power of attorney must be part of the patient chart.
Especially with older people a physician can talk with the social network member(s) and determine the best people to be with the patient and help them stay organized, to keep track of their questions, as well as to follow instructions for treatment. This method has been found to reduce the possibility that the patient will sabotage the treatment plan through disagreeing with the recommendations.
Some young people are more open when they do not have to ask specific questions when a parent is in the exam room. It is a good practice to have the parent leave the room briefly, to allow the adolescent to discuss private issues free of stress or embarrassment. This is a subject of contention among some parents, especially if the patient is 16, and in some states it is legal to receive medical treatment without a parents input, yet the child may be too inexperienced, emotionally distraught, or simply chronologically immature.
Some families may prefer that all medical information be conveyed to one specific person other than themselves. The seemingly organized patient may wish to have another person present to keep track of their own question, as well as the doctor's answers and instructions. A support person can help remember what was said and to further encourage compliance.
This all sounds so simple and straightforward,yet when it comes to siblings making decisions during periods that their parents are not capable, it can be a tine of much confusion, disorganization, and mistakes may inadvertently be made. My friend works as the director of residential living at a long term care facility and has told me about several of the "unusual circumstance" situations she has had to deal with from time to time. Many of which could have been prevented. She among anyone I know , could certainly give feedback about this sensitive issue.
Especially with older people a physician can talk with the social network member(s) and determine the best people to be with the patient and help them stay organized, to keep track of their questions, as well as to follow instructions for treatment. This method has been found to reduce the possibility that the patient will sabotage the treatment plan through disagreeing with the recommendations.
Some young people are more open when they do not have to ask specific questions when a parent is in the exam room. It is a good practice to have the parent leave the room briefly, to allow the adolescent to discuss private issues free of stress or embarrassment. This is a subject of contention among some parents, especially if the patient is 16, and in some states it is legal to receive medical treatment without a parents input, yet the child may be too inexperienced, emotionally distraught, or simply chronologically immature.
Some families may prefer that all medical information be conveyed to one specific person other than themselves. The seemingly organized patient may wish to have another person present to keep track of their own question, as well as the doctor's answers and instructions. A support person can help remember what was said and to further encourage compliance.
This all sounds so simple and straightforward,yet when it comes to siblings making decisions during periods that their parents are not capable, it can be a tine of much confusion, disorganization, and mistakes may inadvertently be made. My friend works as the director of residential living at a long term care facility and has told me about several of the "unusual circumstance" situations she has had to deal with from time to time. Many of which could have been prevented. She among anyone I know , could certainly give feedback about this sensitive issue.
Thursday, January 15, 2009
Social Support and Wellness
Studies have found that people who have extended and available social support networks, consisting of friends and/or family members, are less anxious, and less likely to become depressed or develop posttraumatic stress disorder (Wedding & Stuber, p.25). People who have chronic or acute illnesses were found to have better emotional well-being when they had a supportive social network. The key word here: supportive. In contrast to support and wellness, individuals whose family members or friends were highly critical experienced more relapses and required more medication (Wedding, p. 25). One of my very dear friends (won't mention your name), has had fibromyalgia (FMS) for many years. Currently her family is experiencing a tremendous amount of turmoil for reasons beyond her control and her life is changing very rapidly as a result.
Sunday past, she and I made time to get together despite both of our busy schedules. We visited with my daughters; who she hadn't seen since they were in middle school, then went out for a meal so that we could spend some time in conversation. During the evening we shared stories of a few humorous recent experiences, talked about old times, as well as exchanged with one another about her current situation. When I was doing the reading about social networks, thoughts or her came to mind. Though I could never know exactly how difficult it must be to live with fibromyalgia, I sympathize and want her to know that I'm here for her whenever she needs to talk or spend time with someone who will support her. Someone who has been through what she is going through in her personal life and understands.
When I thought about writing this blog I wanted to be sure to encourage her with the information about positive support and wellness. Additionally, I couldn't blog about supportive social networks without mentioning another dear friend (you know who you are). We've known each other over 20 years and have been supportive of one another through numerous parallel hurdles. A formal study this is not, yet through personal experience I can confirm the validity of the direct relationship between wellness in general and "supportive" social networks. Thank you both for the privilege of your friendship.
Sunday past, she and I made time to get together despite both of our busy schedules. We visited with my daughters; who she hadn't seen since they were in middle school, then went out for a meal so that we could spend some time in conversation. During the evening we shared stories of a few humorous recent experiences, talked about old times, as well as exchanged with one another about her current situation. When I was doing the reading about social networks, thoughts or her came to mind. Though I could never know exactly how difficult it must be to live with fibromyalgia, I sympathize and want her to know that I'm here for her whenever she needs to talk or spend time with someone who will support her. Someone who has been through what she is going through in her personal life and understands.
When I thought about writing this blog I wanted to be sure to encourage her with the information about positive support and wellness. Additionally, I couldn't blog about supportive social networks without mentioning another dear friend (you know who you are). We've known each other over 20 years and have been supportive of one another through numerous parallel hurdles. A formal study this is not, yet through personal experience I can confirm the validity of the direct relationship between wellness in general and "supportive" social networks. Thank you both for the privilege of your friendship.
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