3. Болевые синдромы в онкологии. Паллиативная помощь. Concept of Loss/Death as Loss/Theoretical Frameworks/A Professional Response/The Impact of Working in Palliative Care/Staff Support

MAUREEN A. GILL BA (Oxford) Dip.in Palliative Care (Oxford) RGN.ONC.NDN.
International Nurse Consultant(Palliative Care)


This presentation will define loss and it's associated categories from a research-based approach. Formulated through best U.K. practice, the themes have subsequently been adapted by the author for both formal and field presentation within an international context for her work in differing cultures. Examples of the diversity of these presentations includes delivering the topic to health care professionals in Norway, Mauritius, Malaysia and Romania as well as in various parts of the Kuzbass region of Siberia where evaluation has shown how staff have been able to adapt frameworks for use within economic, political and ethnic variants.

The paper will examine several bereavement and grief frameworks by world -renowned figures such as Worden, Parkes, Tatlebaum and Kubler-Ross.

The author proposes to then examine the hypothesis of William Worden as a suitable framework for international acceptance.

The author will discuss the importance of bereavement support within a multidisciplinary approach and offer strategies for professional and personal survival using the work of Holmes & Rahe and Harper to support the concepts.

The Concept of Hospice Care

Here the author will demonstrate why bereavement support is an integral part of the speciality using the Palliative care frameworks of Twycross and Naysmith & O'Neill.

Loss, Grief and Bereavement

The presentation will approach the headings from a multi-factorial and multi-cultural arena as in the work of Averill, Parkes & Marcus and Neuberger.

Developmental and traumatic losses will be clarified as described by Machin.

Theoretical Frameworks

The models of grieving both diagrammatical (Engal, Wilson, Stroebe & Shut) and tabloid (Parkes, Bowlby, Kubler Ross and Worden) will be examined.

Worden's model will be detailed for discussion as a suitable uncomplicated framework for easily adapted for international use.

Based on the four tasks of mourning it describes categories as-

Accepting the Reality of the Loss
Working through the Pain of the Loss
Adjusting to Life without the Deceased
Emotionally relocating the Deceased and Moving on with Life

The author(Gill)will use a piece of her own research to demonstrate a possible analogy between the feelings experienced in bereavement as documented in a well used framework (Tatlebaum) and those of a novelist writing of a personal experience of death in the family (Leach)

A Professional Response to the Bereaved

In this section of the paper the author will use the Holmes and Rahe Scale to clarify the causes of major stress in our lives and the measurement tool to assess risk. This effective tool is not only useful for measuring the impact of the losses suffered by the bereaved but a guideline for staff in establishing their individual vulnerability working in Palliative Care.

Enhanced communication skills will be a proposed method of dealing with the stress in Palliative Care and the work of Egan, Heron and Buckman used to demonstrate useful ways to help the professional in this difficult area.

The Impact of Working in Palliative Care.

The impact of dealing with loss on a daily basis can have many ramifications for the team of professionals involved.

Personal survival is a joint responsibility between the individual and management. (Managing Cancer Care Guidelines) A multidisciplinary approach is essential according to Twycross and this in itself calls for great changes in ways of working in health care in other countries as related by Gill. Managing change and the associated feelings can run parallel to those experienced in bereavement e.g. denial, anger, bargaining and acceptance as proposed by Harper. These feelings are just as normal in adjustment to working in Palliative care as they are to those managing change. So staff moving into the speciality are vulnerable on both counts and subsequently investment should be made in their mental health as will be described using the work of Penson and Gill.

Some methods for consideration are-
Regular Inter- disciplinary Team Meetings
Clinical Supervision
Access to Regular, Up to date Information on the Speciality
Time for Recreation i.e. Hobbies/Spiritual Refreshment


Supporting families who have been bereaved can be a very rewarding if somewhat challenging part of Palliative Care. Effective communication skills are the key to effective care and support.

While such work can be uplifting it carries with it the possible stress of dealing with death and dying in professional practice. The effect of this trauma on the individual must be considered to enable the staff concerned to learn coping strategies and be able to offer consistent professional support in this area of Palliative Care.

Межрегиональная сибирская научно-практическая конференция "Боль и паллиативная помощь"