University of São Paulo: Publication guides health professionals on adequate care in the grieving process

Just like a wound that heals, grief is a wound that causes suffering and proper care is fundamental to the healing process. Despite the condition installed by the loss, the attitude of health professionals before, during and after death can directly interfere with the coping with family and friends.

In order to guide professionals on the appropriate care for people in grief, researchers from the Study Group on Pediatric Palliativism (Gepap) at the Hospital das Clínicas da FMRP (HCFMRP) created the Guidance Booklet on Grief for Professionals in the Area of ​​Grief. Health .

The initiative was based on studies, discussions on the subject and listening to grieving mothers. “In the hospital environment, we often deal with this type of situation, so it is extremely important that there are guidelines based on evidence and suggestions from family members who have gone through this”, says Raissa Souza Aguiar, author of the booklet and resident physician of the Program of Pediatrics and Childcare at the Faculty of Medicine of Ribeirão Preto (FMRP) at USP.

Among the topics covered are the definition and attitudes of professionals when there is anticipatory grief, which is experienced by the patient or family members and can manifest itself after the communication of a diagnosis or after serious complications; parental grief, which is when parents lose their children; children’s mourning, which is characterized by the mourning of children and adolescents; fetal grief or gestational loss, which is death before birth; and mourning in the event of an unexpected death, which happens in cases of disasters or accidents.

The booklet was reviewed by physicians Leila Costa Volpon and Fabíola de Arruda Leite and psychologists Nichollas Martins Areco and Maria Laura de Paula Lopes Pereira Martins; illustration, by graphic designer Sofia Beatriz Dias de Oliveira; contribution by Isabela Soares Costa and Vanessa Alves da Costa Dessimoni; and excerpts from interviews from the research project Caring for Bereaved Parents – Looking beyond the child’s death.

grieving process
Grief can be classified by stages, but it is important to understand that the process is not always linear and that there is no set deadline for it to happen. In addition, the bereaved person may have emotional, cognitive, behavioral and physiological manifestations.

“The process of mourning is a work of adjustment to the loss, which implies suffering, as well as the ability to find some hope, comfort and life alternatives”, explains Raissa.

Here are the steps, according to the booklet:

Accept the reality of the loss, overcoming the initial tendency to deny it;
Recognize and deal with the pain of loss;
Make adjustments at different levels, both external and internal;
Emotionally reframing the one who is no longer present;
Emotionally integrate the loss.
Difference between normal and complicated grief
The booklet also dedicates an exclusive chapter to differentiating between grief considered normal and complicated grief. “Complicated grief occurs when the affective connection with the deceased remains intense, compromising the processing of the grief experienced and the acceptance of it. In these cases, the bereaved may present reactions of denial, ambivalence, distortion and permanence in the memories of the past, reflecting on personal imbalance and illness”, comments Raissa.

Among the risk factors for complicated grief are inherent conditions, such as anxiety disorder and a history of multiple traumas; conditions related to the type of loss, such as in cases of violence or homicide; and low social support, cognitive difficulties during the process and individual aspects of the circumstance of death.

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