The Clinical Guide to Supportive and Palliative Care for HIV/AIDS

A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 16: Grief and Bereavement• What do you need to leave behind?• What do you need to add?In summary, 26 interventions picas suggested to help people coping with AIDS-related death include:• Reaching out to the bereaved• Giving the bereaved permission to grieve in ways that work for them• Normalizing responses to grief• Educating about the grief process and what to expect, especially during thefirst year• Encouraging good self-care• Referring for appropriate medical evaluation• Encouraging use of creative techniques such as keeping a journal, art and music• Encouraging use of ritual• Exploring spiritual responses, especially the search for meaning• Strengthening and encouraging use of a support system• Affirming efforts to re-engage in life• Helping the bereaved recognize opportunities for personal growth andtransformationIn reaching out to the bereaved, the palliative care team may experience their own issues ofgrief and loss. This is a normal response; the important thing is to confront these issues separatelyso that one can be fully present to the bereaved in their time of need. It may be appropriate tocry with, or in front of, the bereaved as long as they do not have to comfort members of thepalliative care team. Health care professionals have a responsibility to process their own griefwork in order to be present to others who are grieving. Good self-care and identification ofhealthy, appropriate coping mechanisms are essential. (See Chapter 20: Care for the Caregiver.)It is also important for the palliative care team to maintain a therapeutic perspective in reachingout to the bereaved. Remember:• No one can take away the pain of grief.• Don’t let a sense of helplessness prevent outreach to the bereaved.• Recognize the value of “being present” to the bereaved.• Develop empathetic listening skills. 2In dealing with AIDS-related deaths, there are further challenges for the palliative care team.Mallinson notes that in addition to addressing grief issues, health care professionals must alsoaddress the concurrent stressors: substance abuse, mental health issues, and the effects ofhomophobia, racism, and stigmatization, and advocate for accessible services and communityresources. 1XVICONCLUSION■ Palliative care is a holistic approach to medicine that does not end with the death of a patient.Caring for the bereaved is a responsibility and a privilege. In AIDS-related deaths, thebereaved face significant issues that can complicate their grief process. Interventions thatincorporate a holistic approach to grief and loss can facilitate the bereavement process, possiblyimproving the bereaved person’s ability to function, reducing some of the pain experienced,and providing an opportunity for transformation. 1U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau 345