An example of a critical incident analysis about grief

Setting: Care Home, Dementia Unit

Account of the incident
I had met “Miss Adams” on a few occasions, and she always appeared bubbly in personality. However, I began to notice that she appeared to become more withdrawn and irritable. I spent some time speaking with her on a one-to-one basis and she explained to me that her nephew was ill and dying. Although she would mention him, it would only be briefly and then she appeared to want to change the subject.
Then I heard from another worker that her nephew had passed away, so I went to visit her more frequently. In the times directly after his death, I often found Miss Adams to be sleeping, and whenever we spoke she would tell me how tired she was. I noticed she had placed a wish on to the ‘wishing tree’ which read “[Miss Adams] wishes for quiet”. More recently, I have met her and she has appeared irritated at various individuals around her and she would also talk about things in the care home as if there was a conspiracy happening around her. One day, she asked me to go with her to the lounge where she told me about a woman staying at the care home who was 97-years old. She looked annoyed at this, and asked me what I thought about it. I said that I did not know the lady and therefore could not comment.
On a few of these occasions she would appear annoyed at me and ask where I had been and why I had not been to see her the day before. I would explain to her the days I worked at the care home, and always ensure to tell her when I would next be available to chat before parting.
My Initial Responses to the Incident
I instantly recognised her sleepiness would be linked to her recent bereavement, as when I have experienced anything similar I have become very tired. At first I was confused as to why she was talking about the other residents in a negative way, as this was not something which she had done prior to her nephew passing away. On reflection, I feel that this was a reaction to being surrounded by older people living, whilst she had had lost someone who was still young; which I feel she is finding difficult. Perhaps she is also feeling a sense of guilt that she herself has now outlived younger relatives.
Issues and Dilemmas Highlighted by this Incident
Moral judgments are based on human welfare (Banks, 1995); Miss Adams appears distressed therefore this approach would strive for Miss Adams to accept the death of her nephew and to find peace. Banks (1995) describes a feminist ethical perspective as an ‘ethic of care’ approach regards relationships as part of an individual’s identity. To lose a loved one, is to lose a part of yourself.
I also feel there is a responsibility to ensure the other residents do not become distressed because of Miss Adams’s feelings, and that she does not place blame or acts hurtfully towards other residents (Scottish Social Service Council (SSSC) Codes of Practice, Standard 4).
The SSSC codes of practice state that a social worker should be reliable and dependable (2.4). Miss Adams felt I had not been visiting her when I said I would, therefore she would not describe me as meeting this standard. I have tried to always end our conversations by explaining to her when I would next be available to meet her if she would like to talk. It takes time for people to move through the grieving process. Miss Adams will need time and space, and it is important that she feels safe and comforted during this.
My Learning
Rubin (1993) states that in order to survive individuals must regard themselves and the things they hold close as being important; this is the attachment bond between people. Parents nurture and teach their children therefore regarding this experience as valuable. This will strengthen the emotional involvement in the relationship.
Children are a link to the person’s past whilst they move forward into the future with the ability to rectify the mistakes made by the person in their past (Rubin, 1993). Miss Adams never married although she had a male friend whom she was very closed with. During one of our early conversations Miss Adams told me she regretted never marrying him, as he had asked many times, and also not having children of her own. She has photos in her room of her nieces and nephews who she is very close to. I believe that Miss Adams is not only grieving for her nephew who she was close to, but she is also grieving for her friend who passed away many years before and the decision she took not to marry and start a family of her own.
Kubler-Ross (1975) describes the five stages of grief; denial, anger, bargaining, depression and acceptance. I believe Miss Adams is at the anger stage, although at times I have spoken with her I have felt she was at the depression stage. The stages of grief are not linear so it may be that Miss Adams will continue to move between these stages for a while before she can reach the acceptance stage.
Outcomes
As there are so many experiences of loss in the care home, for example loss of independence or a loss of a close loved one, it would seem beneficial to have someone who is trained in bereavement counselling to be based at the care home. Someone who can spend time with residents in one-to-one and group sessions, talking about these experiences in a therapeutic environment.
I will continue to visit Miss Adams on a regular basis to ensure she has the experience to discuss her feelings if she so wished. I feel that, sometimes, having the opportunity to talk is as important as conversations themselves. I must also ensure that she feels there are also other people available for her to talk to and support her, as we are approaching the end of the placement and I would not want her to experience a further sense of loss when I leave the care home.
References
Banks, S. (1995) Ethics and Values in Social Work. Macmillian Press Ltd, London.
Kubler-Ross, E. (1975) On Death and Dying. Prentice Hall.
Rubin, S.S. (1993) ‘The Death of a Child is Forever: The Life Course Impact of Child Loss’ in Stroebe, M.S. Stroebe, W. and Hansson, R.O. (1993) (eds) Handbook of Bereavement. Cambridge University Press, New York.
Stroebe, M.S. Stroebe, W. and Hansson, R.O. (1993) (eds) Handbook of Bereavement. Cambride University Press, New York.

Used with permission of the author, Elena Martin.

Moira Dunworth,

Practice Teacher

July 2010

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Example of a critical incident analysisbyElena Martinis licensed under aCreative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.