Outcomes for study

​1. Mentions an estranged relationship

​2. Talks openly about "what happened"
3. Shows feeling

​4. Agrees to receive contact 

5. Agrees to initiate contact

6. Acknowledges having "done enough" to reconcile

Outcomes worth studying

  1.  Visible emotional expression
  2. Quiet reminiscing
  3. Religious practice or ritual
  4. Communal support observed
  5. Love expression
  6. Efforts at reconciliation
  7. ​Realistic thinking/planning

Outcomes Worth studying

  1. Mentions a previous loss
  2. Expresses Emotion
  3. Receives Validation
  4. Shares Reminiscences
  5. Cries while sharing
  6. Considers referral
  7. Expresses gratefulness or increased hope
Outcomes: Openly discusses an “end of life” issue such as:⦁   
1. Afterlife⦁  
2. Relationship with the Divine,        
3. Pain control⦁  
4. Reconciliation with someone
5. Life review,⦁  
6. Forgiveness of sins/regrets          
​7. Religious membership/practice⦁    8. Concern for survivors⦁    
9. Bereavement of other deceased⦁   10. Organ donation⦁  
​11. Burial arrangements

Outcomes to hope for:

  1. - Mentions need to adjust
  2. - Shows feelings about the situation
  3. - Can discuss some implications of the change
  4. -Considers options for adjustment
  5. - Appears to be a bit more hopeful 

11 - Estrangement -Illness or injury often brings back to consideration open personal conflicts that have distanced and even estranged people from one another. This need occurs when patients and family members seek to re-unite with specific people who have either felt or caused major personal hurts in the past. A spiritual clinician can serve as a transitional facilitator of reconnection, and when possible, healing of previously strained or estranged relationships.

Axis Two: 5 Major Loss Needs

9 - Dying - Our human need to accomplish final goodbyes and "last things" in preparation for our own death, can be appreciably met by at least one savvy helper who has learned to  a) artfully initiate conversations in which that process can begin, b) listen carefully and personally 3) patiently bring wisdom and perspective to conversations about dying and the person's life. Such people now populate the modern fields of hospice and palliative care. Often patients are not capable of any of this near the end of their lives. Better to address these issues earlier.

10 - Loss Adjustment -Needing to adjust to irreversible negative changes in appearance or function, e.g., from accidents, strokes or attacks. Interpersonal care of this need, individually or in groups, helps a person to begin developing a new and necessary style of living. Care begins with empathic connection, both verbal or non-verbal, as soon after the loss as possible. It then proceeds with personal presence over time, and timely providing of new perspectives.

8 - Grief Counseling - Health care settings tend to raise to consciousness previous major losses, with their accompanying warm, sad, loving and disappointing memories. Needing to share feelings and reminiscence about a major loss  experienced long ago, calls for a good listener to recognize, and then respond with gentle use of a few focused, compelling questions, giving the impression that endless time is available. Such remedial grieving generally takes no longer than 20 minutes and provides a service that is not likely to be forgotten.

7- Grief Support -Needing to begin incorporating into your life the new realization that  somebody or something important to you is suddenly gone, or about to be, constitutes a universal spiritual need. Rendering us clearly powerless to stop the loss, those times make the fact of transcendent power obvious. The personal processes that tend to follow major loss, now collectively called grieving, is never complete. Facilitating grief is an art all its own that virtually any caregiver can learn.