Grief, Loss,Death And Dying
Health & Medicine
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Transcript of Grief, Loss,Death And Dying
Mariane T. Sibala, RNLarmen de Guia Memorial College
Loss is a universal experience that occurs throughout the lifespan.
Grief is a form of sorrow involving feelings, thoughts and behaviors caused by bereavement.
Responses to loss are strongly influenced by one’s cultural background.
The grief process involves a sequence of affective, cognitive and psychological states as a person responds to and finally accepts a loss.
LOSS = something of value is gone GRIEF = total response to emotional
experience related to loss BEREAVEMENT = subjective response to
by loved ones MOURNING = behavioral response
Refuses to believe that loss is happening
Feelings of Guilt, punishment for sins
Laments over what has happened
Begins to plan (e.g. wills, prosthesis)
The end of life The full cessation of vital actions Permanent state in the field of biology All living things eventually die What are the person’s feelings towards
Present generation may be unaware of feelings
Prolonging life Common fears Behaviors of health care professionals
“No, not me…” After the initial shock has worn off, the
next stage is usually one of classic denial, where they pretend that the news has not been given.
They effectively close their eyes to any evidence and pretend that nothing has happened.
Do not interfere unless it becomes destructive
Do not support denial; conversations should include reality
Continue to teach and encourage self care activities.
“Why me?” This stage often occurs in an explosion of
emotion, where the bottled –up feelings of the previous stages are expulsed in a huge outpouring of grief.
Whoever is in the way is likely to be blamed.
Give space allowing them to rail and below. The more the storm blows the sooner it will blow itself out.
Try not to respond in “kind” When anger is destructive , it must be
addressed directly. Remind the person of appropriate and inappropriate behavior.
“Yes me, but…” The patient attempts to negotiate a
postponement with God and is generally kept a secret.
Spend time with patients Discuss importance of valued objects and
The inevitability of the news eventually (and not before time) sinks in and the person reluctantly accepts that it is going to happen.
Be available Don’t attempt to cheer person up Find out any religious support
Restful time, but not necessarily happy. Often begin putting their life in order,
sorting out wills and helping others to accept the inevitability.
Plan care to allow the person with whom patient is comfortable to care for him or her
It is important that you don’t withdraw
May have increased hallucinations Decreased appetite May have temperature spikes Incontinent for stool and urine 24 to 72
hours prior to death Pain may be more intense Restlessness is common 12 to 24 hours
prior to death
Changes in respiratory status Increase in chest fluids Grunting and moaning on expiration Skin changes
The role of the nursing staff is fundamentally supportive
Accept the physical and mental state he is in
Show him that they will not abandon him Responds to the persons needs in a
physical, psychological, social and intellectual level
Biological needs, reduction and control of pain
Pain is a subjective experience Acute pain: usually temporary Chronic pain: interrupts normal everyday
functioning Medication is more effective in the
context of a holistic intervention
Feelings of anger, sadness, depression are part of a wider process of “anticipatory grief”, useful for the patient’s psychological preparation to die
Nursing staff has to comprehend and the person to express these feelings
The only way for the person to reconcile with these feelings is to talk to someone who is willing to listen
Support has to respond to the person’s need for safety, autonomy and self-control
Emotional and social withdrawal Need of emotional withdrawal co-exists with
the need of belonging to an accepting and supportive social environment
When family/medical nursing staff keep their distance in order to protect themselves, the person experiences a “social death”, which is sometimes more painful than the actual death
Nursing staff must treat the dying person without fear, encourage relatives to be close to him, act as a liaison with the outside world
The new reality: irrational, unfair, difficult “why” Need to evaluate his life as meaningful,
important, useful Nursing staff should stand by him without
being judgmental, let him decide where he wants to spend his last days, and interact with him as a person who LIVES
Nurses need to take time to analyze their own feelings about death before they can effectively help others with terminal illness
Understand that you may experience grief
Nurses have to be strong to control their feelings to be able to tolerate pain, illness, and death, and to keep their distance
Provide relief from illness, fear and depression
Help clients maintain sense of security Help accept losses Provide physical comfort
1-5 immobility and inactivity; wishes and unrelated action responsible for action
5-10 final but can be avoided 9-12 understands own mortality and fears
death 12-18 fears and fantasizes avoidance 18- 45 increased attitude awareness 45-65 accepts mortality Above 65 multiple meanings; encounters