Loss, Death, Grieving Nursing by its nature is involved in all processes of life: from birth to...
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Transcript of Loss, Death, Grieving Nursing by its nature is involved in all processes of life: from birth to...
Loss, Death, Grieving
Nursing by its nature is involved in all processes of life: from birth to death. Nurses interact daily with clients and families experiencing loss and grief.
GRIEF AND THE GRIEVING PROCESS
The unique function of the nurse is to assist the individual sick or well in the performance of those activities contributing to health or its recovery
(or to a peaceful death) that he would have perform unaided if he had the necessary strength, will, or knowledge, and to do this in such a way as to help him gain independence as rapidly as possible (Henderson, 1966).
GRIEF AND THE GRIEVING PROCESS
Loss-the removal or absence or an important object or subject from an individual’s life; it is state of being without something one has had. Loss can be actual or potential.
The more individuals have invested emotionally in a person, object, or aspect of self, the more threatened they are likely to feel as they anticipate that loss.
GRIEF AND THE GRIEVING PROCESS
Loss may be
Actual
Perceived
about external objects
about known Environment
about significant others
about an aspect of Self
of Life
Grief –the normal response to and
personal experience of loss of something
that is critical to one’s sense of wellbeing.
It is a profound, holistic stat that affects
how a person think, eats, sleeps, and
makes it through the day.
Grief is a painful response that involves
strong emotions such as rage, despair,
and fear.
GRIEF AND THE GRIEVING PROCESS
GRIEF AND THE GRIEVING PROCESS
A grieving person may also present with
the feeling of chocking, shortness of
breath, need for sighing, insomnia,
confusion, absentmindedness, confusion
and difficulty in concentration.
GRIEF AND THE GRIEVING PROCESS
Types of grief that may be expressed are:
Abbreviated grief-brief but genuine
Disenfranchised grief-grief that cannot
be acknowledged openly
Complicated grief-unhealthy grief;
inhibited, delayed, exaggerated,
unresolved/chronic
GRIEF AND THE GRIEVING PROCESS
Loss may be personal, group or multiple.
Mourning-is the behavioural process though which
grief is eventually resolved or altered; it the
cultural patterning of a bereaved person’s grief.
Cultures provide various ways for individuals to
convey their grief to others through culturally
sanctioned attitudes and customs.
Bereavement denotes the period during which the
grief process unfolds, ending with the
reorganization of the individual’s life.
Kubler-Ross Stages of GriefThe Stages Manifestations
Denial
Anger
Muscular weakness, clammy sensation, inability to think, feel, or move; may report having dreams in which the deceased was alive
Anger towards the deceased, towards God, caregivers and jealousy towards those who still have their loved ones alive
Kubler-Ross Stages of GriefStage
Bargaining
Depression
Acceptance
Manifestations Trying to postpone the inevitable
shopping for Rx, bargains with God for a better life.
One withdraws from the world, talks less, turns visitors away; refuses food, medication etc.
Comes to terms with the situation, may want to say last words to close relations
Engel’s Stages of Grieving
Shock and disbelief
Developing awareness
Restitution
Resolving the loss
Idealization
outcome
Expression of Grief
There is no single correct way nor a correct
timetable by which a person progresses
through the grieving process and no
individuals are responding to the same loss
cannot be expected to follow the same
pattern or schedule in resolving their
grieve, even while they support each other.
GRIEF AND THE GRIEVING PROCESS
The nature and extent of grief is influenced by
Age
Nature of the loss
Cultural and spiritual beliefs
Gender roles
Socio-economic status/social support
systems
The Dying PatientLoss is an element of dying just as it is for bereavement.
Individuals with fatal diagnoses experiences losses.
These may include:
Loss of being a healthy person functioning in the
society
Loss of independence, self esteem and integrity.
Loss of job
Loss of the ability to live without interruptions of
frequent hospitalization and painful treatments.
Loss of friends and love ones
Fears of the dying client
These loses may arouse fears in the patient
Fear of Loneliness
• Distancing by support people and caregivers
can occur
• Debilitation, pain, and incapacitation
• Hospital, a place that can be very lonely
• Fear of dying alone
Fears of the dying client Fear of Sorrow
• Sadness
• Letting go of hopes, dreams, the future
• Awareness of own mortality
• Grief about future losses
• Anticipatory grief that involves mourning, coping
skills
• Grief related to diagnosis that has a long term effect
on the body such as cancer
• Patient may feel well at time of diagnosis
Fears of the dying client
Fear of the unknown:
• Death is an unknown state
• What will happen after death?
• What will happen to loved ones, those left
behind
Dying with Dignity
Dying Persons’ Bill of Rights (look for)
Promotion of comfort
Maintenance of independence
Prevention of loneliness and isolation
Promotion of spiritual comfort
Support for the grieving family
Hospice Care
Approaching Death: Some Physical Changes
Dying person turns toward light - sees only what is near
Can only hear what is distinctly spoken Touch is diminished - response to
pressure last to leave Dying person might turn toward or speak
to someone not visible to anyone else Eyes may remain open even if
unconscious Person might rally just before dying
Approaching Death: Some Physical Changes
Temperature may increase or decrease Pulse may be fast, irregular, weak,
difficult to find Respirations may be rapid, shallow,
noisy, Cheyne-Stokes BP decreases Peripheral circulation is impaired
Approaching Death: Some Physical Changes
Thirst; dry mouth Sight fails Asphagia Mental alertness varies Hearing- supposed to be last sense to be
lost Relaxation of muscles
Approaching Death: Some Physical Changes
Pupils might react sluggishly or not at all
to light
Pain might be significant
Assess for pain if person unable to talk:
restlessness, tight muscles, facial
expressions, frowns
Provide pain medication as needed
Approaching Death: Some Physical Changes
Death is the end, as we know it, for that
person
We can only support, listen
therapeutically,
Make the person as physically
comfortable as possible
We can also use our knowledge and
expertise to strengthen, support, and
prepare the family
Some Changes After Death
Physical Changes After Death Pupils- Fixed and dilated Algor Mortis- Rapid cooling of the body Rigor Mortis- Stiffening of the body, develops
2-4 hours after death Livor Mortis- Purple discoloration of skin in
dependent areas