Mariane T. Sibala, RNLarmen de Guia Memorial College

2009

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

Stages Behaviors

D

A

B

D

A

Refuses to believe that loss is happening

Retaliation

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

death?

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

people.

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

and fears