Ch 30 Experience Of Loss, Death And Grief

Front 1

Loss

Back 1

- People experience loss when another person, possession, body part, familiar environment, or sense of self changes or is no longer present
- As we move forward in life, we learn that change always involves necessary losses, which are part of life
- How an individual interprets the meaning of the perceived loss affects the intensity of grief response
- Easy to overlook because they are so internally and individually experienced
- Death is the ultimate loss

Front 2

Maturational Losses

Back 2

- Are a form of necessary loss and include all normally expected life changes across the life span
- Mother feels loss when her child leaves home for the first day of school

Front 3

Situational Loss

Back 3

Sudden, unpredictable external events
An automobile accident

Front 4

Actual Loss

Back 4

Occurs when a person can no longer feel, hear, or know a person or object

Front 5

Perceived Loss

Back 5

Are uniquely defined by the person experiencing the loss and are less obvious to other people

Front 6

Grief

Back 6

Is the emotional response to a loss, manifested in ways unique to an individual, based on personal experiences, cultural expectations, and spiritual beliefs

Front 7

Mourning

Back 7

- Coping with grief involves a period of mourning
- Outward, social expressions of grief and the behavior associated with loss

Front 8

Bereavement

Back 8

Captures both grief and mourning and includes the emotional responses and outward behaviors of a person experiencing loss

Front 9

Normal (Uncomplicated) Grief

Back 9

- Is the most common reaction to death
- Normal grief is a complex response with emotional, cognitive, social, physical, behavioral, and spiritual concepts
- Recent study found that feelings of acceptance, disbelief, yearning, anger, and depression were displayed in normal bereavement grief
- Yearning which is a longing or searching for the deceased person was the most common negative feeling, peaking around 2 months after the loss
- Acceptance was the strongest initial response and grew increasingly stronger over time
- Negative emotions (anger and depression) peaked around 4 months and were in decline by 6 months

Front 10

Complicated (Dysfunctional) Grief

Back 10

- Grieving person has a prolonged or significantly difficult time moving forward after a loss
- Experience a chronic and disruptive yearning for the deceased and are likely to have trouble accepting the death and trusting others, feel excessively bitter, or are uneasy about the future
- May feel emotionally numb
- Loss associated with homicide, suicide, sudden accidents, or the loss of a child have the potential to become complicated
- Lasts at least 6 months after a loss and it interrupts every dimension of the person’s life

Front 11

Anticipatory Grief

Back 11

- Unconscious process of disengaging or letting go before the actual loss or death occurs, especially in situations of prolonged or predicted loss

- Experience their more intense responses to grief (shock, denial, and tearfulness) before the actual death occurs and often feel relief when it finally happens

Front 12

Disenfranchised Grief

Back 12

- Also known as marginal or unsupported grief
- When their relationship to the deceased person is not socially sanctioned, cannot be openly acknowledged or publicly shared, or seems lesser significance
- Death of a very old person, and ex-spouse, a gay partner, or even a loved pet

Front 13

Five Stages of Dying

Back 13

Denial
Anger
Bargaining
Depression
Acceptance

Front 14

Denial

Back 14

Person acts as though nothing has happened and refuses to accept the fact of the loss

Front 15

Anger

Back 15

- Stage of adjustment to loss
- Person expresses resistance and sometimes feels intense anger at God, other people, or the situation

Front 16

Bargaining

Back 16

- Cushions and postpones awareness of the loss by trying to prevent it from happening
- Grieving or dying people make promises to self, God, or loved ones that they will live differently if they can be spared the dreaded outcome

Front 17

Depression

Back 17

- When person realizes full impact of the loss
- Overwhelmingly sad, hopeless, and lonely

Front 18

Acceptance

Back 18

The person incorporates the loss into life and finds ways to move forward

Front 19

Attachment Theory

Back 19

- Attachment, an instinctive behavior, leads to the development of affectional bonds between children and their primary caregivers
- 4 phases of mourning:
- Numbing
- Yearning and Searching
- Disorganization and Despair
- Reorganization

Front 20

Numbing Phase of Mourning

Back 20

- The shortest phase of mourning
- May last from few hours to a week or more
- Person is stunned, unreal
- Numbing protects the person from full impact of the loss

Front 21

Yearning and Searching Phase of Mourning

Back 21

- Emotional outbursts of tearful sobbing and acute distress characterize the second bereavement phase
- Physical symptoms include:
- Tightness in the chest and throat
- Shortness of breath
- Feeling of lethargy
- Insomnia
- Loss of appetite
- Experiences an inner intense yearning for the lost person or object
- Lasts for months or considerably longer

Front 22

Disorganization and Despair Phase of Mourning

Back 22

- A person endlessly examines how and why the loss occurred or expresses anger at anyone who seems responsible for the loss
- Grieving person retells the loss story again and again
- Gradually person realizes the loss is permanent

Front 23

Reorganization

Back 23

- Which usually takes a year or more
- Person begins to accept change, assume unfamiliar roles, acquire new skills, and build new relationships

Front 24

Grief Tasks Model

Back 24

- Working through the grief tasks typically requires a minimum of a full year, although the time varies from person to person

Task 1 : Accept the reality of the loss
Task 2: Work through the pain of grief
Task 3: Adjust to the environment in which the deceases is missing
Task 4: Emotionally relocate the deceased and move on with life

Front 25

Dual Process Model

Back 25

- Loss oriented behaviors include grief work, dwelling on the loss, breaking connections to the deceased, and resisting activities to get past the grief
- Restoration oriented activities such as attending to life changes, finding new roles or relationships, coping with finances, and participating in distractions

Front 26

Personal Relationships

Back 26

- When loss involves another person, the quality and meaning of the lost relationship influences the grief response

Front 27

Coping Strategies

Back 27

- Emotional disclosure (venting, or talking about one’s feelings) has been viewed as an important way to cope with loss

- Focusing on positive emotions and optimistic feelings might be an even more important indication of successful coping in bereavement

Front 28

Socioeconomic Status

Back 28

- Influences a person’s ability to access support and resources for coping with loss and physical responses to stress

Front 29

Culture and Ethnicity

Back 29

- Try to understand and appreciate each client’s cultural values related to loss, death, and grieving
- Many people in Western European and American cultures hold back their public displays of emotion

Front 30

Spiritual and Religious Beliefs:
Spiritual Integration

Back 30

Occurs when an individual comes to terms with his or her life and puts life’s pieces together in a way consistent with one’s entire life

Front 31

Assessment of Grief and Loss

Back 31

- When assessing clients and family members explore factors that are affecting their grief, their unique grief responses, and their expectations, including their wishes for end-of-life care
- Speak to clients and family members using honest and open communication
- “Tell me how you feel about your cancer diagnosis”
-“You seem sad today. Can you tell me more?”
- “What is the most important thing I can do for you right now?”

Front 32

Planning

Back 32

- Care plan for the dying client focuses on comfort, preserving dignity and quality of life, and providing family members with emotional, social, and spiritual support

Front 33

Palliative Care

Back 33

- Is the prevention, relief, reduction, or soothing symptoms of disease or disorders throughout the entire course of an illness, including care of the dying and bereavement follow-up for the family

- Interventions for people who face chronic life-threatening illnesses
- Help clients and families achieve the best possible quality of life

Front 34

Hospice Care

Back 34

- Hospice care is a final phase of palliative care
- Designed for clients who no longer benefit from medical treatments, who will likely not live more than 6 months, or who are actively dying
- Defines primary obligations of the collaborative team offering palliative care:
- Affirm life, and regard dying as a normal process
- Neither hasten nor postpone death
- Provide relief from pain and other distressing symptoms
- Integrate psychological and spiritual aspects of client care
- Offer a support system to help clients live as actively as possible until death
- Offer a support system to help families cope during the client’s illness and their own bereavement
- Enhance the quality of life

- Is a philosophy and a model for the care of terminally ill clients and their families
- Gives priority to managing the client’s pain and other symptoms, comfort, quality of life, and attention to physical, psychological, social, and spiritual needs and resources
- Hospice caregivers try to support the client’s wishes but also consider what is best for everyone
- To be eligible for home hospice services a client must have a family caregiver to provide daily basic care

Front 35

Provide Psychosocial Care

Back 35

Clients at the end of life experience a range of psychological symptoms, including anxiety, depression, altered body image, denial, powerlessness, uncertainty and isolation

Front 36

Manage Symptoms

Back 36

- Managing the multiple symptoms commonly experienced by chronically ill or dying clients remains a primary goal of palliative care nursing
- As renal and liver function decline in the dying client, metabolism and rate of drug clearance diminish, indicating the potential need for decreased dosages at the end of life to avoid toxicities
- Remain alert to the potential side effects of opioid administration: constipation, nausea, sedation, respiratory depression, or myclonus

Front 37

Promote Dignity and Self-Esteem

Back 37

- Nurses promote a client’s self esteem and dignity by respecting him or her as a whole person with feelings, accomplishments, and passions independent of the illness experience
- Nursing strategies that promote hope are often quite simple:
- Demonstrating patience, treating the client’s family well and being friendly

Front 38

Protect Against Abandonment and Isolation

Back 38

- Many terminally ill clients fear dying alone
- Consider whether or not to put patient in a private room
- Many clients, on the other hand, appreciate being able to stay involved and interact with others, which is possible when sharing a room
- Suggest that a family member stay through the night if possible

Front 39

Support the grieving family

Back 39

- Lack of information is the major reported concern of family members of dying clients
- During respite care, the client temporarily receives care from others so that family members are able to get away to rest and relax
- Educate the family on the symptoms the client will likely experience and the implications for care
- It is common for the client in the last days of life to have decreased appetite or feel nauseated by food
- Family members often seek out personal time with the nurse to share their concerns, ask about treatment options, validate perceived changes in the client’s status, explore the possible meaning of the client behaviors, or suggest ideas for care
- Nurses are a primary source of family support in hospice or home care

Front 40

Assist with End-of-Life Decision Making

Back 40

- The publication Five Wishes recommends that clients consider five things:
- Who you want to make your health care decisions if you are unable to do so
- What medical treatment you do or do not want
- How comfortable do you wish to be
- How you want to be treated by others
- What you want your loved ones to know

Front 41

Facilitate Mourning

Back 41

- Help the survivor accept that the loss is real
- Support efforts to adjust to the loss
- Encourage establishment of new relationships
- Allow time to grieve
- Interpret “normal” behavior
- Provide continuing support
- Be alert for signs of ineffective, potentially harmful coping mechanisms, such as alcohol and substance abuse or excessive use of over-the-counter analgesics or sleep aids

Front 42

Care After Death

Back 42

- Federal and state laws require that institutions develop policies and procedures for certain events that occur after death:
- Requesting organ or tissue donation
- Autopsy
- Certifying and documenting the occurrence of a death
- Providing safe and appropriate postmortem care
- Inform family members that an autopsy does not deform the body and that all organs are replaced in the body
- Family members deserve and expect a clear description of what happened to their loved one, especially in cases of sudden, unusual, or unexpected circumstances