Loss, Death and Grief

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Loss, Death and Grief
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LOSS

• Necessary
• Actual
• Perceived
• Maturational
• Situational

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GRIEF

• Emotional response to loss
• Unique and individualized
• Based on personal experiences, cultural
  expectations and spiritual beliefs

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Mourning

• The outward, social expression of a loss
• Involves working through the grief until an
  individual accepts and adapts to his/her
  expectations to go on in life without what was
  lost

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Bereavement

• Involves grief and mourning
• Inner feelings and outward reactions of the
  survivors
• A process
• Not linear
• Does not proceed in sequential stages
• May take many years to effectively heal and learn
  to live with a loss

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Types of Grief

• Normal
• Anticipatory
• Complicated
• Disenfranchised

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Factors Influencing Loss and Grief

• Human development
• Psychosocial perspectives
• Socioeconomic status
• Personal relationships
• Nature of loss
• Culture and ethnicity
• Spiritual beliefs

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Coping with Grief and Loss

• What must we know about the person?

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• What is Hope?
• Why is it important?

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Grief and the Nursing Process

• Assessment
• Assess actual reaction
• Identify type and stage of grief
• Communication is essential
• Grief reaction is individualized, but one or more
  common symptoms are often experienced (Box 29-4)
• Identify factors that affect grief (Table 29-3)
• Discuss End-of-Life issues with client and family
• Identify client expectations
• Assess your own emotional well-being and
  involvement

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Nursing Diagnoses

• Anxiety
• Caregiver Role Strain
• Compromised Family Coping
• Ineffective Community Coping
• Ineffective Denial
• Fear
• Anticipatory Grieving
• Dysfunctional Grieving
• Hopelessness
• Powerlessness
• Social Isolation
• Spiritual Distress
• Readiness for Enhanced Spiritual Well-being

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Planning

• Grief is therapeutic and necessary
• Set goals and outcomes
• Set priorities
• Influenced by client expectations, clinical
  condition, and client preferences
• Ensure continuity of care

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Implementation

• Goal enabling client to return to optimal
  physical and emotional functioning
• Select interventions that help individual cope
  with stressors and move toward healthy grief
  resolution
• Therapeutic communication is essential
• Acknowledge clients/familys grief
• Be aware that behaviors may change
• Promote Hope (p. 584-585)
• Facilitate Mourning (p. 585)

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Evaluation

• How do you evaluate your plan of care for the
  grieving or dying patient?

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Palliative Care

• Provide relief from pain and other distressing
  symptoms
• Affirm life and regard dying as a normal process
• Neither hasten or postpone death
• Integrate psychological and spiritual aspects of
  client care
• Offer a support system
• to assist client to live as actively as possible
  until death
• to help families cope during clients illness and
  their bereavement
• Enhance quality of life

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Skills Necessary for Palliative Care

• Establishing caring/trusting relationship
• Comprehensive assessment of symptoms
• Promote clients self-esteem and protect clients
  dignity
• Attend to appearance of client and environment
• Allow client to make care decisions
• Keep client and family well informed
• Provide privacy during procedures or when client
  and family need time together
• Prevent abandonment and isolation
• Support grieving family

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Hospice Care

• Alternative care delivery model
• Generally less than 6 months to live
• Family centered care with goal of keeping client
  comfortable and maintaining satisfactory
  lifestyle until death
• Nurses role
• to be open to client desires and meet the wishes
  of the dying client
• to involve family as active participants

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Postmortem Care

• Know the policy/protocol of your facility
• Validation of death
• Documentation
• Care of body (Box 29-9)
• Organ or tissue donation procedures
• When coroner must be notified
• Voluntary vs. mandatory autopsy
• Tend to the body with sensitivity and dignity
  (must be aware of religious or cultural beliefs
  of deceased)
• Family becomes primary client after death occurs

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The Grieving Nurse

• Once rapport and a trusting relationship is
  established with a client it is normal to
  experience feelings of loss and sadness when they
  die.
• Coping
• Attend viewing
• Write a letter of sympathy
• Acknowledge and accept the grieving process
• Develop support system