Grief and Loss

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Grief and LossEnd-of-Life Issues
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Definitions

• loss
• actual
• perceived
• maturational loss
• situational loss
• Potter Perry, p. 613-615

• grief
• mourning
• bereavement
• anticipatory grief
• dysfunctional grief
• disenfranchised grief

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Types of Losses

• loss of external objects
• loss of known environment
• loss of significant other
• loss of an aspect of self
• loss of life

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Factors Affecting Experience Of Loss

• perceived meaning of the loss
• age and developmental stage, sex roles
• nature of relationship
• cultural and spiritual beliefs
• support systems
• coping strategies

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Coping Mechanisms in Grief and Loss

• Grieving is a normal adjustment process and takes
  time
• Hope
• Mourning
• Grief Work
• To accept reality of the loss
• Experiencing the pain of grief
• Adjusting to an environment that no longer has
  the lost object/person
• Reinvesting emotional energy in new relationships

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10 Key Facts About Grief and Grieving

• Grief is normal
• The worst kind of grief is YOURS.
• The way out of grief is through it.
• Your grief is intimately connected to the
  relationship.
• Grief is hard work.
• Your grief will take longer than most people
  think.
• Grief is unpredictable.
• There may be "secondary losses" to deal with.
• Grief comes and goes.
• Effective grief work is not done alone.
• ref Grief Journey http//www.griefjourney.com/f
  reepdfs/1020Facts20about20Grief.pdf

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Theories of Grieving
Potter Perry, p. 616
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Grief Cycle (Kubler-Ross, 1973)
http//www.openingspace.net/papers_facilitation_ch
angeGriefTransformation.shtml
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Most Important Needs Of Families Of Dying Clients

• Ref Furukawa, M.M. (1996) Meeting the needs of
  the dying patient's family. Critical Care Nurse,
  16(1), 51-7.
• Information Needs
• To have questions answered honestly
• To know specific facts about the client's
  condition
• To receive information about the client daily
• To know exactly what is being done for the client
• To know why things were done for the client
• To have understandable explanations
• To be called at home about changes in the
  client's condition
• To be informed of impending death

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Most Important Needs Of Families Of Dying Clients
(contd)

• Emotional Needs
• To be with the dying person
• To be helpful to the dying person
• To feel hospital personnel care about the client
• To be assured the best care possible is being
  given to the patient
• To feel there is hope
• To ventilate emotions
• To receive comfort and support from family
  members
• To receive acceptance, support and comfort from
  healthcare professionals.

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Nursing Interventions For Grieving Clients And
Families

• "Being with"
• Support coping strategies
• Promote grief work at each stage PP, 633
• Use of touch
• Listen attentively
• Maintain hope

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Nursing Interventions For Grieving Clients And
Families (contd)

• Promote physical well-being, comfort
• Show respect for cultural heritage
• Promote family cohesiveness
• Identify risk for dysfunctional grieving
• Teaching and referrals
• Potter Perry, p. 633 Friedman, Table 14-7,
  14-8

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Sources Of Support For Dying Clients And Their
Families

• palliative care
• hospice
• community agencies