Grief and Loss

LP 20-Exam 4

necessary loss

• apart of life

• learn to expect most necessary losses are replaced by something different or better

maturational loss

form of necessary loss & includes normal expected life changes across lifespan

EX: mother feels loss when child leaves home for school

unwanted/unexpected loss

seems unnecessary and aren’t expected

situational loss

EX: person in an accident and has injury’s that makes it impossible to return to work/school

→leading to loss of function, income, life goals, & self esteem

physical absence vs. psychological absenece

missing a loved one from college or military VS. dementia/alzheimer’s

anticipatory grief

beginning grief process before actual loss

complicated grief

difficulty progressing through normal phases

• chronic

• delayed

• exaggerated

• masked

disenfranchised grief

when a loss is experienced & cant openly acknowledge it

unresolved grief is called …

shadow grief; nurses often experience it & can cause illness & burnout

stages of grief

1. denial

2. anger

3. bargaining

4. depression

5. acceptance

what NOT to say…

• i know exactly how you feel

• you had so many years together-you’re lucky

• at least you have your kids

• you can always have another baby

• he lived a long, full life

• she is not suffering & is in a better place now

• you should be over it- its time to move on

things to say/do…

• silence

• touch

• ask/allow to share feelings

• im sorry

• this must be very difficult for you

• im sorry you’re going through this painful process

• I didn’t know him well, what was he like?

• this isn’t easy is it- what will you miss most about him?

• you will never forget her will you?

communicating with dying pt…

-therapeutic comm.:

• expresses respect for pt

• maintains realistic hope

• offers appropriate reassurance & support

-careful attention to what pt expresses verbally & nonverbally

-if pt doesn’t wish to comm. at certain time, they need to know that its ACCEPTED and will be respected

primary goal of “…” us to help pts & families achieve best possible quality of life.

palliative care

s/s of approaching death for respiratory & cardiac

C:

• edema of limbs, abd. swelling

R:

• SOB, cough, mucus production

s/s of approaching death for GI & GU

GI:

• N/V, sore mouth, constipation, diarrhea, constipation, poor appetite & wt loss

GU:

• UTI, foul cloudy concentrated urine, bladder spasm, urine retention, decreased/no urine

s/s of approaching death for neuro & MS

N:

• less engagement, concerns w/ talking/hearing, more focus on personal needs & comfort, agitation

MS:

• obvious deterioration, weakness, sluggishness, lethargy, muscle twitching

s/s of approaching death for skin

• irritation or dryness

• pressure areas that appear quickly

• jaundice, pale, gray

• loose skin

• aversion to touch