Unit 11 Grieving

Actual Loss

• Can be recognized and seen by other people

  • Ex) Death of a spouse/ loss of family member

  • This can be seen and felt by others as well

• Can be verified

Perceived

• Experienced by the individual and may be by others/ but cannot be verified

• Psychosocial loses » nobody else can witness

  • Ex) loss of beauty

  • Ex) losing a job

  • Ex) loss of independence

• Situational

  • Ex) loss of job, child, losing a home, etc.

• Developmental

  • Ex) loss of hearing

  • Ex) going to college

  • Ex) menopause

  • Ex) Retiring

Sources of Loss

• Aspect of self

• External objects

• Familiar environment

• Loved ones

Aspect of self

• May or may not be obvious to others

  • Ex) scar (obvious)

  • Ex) empty nest syndrome (not obvious)

  • Ex) loss of beauty, strength

  • Ex) Loss of job / retirement

  • Ex) Puberty

  • Ex) Loss of childbearing

External Objects

Inanimate/animate objects

Inanimate objects

• Loss of house in fire

• Losing a relic/heirloom that has importance

• Jewelry, clothing (that has meaning)

Animate objects

• Ex; pets

Familiar environment

• Separation from environment can be devastating

  • Loss in familiarity

  • Older adults relocating

  • Going away to college

  • Ex) hurricane sandy

    • Hundreds lost their homes, churches, communities

Loved ones

• Loss through illness, separation, death

• Can be permanent or temporary

Grieving (3 types)

• Grief

• Bereavement

• Mourning

Grief

• A total response to an emotional feeling of loss

  • Thoughts, feelings, behavior

• Social process best carried out by the help of others » Grief is a social process

Bereavement

• Subjective response to the loss after death of a person with whom there was a significant relationship

Mourning

• Behavioral process where grief is resolved!

• Influenced by culture, spiritual beliefs and customs

Clinical Manifestations

Physiological, psycho-socio-cultural, developmental

Stages of Grieving (Kubler-Ross)

• Denial

• Anger

• Bargaining

• Depression

• Acceptance

Denial

• Refusal to believe in reality

• “no, not me”

Anger

• “Why me?! » Blame God

Bargaining

• If I survive this, I’ll give up smoking” » “yes me, but..”

Depression

• May be withdrawn

• “Yes, this is happening”

Acceptance

“Okay, this is what it is”

Factors influencing Loss and Grief Responses

• Significance of the loss

• Age

• Culture

• Spiritual beliefs

• Gender

• Socioeconomic status

Significance of the loss

• Important to see the person’s perceptions that is experiencing loss

  • Ex; divorce may be a happy or sad depending on the individual

Age

• Determines how grief is expressed » reaction and understanding

  • Ex; an infant vs an adult experiencing loss

Age

• Determines how grief is expressed » Reaction and understanding

  • Ex; an infant vs an adult experiencing loss

Culture

Customs (how grief happen) » Greatest impact

Spiritual Beliefs

Own way to grieve

Gender

• Ex; men are socialized to be strong

  • May not cry at funerals

• Socioeconomic status » Grief can be delayed » worried about financial status

Developmental Concept of Death

• Infancy

• Childhood

• Older Children

• Adolescence

• Adulthood

• Maturity

Infancy (0-5)

• Don’t understand death

• Death is reversible

  • Ex; mommy is just sleeping

Childhood (5-9)

• Threatens their ability to develop properly

• May regress

• It is important to keep their environment as routine as possible

Older Children (9-12)

• Believe death is inevitable

• Begin understanding their own mortality

• Start to believe what others believe about death

Adolescence (12-18)

• Fear lingering death

• Fantasize that death can be defied

  • Often engage in risky behavior

  • Believe they are invincible

• Seldom think they can die

Adulthood (18-65)

• Loss is influenced by religion and culture

• At this point — have experienced death at a personal level

• Accept their death

• They experience a peak in anxiety regarding death

  • Diminished with spiritual well being

• Accept that death is a normal part of development

Maturity (65+)

• Fear prolonged death/illness

  • Do not want to be sick for long

  • Do not want to drag out their dying process

• Want to be and go in peace

• Death has multiple meanings

Nursing Process

Nursing assessment, nursing diagnosis, nursing interventions, post-mortem care,

Nursing Assessment

• Stages of grief

• Physical status

• Emotional reactions

Nursing Diagnosis

• Grieving

• Grieving / Complicated

• Risk for loneliness

• Social Isolation

• Interrupted family processes

• Anxiety / fear

• Hopelessness

Nursing Interventions

• Identify own feelings

• Use therapeutic communication

• Address the physiological needs during the dying

• Support process of grieving

• Referral to support services

Identify own feelings

Can’t impose your feeling on others

Use therapeutic communication

• Communicate even if the person is dying

  • Hearing is the last sense to go

  • Be careful and mindful what you say

Address the physiological needs during the dying process

Does the patient have advanced directives?

Referral to support services

Ex; spiritual services, social work, group therapy, family counseling

Post-Mortem Care

• Consider religious and cultural preferences

• Involve family if appropriate

• Physical preparation of the body

• Identification and disposition of deceased

Physical Preparation of the Body

• Give the patient a full bed bath — clean the body for family viewing

  • Supine position

  • Sleeping position — head at 30 degrees propped with pillow

  • Eyes and mouth closed

  • Remove jewelry except wedding ring

    • Label jewelry and put in bag

  • Tag body and belongings » for identification

• Remove and secure all tubes / lines

Dying Patients Have Rights — Must Treat Body/Individual with Respect and Dignity

• Hospice — End of care

• Health literacy — Do people understand