Unit 11 Grieving
Loss
Homeostasis
Actual Loss
Can be recognized and seen by other people
Ex; Death of a spouse/ loss of a family member
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
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
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
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 a 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
Unkept appearance
Weight loss/ weight gain
People can become sick because of grieving
Can cause: stress, anorexia, anxiety, chest tightness, heart palpitations, menstrual cycle disturbances, etc.
Psycho-socio-cultural
Behavioral changes
Depression
Crying
Sleep disturbances
Difficulty concentrating
Altered libido
Excessive dependence
Developmental
Age can influence how someone grieves
Stages of Grieving (Kubler-Ross)
Denial
Refusal to believe in reality
“no, not me”
Anger
“Why me?” » Blame God
Bargaining
“If I survive this, I will give up smoking” » “Yes me, but..”
Depression
May be withdrawn
“Yes, this is happening”
Acceptance
“Okay, me”
Factors influencing Loss and Grief Responses
Significance of the loss
Important to see the person’s perception that is experiencing
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
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 (0-5)
Don’t understand death
Death is reversable
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
Stages of grief
Physical status
Emotional reactions
Beliefs and rituals
Nursing Diagnosis
Grieving
Grieving / Complicated
Risk for loneliness
Social Isolation
Interrupted Family Processes
Anxiety / Fear
Hopelessness
Nursing Interventions
Identify own feelings
Can’t impose your feelings 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 processes
Does the patient have advanced directives?
Support process of grieving
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
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 bad
Tag body and belongings » for identification
Remove and secure all tubes / lines
Identification and disposition of deceased
Dying patients have rights — must treat body / individual with respect and dignity
Hospice — End of care
Health literacy — Do people understand
Loss
Homeostasis
Actual Loss
Can be recognized and seen by other people
Ex; Death of a spouse/ loss of a family member
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
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
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
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 a 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
Unkept appearance
Weight loss/ weight gain
People can become sick because of grieving
Can cause: stress, anorexia, anxiety, chest tightness, heart palpitations, menstrual cycle disturbances, etc.
Psycho-socio-cultural
Behavioral changes
Depression
Crying
Sleep disturbances
Difficulty concentrating
Altered libido
Excessive dependence
Developmental
Age can influence how someone grieves
Stages of Grieving (Kubler-Ross)
Denial
Refusal to believe in reality
“no, not me”
Anger
“Why me?” » Blame God
Bargaining
“If I survive this, I will give up smoking” » “Yes me, but..”
Depression
May be withdrawn
“Yes, this is happening”
Acceptance
“Okay, me”
Factors influencing Loss and Grief Responses
Significance of the loss
Important to see the person’s perception that is experiencing
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
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 (0-5)
Don’t understand death
Death is reversable
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
Stages of grief
Physical status
Emotional reactions
Beliefs and rituals
Nursing Diagnosis
Grieving
Grieving / Complicated
Risk for loneliness
Social Isolation
Interrupted Family Processes
Anxiety / Fear
Hopelessness
Nursing Interventions
Identify own feelings
Can’t impose your feelings 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 processes
Does the patient have advanced directives?
Support process of grieving
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
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 bad
Tag body and belongings » for identification
Remove and secure all tubes / lines
Identification and disposition of deceased
Dying patients have rights — must treat body / individual with respect and dignity
Hospice — End of care
Health literacy — Do people understand