DEATH DYING GRIEF LOSS Loss v Occurs when

DEATH & DYING GRIEF & LOSS

Loss v. Occurs when a valued person, object, or situation is changed v Types of Losses: v actual loss v perceived loss v anticipatory loss

Grief • Grief is a normal response to loss. • It can be the loss of a home, job, marriage or a loved one. • Often the most painful loss is the death of a loved one, whether from a long illness or from an accident or an act of violence.

Grief is the Emotional Reaction to Loss • Bereavement – a state of grieving during which a person goes through a grief reaction • Mourning – a period of acceptance of loss and grief during which the person learns to deal with the loss

Engels: 6 Stages of the Grief Reaction • Shock and Disbelief • Developing Awareness • Restitution • Resolving the Loss • Idealization • Outcome

Shock from Grief can be at a Global Scale, a community scale…

…To a local scale

• From Sudden, Acute Trauma… • …To longterm, chronic disease

Stages of the Grief and Loss/ Death & Dying Process • • • Denial Anger Bargaining Depression Acceptance

Five Principles of Palliative Care (Hospice Care) 1. respect the goals, likes and choices of the dying patient 2. look after medical, emotional, social, and spiritual needs of the dying person 3. Support the needs of the family members 4. help the patient gain access to needed healthcare providers and appropriate settings 5. build ways to provide excellent end of life care

Ethical and Legal Dimensions • managed death • Withholding life support measures • patients look to nurses for information, advice and support • legalized physician assisted suicide • physicianadministered lethal injections create ethical dilemmas

Advanced Directives • Living Will – provides specific instructions about the kinds of health care that should be provided or foregone in a particular situation • Durable Power of Attorney – appoints an agent the person trusts to make decisions in the event of the appointing person’s subsequent incapacity

Factors That Influence Death and Dying • • • Developmental Family Socioeconomic Cultural Religious Cause of Death

Nursing Process • Assessment determine the adequacy of the patient’s and family’s their perceptions, coping strategies and resources knowledge, Questions to Ask: – What have you been told about your condition? – Have you had any previous experience with this condition or death of a loved one? – Tell me about how you are coping – What is helping you get through this?

Nursing Process • Planning – the patient and family will: • demonstrate freedom in expressing feelings • identify and use effective coping strategies • accept the need for help as appropriate • make healthcare decisions reflecting personal values and goals

Nursing Process • Implementing the nurse’s aim is to care for the dying patient and their families as well as to promote health and prevent illness in the family Nursing Diagnoses: – impaired adjustment r/t newly diagnosed terminal illness – caregiver role strain r/t hospital discharged dying pt because of inadequate insurance – dysfunctional grieving r/t inability to accept death of infant

Nursing Interventions • Monitor anxiety • Monitor changes in mood/affect • Communicate willingness to discuss death • Encourage patient and family to share feelings about death • Monitor pain • Facilitate obtaining spiritual support for patient and family • Include the family in care decisions and activities as desired

Nursing Process • Evaluating – does the plan of nursing care for the dying patient meet the outcome of a comfortable, dignified death? – do family members resolve their grief after a suitable time of mourning and resume meaningful life roles and activities?

Question #1 A nurse caring for a 15 y/o pt. with terminal CA has assessed that the pt. is very quiet and has not expressed his feelings. The nurse will need to implement: A. B. C. D. A referral for bereavement consult to enhance care Interventions for a pt isolated in inner thought Assessment skills to determine fear and anxiety Therapeutic skills to enhance communication

Question #2 • A pt who has ovarian CA with metastasis to the liver complains of increased pain and dysphasia. A physician orders a barium enema. The patient states, “I don’t want this test. What should I do? ” The nurse should: a. b. c. d. Encourage her to refuse the test Inform the MD of her statement Educate her on the test’ s benefits Educate her on the procedure

See if you can identify the Stages of grief: • “I’ve always gone to church and worked hard. This is so unfair. My sister never does a thing for anybody and she is healthy as a horse!” • “I know that if I just eat more carefully this whole thing will reverse itself. No way can I be so sick at my age. ” • “At this point I want to rewrite my will and fix up the obituary. That will make thngs easier on my wife. ” • “If it is God’s will that I die, so be it. But I know that he wants me to see my last child through to graduation and I’m going to do it. ”

For The Family • Time • Rest, Relaxation, Exercise, Nourishment, Diversion • Security • Hope • Caring • Goals • Small Pleasures