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Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 10 Grief and Loss.

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Presentation on theme: "Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 10 Grief and Loss."— Presentation transcript:

1 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 10 Grief and Loss

2 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Grief Subjective emotions and affect; normal response to loss Grieving/bereavement: process by which person experiences grief; content, process Anticipatory grieving: persons facing an imminent loss begin to deal with very real possibility of loss or death in near future. Mourning: outward expression of grief, including rituals

3 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Types of Losses Physiologic loss Safety loss Loss of security, sense of belonging Loss of self-esteem Loss related to self-actualization

4 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Theories of Grieving Kubler-Ross’s five stages of grieving (see Table 10.1) –Denial –Anger –Bargaining –Depression –Acceptance

5 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Theories of Grieving (cont.) Bowlby’s phases of grieving –Numbness, denial of loss –Emotional yearning for lost loved one; protest over permanence of loss –Cognitive disorganization, emotional despair; difficulty functioning –Reorganization, reintegration

6 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Theories of Grieving (cont.) Engel’s five stages of grieving –Shock and disbelief –Developing awareness –Restitution –Resolution of loss –Recovery Horowitz’s four stages of loss and adaptation –Outcry –Denial and intrusion –Working through –Completion

7 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? The first stage of grieving according to Kubler-Ross is anger.

8 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False Rationale: According to Kubler-Ross, the first stage of grieving is denial, which is followed by anger.

9 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Tasks of Grieving Rando’s “six Rs” –Recognize –React –Recollect and reexperience –Relinquish –Readjust –Reinvest Worden’s tasks –Accept reality of loss –Work through pain of grief –Adjust to changed environment due to loss –Emotionally relocate loss and move on

10 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Dimensions of Grieving Cognitive responses –Questioning, trying to make sense of loss –Attempting to keep lost one present Emotional responses (anger, sadness, anxiety) Spiritual responses Behavioral responses Physiologic responses

11 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Cultural Considerations Grief by all for lost loved ones Rituals, habits surrounding death highly variable Grieving, mourning, integration of loss culturally defined Need for nurses to be sensitive to cultural differences/rituals Cultural rituals with roots in major religions

12 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Cultural Considerations (cont.) African Americans: deceased viewed in church before burial in cemetery; public prayers, black clothing, decreased social activities Muslim Americans: five steps of burial procedure including washing, dressing, and positioning of the body –First step: traditional washing of the body by a Muslim of the same gender

13 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Cultural Considerations (cont.) Haitian Americans: vodun (voodoo) Chinese Americans: strict norms for announcing death, preparing body, arranging funeral and burial, mourning after burial –Bowls of food on table for spirit for 1 year after death

14 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Cultural Considerations (cont.) Japanese Americans: death as life passage; bathing with warm water and dressing in white kimono after purification rites Filipino Americans: black clothing or armbands; wreaths on casket; black cloth on home of deceased

15 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Cultural Considerations (cont.) Vietnamese Americans: bathing deceased and dressing in black clothing; rice in mouth and money; display of body for viewing in home before burial

16 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Cultural Considerations (cont.) Hispanic Americans: novena (9-day prayers) and rosary; luto Native Americans: tribal medicine man or priestly healer; baptism ceremonies; end of mourning noted with ceremony at burial ground with grave covered with blanket or cloth later given to tribe member

17 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Cultural Considerations (cont.) Orthodox Jewish Americans: relative staying with dying person; body covered with sheet; eyes closed; burial within 24 hours of death unless Sabbath; Shivah

18 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following cultures most likely would practice washing of the deceased body by a member of the same gender? –A. African American –B. Muslim American –C. Haitian American –D. Chinese American

19 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B. Muslim American Rationale: Muslim Americans adhere to five steps of the burial procedure, including washing, dressing, and positioning of the body. The first step is traditional washing of the body by a Muslim of the same gender. –This is not applicable to African Americans, Haitian Americans, or Chinese Americans.

20 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Cultural Considerations (cont.) Nurse’s role –Encouraging patients to discover, use effective and meaningful grieving behaviors –Praying –Staying with body –Performance of rituals –Memorials, public services

21 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Disenfranchised Grief Grief over loss that is not or cannot be openly acknowledged, mourned publicly, or supported socially: –A relationship has no legitimacy. –The loss itself is not recognized. –The griever is not recognized.

22 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Disenfranchised Grief (cont.) Grief process more complex due to absence of usual support for grieving, healing Experienced by nurses when need to grieve not recognized Can also be experienced by other “helping” professionals such as chaplains and clergy too

23 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Complicated Grieving Person devoid of emotion; grieving for prolonged periods; expressions of grief seem disproportionate to event

24 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Complicated Grieving (cont.) Characteristics of susceptibility –Low self-esteem –Low trust in others –Previous psychiatric disorder –Previous suicide threats or attempts –Absent or unhelpful family members –Ambivalent, dependent, insecure attachment to deceased person

25 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Complicated Grieving (cont.) Risk factors leading to vulnerability –Death of spouse or a child –Death of parent (particularly in early childhood or adolescence) –Sudden, unexpected, untimely death –Multiple deaths –Death by suicide or murder Unique, varied experience (physical, emotional reactions)

26 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins The Nursing Process: Assessment All dimensions of human response (see Box 10.1) Three critical components –Adequate perception regarding loss –Adequate support while grieving for loss –Adequate coping behaviors during process

27 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins The Nursing Process: Diagnosis Possible nursing diagnoses –Grieving –Complicated grieving –Risk for complicated grieving –Anticipatory grieving

28 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins The Nursing Process: Outcomes Outcome identification: patient will –Identify effects/meaning of his or her loss –Seek adequate support/develop plan for coping/apply effective coping strategies –Recognize negative effects of loss on life –Seek or accept professional assistance if needed

29 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins The Nursing Process: Interventions Exploring perception of loss –Cognitive responses –Adaptive denial Obtaining support Promoting coping behaviors (see Nursing Interventions for Grief) –Reviewing strengths of past coping –Encouraging self-care –Using communication, interpersonal skills

30 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Nurses commonly experience complicated grief.

31 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False Rationale: Although it is possible for anyone to experience complicated grief, a nurse would be more likely to experience disenfranchised grief when his or her need to grieve is not recognized.

32 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins The Nursing Process: Evaluation Review of tasks, phases of grieving Demonstration of continuing denial or outcry Evidence of reorganization, recovery, healing

33 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Self-Awareness Issues Examining one’s own experiences with grief, loss Taking self-awareness inventory, reflecting on results Performing ongoing self-evaluation


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