2Loss, Death, GrievingNursing by its nature is involved in all processes of life: from birth to death. Nurses interact daily with clients and families experiencing loss and grief.
3GRIEF AND THE GRIEVING PROCESS The unique function of the nurse is to assist the individual sick or well in the performance of those activities contributing to health or its recovery (or to a peaceful death) that he would have perform unaided if he had the necessary strength, will, or knowledge, and to do this in such a way as to help him gain independence as rapidly as possible (Henderson, 1966).
4GRIEF AND THE GRIEVING PROCESS Loss-the removal or absence or an important object or subject from an individual’s life; it is state of being without something one has had. Loss can be actual or potential.The more individuals have invested emotionally in a person, object, or aspect of self, the more threatened they are likely to feel as they anticipate that loss.
5GRIEF AND THE GRIEVING PROCESS Loss may beActualPerceivedabout external objectsabout known Environmentabout significant othersabout an aspect of Selfof Life
6GRIEF AND THE GRIEVING PROCESS Grief –the normal response to and personal experience of loss of something that is critical to one’s sense of wellbeing. It is a profound, holistic stat that affects how a person think, eats, sleeps, and makes it through the day.Grief is a painful response that involves strong emotions such as rage, despair, and fear.
7GRIEF AND THE GRIEVING PROCESS A grieving person may also present with the feeling of chocking, shortness of breath, need for sighing, insomnia, confusion, absentmindedness, confusion and difficulty in concentration.
8GRIEF AND THE GRIEVING PROCESS Types of grief that may be expressed are:Abbreviated grief-brief but genuineDisenfranchised grief-grief that cannot be acknowledged openlyComplicated grief-unhealthy grief; inhibited, delayed, exaggerated, unresolved/chronic
9GRIEF AND THE GRIEVING PROCESS Loss may be personal, group or multiple.Mourning-is the behavioural process though which grief is eventually resolved or altered; it the cultural patterning of a bereaved person’s grief. Cultures provide various ways for individuals to convey their grief to others through culturally sanctioned attitudes and customs.Bereavement denotes the period during which the grief process unfolds, ending with the reorganization of the individual’s life.
10Kubler-Ross Stages of Grief The StagesManifestationsDenialAngerMuscular weakness, clammy sensation, inability to think, feel, or move; may report having dreams in which the deceased was aliveAnger towards the deceased, towards God, caregivers and jealousy towards those who still have their loved ones alive
11Kubler-Ross Stages of Grief BargainingDepressionAcceptanceManifestationsTrying to postpone the inevitable shopping for Rx, bargains with God for a better life.One withdraws from the world, talks less, turns visitors away; refuses food, medication etc.Comes to terms with the situation, may want to say last words to close relations
12Engel’s Stages of Grieving Shock and disbeliefDeveloping awarenessRestitutionResolving the lossIdealizationoutcome
13Expression of GriefThere is no single correct way nor a correct timetable by which a person progresses through the grieving process and no individuals are responding to the same loss cannot be expected to follow the same pattern or schedule in resolving their grieve, even while they support each other.
14GRIEF AND THE GRIEVING PROCESS The nature and extent of grief is influenced byAgeNature of the lossCultural and spiritual beliefsGender rolesSocio-economic status/social support systems
15The Dying PatientLoss is an element of dying just as it is for bereavement. Individuals with fatal diagnoses experiences losses. These may include:Loss of being a healthy person functioning in the societyLoss of independence, self esteem and integrity.Loss of jobLoss of the ability to live without interruptions of frequent hospitalization and painful treatments.Loss of friends and love ones
16Fears of the dying client These loses may arouse fears in the patientFear of LonelinessDistancing by support people and caregivers can occurDebilitation, pain, and incapacitationHospital, a place that can be very lonelyFear of dying alone
17Fears of the dying client Fear of SorrowSadnessLetting go of hopes, dreams, the futureAwareness of own mortalityGrief about future lossesAnticipatory grief that involves mourning, coping skillsGrief related to diagnosis that has a long term effect on the body such as cancerPatient may feel well at time of diagnosis
18Fears of the dying client Fear of the unknown:Death is an unknown stateWhat will happen after death?What will happen to loved ones, those left behind
19Dying with Dignity Dying Persons’ Bill of Rights (look for) Promotion of comfortMaintenance of independencePrevention of loneliness and isolationPromotion of spiritual comfortSupport for the grieving familyHospice Care
20Approaching Death: Some Physical Changes Dying person turns toward light - sees only what is nearCan only hear what is distinctly spokenTouch is diminished - response to pressure last to leaveDying person might turn toward or speak to someone not visible to anyone elseEyes may remain open even if unconsciousPerson might rally just before dying
21Approaching Death: Some Physical Changes Temperature may increase or decreasePulse may be fast, irregular, weak, difficult to findRespirations may be rapid, shallow, noisy, Cheyne-StokesBP decreasesPeripheral circulation is impaired
22Approaching Death: Some Physical Changes Thirst; dry mouthSight failsAsphagiaMental alertness variesHearing- supposed to be last sense to be lostRelaxation of muscles
23Approaching Death: Some Physical Changes Pupils might react sluggishly or not at all to lightPain might be significantAssess for pain if person unable to talk: restlessness, tight muscles, facial expressions, frownsProvide pain medication as needed
24Approaching Death: Some Physical Changes Death is the end, as we know it, for that personWe can only support, listen therapeutically,Make the person as physically comfortable as possibleWe can also use our knowledge and expertise to strengthen, support, and prepare the family
25Some Changes After Death Physical Changes After DeathPupils- Fixed and dilatedAlgor Mortis- Rapid cooling of the bodyRigor Mortis- Stiffening of the body, develops 2-4 hours after deathLivor Mortis- Purple discoloration of skin in dependent areas
26Some Changes After Death Certification of death by the physicianperformance of last offices