Loss, Grief, Death Birth, loss, and death are universal experiences.
Loss-loss is experienced with the absence of an object, person, body part or function, or emotion that was formerly present.
Sources of Loss Loss of an aspect of oneself-a body part, a physiologic function or a psychological attribute. Loss of an object external to oneself. Separation from an accustomed environment. Loss of a loved or valued person. Developmental-losses that occur in the process of normal development.
Kubler-Ross has described the stages of grief and observable behaviors that have occurred with each stage.
Stages of Grieving Denial
Anger
Bargaining
Depression
Acceptance
Parkes’s Model Numbness-brief, uses denial as a coping mechanism Yearning-usually several months. Thoughts focus on deceased. Disorganization-Social withdrawal at times. Accident prone, depression. Reorganization- Gradual renewal in interest in others, job, activities.
Demi’s Grief Cycle Shock- Disorganized thinking, wish to join the deceased Protest-Anger, fatigue, weight loss, seeks help and advice of others Disorganization-Difficulty making decisions, perception of life as meaningless, loss of interest in people and activities Reorganization- realistic memory of deceased
Life span concepts and death The infant/toddler If loss of person who cares for them interferes with sense of trust—child will develop inability to achieve warm relationships—this will last his lifetime
The preschooler learns about the concept of death when a pet dies or they see a dead mouse. Envision death: Temporary Little adult fear of death
Schoolager Additional experience with death. At about 9 years of age: Death is: not reversible permanent inevitable
The Adolescent/Young Adult Immune to death
Middle Age Concrete plans for death.
Older adult Life review Ego Integrity Vs Despair
Physiological Changes as One Nears Death Cardiovascular Decreased stroke volume, the power to circulate blood decreases. Poor circulation.
Respiratory system Slowed respiration increased secretions
Neuromuscular Severe weakness and fatigue. General loss of ability to swallow, loss of gag reflex Tone of body sphincters lost Decreased LOC
Neuromuscular continued: DTR’s decrease or are not perceptible Vision blurs Touch remains intact Hearing last sense to leave
GI system Digestion slows Total body metabolism slows Constipation due to decreased peristalsis (abdomen becomes distended)
Modifications of Care Don’t turn suddenly Position on side Mouth care Keep skin dry Artificial tears Analgesics Include patient in decision making
Other special needs of the dying Promotion of comfort Maintenance of independence Conservation of energy Prevention of loneliness and isolation Promotion of spiritual comfort Support the grieving family
Legal issues surrounding death When does death occur Documentation of death Euthanasia Dignity of the body Required request No code orders
Care of the Body after Death Rigor mortis –occurs 2-4 hours after death Position of body Cleaning body Family support Proper identification Rigor mortis leaves after about 96 hours Body temperature after death
Role of Funerals Helps family accept the reality of death Family accepts support of others Cements memories