Jenny Huri 2011 (Foundation)

Students will be able to  Define and understand loss  Define and understand grief  Support the patient and family in grief  Assess and support the dying patient and his family  Identify actions that promote effective end of life care Learning outcomes 1 and 3 HEAL4002

One of the most difficult realities that nurses face is that, despite our very best efforts, some patients will die. Although we cannot change this fact, we can have a significant and lasting effect on the way in which patients live until they die, the manner in which death occurs and the enduring memories of the death for families (Smeltzer & Bare, 2005)

 are uniquely prepared to offer compassionate care for dying patients and their families.  have a fundamental responsibility to alleviate pain and suffering.  are educated in pain management, palliative care and in helping people cope with grief, death and dying.  are key members of interdisciplinary teams caring for dying patients and their families

 WHO – an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the relief of suffering by means of early identification and assessment and treatment of pain and other problems.

 LOSS is said to have occurred “when something or someone can no longer be seen, felt, heard, known or experienced.  There is a sense of being deprived of something of value, of having something taken away against one’s will or of being robbed (Crisp and Taylor,2005)  Understanding the meaning of loss is a vital aspect of caring for survivors and care givers

LOSS  Loss is a normal part of the life cycle  People experience loss in the form of change, growth and transition  The experience can be painful, frightening and lonely  Triggers an array of emotional responses  Can manifest itself in different ways.

 Age  Gender  Personality  Cultural heritage  Race  religion

 Actual  Perceived  Maturational  Situational

Reduces the chance of attaining personal goals  loss of sight  Speech  Mobility  Limb  Spinal injury

 Dignity  Confidence  Self esteem  Alteration of hope

 From being a baby  Loss of childhood  From teenager to adult  From roaring 40’s to 50’s  Life after 50

 Sudden, unpredictable  Physiological  Social - Divorce  Psychological  Natural disaster  Illness – life threatening or Chronic

 Loss is experienced in the form of : - Losing a loved one (person or pet) – life significant other - change (moving house, country, job) – known environment - health (illness or accident) aspect of self - losing things we own by accident or theft – external objects - our place in the world  Precipitates a painful human emotion - Grief

EMOTIONAL RESPONSES  Denial  Shock – “I feel numb”  Disbelief – feeling of unreality  Anger - hostility  Unbearable loneliness  Sadness  Depression – hopelessness – worthless

EMOTIONAL RESPONSES  Social withdrawal – no one cares or really understands  Apathy  Longing for who or what was lost  Blaming self or others – what you could have done, but didn't - guilt  Questioning beliefs  Feelings of panic - self destruction, desire to run away and “chuck it all in”

PHYSIOLOGICAL RESPONSES  Increase in heart rate  Blood pressure changes  Chest discomfort  Shortness of breath – tightness in throat  Appetite changes – digestive symptoms  Sleep deprivation  Abdominal upsets – hollow feeling in stomach  Weight loss, hair loss, memory loss

CHANGES IN BEHAVIOUR  Purposeless activity  Crying  Lack of interest  Easily distracted  Forgetfulness  Slow movements

 The emotional suffering you feel when someone or something you love is taken away.  A natural response to loss which we all experience at some time  Usually associated with the death of a loved one – most intense  The more significant the loss, the more intense the grief  Very personal and highly individual experience – no right or wrong way to grieve

Dr Patch Adams “ the worst part for people who are considered to be dying is being treated as if they are already dead – people want visitors who are jolly fun and cheerful” “ Dying is that process a few minutes before death, when the brain is deprived of oxygen, everything else is living”

 False reassurance  Sympathy  Changing the subject  Giving personal opinions  Approval or disapproval  Arguing

 Bereavement is the actual process a person goes through following a significant loss  It has been likened to thoughts and feelings following the experience of being robbed or deprived of something of value  Something suddenly been yanked away (Crisp & Taylor, 2005)

T – to accept reality of loss E – experience the pain of loss A – Adjust to an environment that no longer includes the lost person, object or aspect of self R – reinvest emotional energy into new relationships

Nurses and caregivers need to……..  accept diversity in the beliefs and responses of others.  view each situation as unique.  respond to situations in an honest, sensitive and caring manner.  take time to intervene sensitively and appropriately when caring for those who have experienced a loss

Nursing goals for dying patient  Gaining and maintaining comfort  Maintaining independence in ADL’s  Reducing anxiety  Ensuring feelings of security – do not leave alone  Achieving spiritual comfort and forgiveness  Gaining relief from loneliness and isolation  Allow patient / family control & involvement  Tailor to beliefs, customs and practices held by patients

 Provide relief from pain and other distressing symptoms  Affirm life and regard dying as a normal process  Neither hasten or postpone death  Integrate the psycological and spiritual aspects of patient care  Support patients to live as actively as possible until death  Use a team approach to address the needs of patients and their families  Enhance quality of life, and positively influence the course of illness