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Loss, Grief, & Bereavement. Grief, Loss and Bereavement. Patient, family and nurse all experience losses Each person grieves in their own way An interdisciplinary care approach is vital. Nurse’s Role. Assess the grief Assist the patient with grief Support survivors. The Grief Process.

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Loss, Grief, & Bereavement


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    Presentation Transcript
    1. Loss, Grief, & Bereavement

    2. Grief, Loss and Bereavement • Patient, family and nurse all experience losses • Each person grieves in their own way • An interdisciplinary care approach is vital

    3. Nurse’s Role • Assess the grief • Assist the patient with grief • Support survivors

    4. The Grief Process • Begins before the death • Not orderly or predictable • Includes a series of stages or tasks • No one “gets over it” • Grief work leads to living with the loss Chan et al., 2004

    5. Loss • A loss may be a person, thing, relationship, or situation. • Grief is an emotional response to loss • Mourning is the outward, social expression of loss • Strongly influenced by culture Corless, 2006

    6. Bereavement • The reaction of the survivor to the death of a family member or close friend. • Be aware of cultural characteristics. D’Avanzo & Geissler, 2003

    7. Types of Grief • Grief before loss • Actual or fear of potential losses • Experienced by patient, family, professionals • Children have unique needs Glass et al., 2006 Anticipatory Grief

    8. Normal Grief (Uncomplicated) • Normal feelings, behaviors and reactions to loss • Physical, emotional, cognitive and behavioral reactions

    9. Complicated Grief • Chronic grief • Delayed grief • Exaggerated grief • Masked grief

    10. Complicated Grief – Risk Factors • Sudden or traumatic death • Suicide, homicide • Death of a child • Multiple losses

    11. Disenfranchised Grief • When loss cannot be openly acknowledged or socially sanctioned • At risk- AIDS partners, ex-spouse, step-parent/child, terminated pregnancy

    12. Children’s Grief • Based on developmental stages • Can be normal or complicated • Symptoms unique to children

    13. Stages and Tasks of Grief Stage 1 Notification and shock Stage 2 Experience the loss Stage 3 Reintegration Corless, 2006

    14. Factors Influencing the Grief Process • Survivor personality • Coping skills, patterns • History of substance abuse • Relationship to deceased • Spiritual beliefs • Type of death • Survivor ethnicity and culture

    15. Grief Assessment • Begins at time of admission or diagnosis • Ongoing to detect complicated grief Corless, 2006

    16. Assessment by the Nurse • Type of grief • Grief reactions • Influencing factors • General health of caregiver/survivor Glass et al., 2006

    17. Bereavement Interventions • Plan of care • Attitude • Cultural practices • What to say • Anticipatory grief

    18. Bereavement Interventions for Children and Parents • Recognize developmental stage • Refer to support groups

    19. Anticipatory Grief Interventions for Patient and Family • Preventive approaches to minimize sense of loss • Adaptive equipment to minimize loss of mobility • Advance directives to minimize loss of control • Reframing experiences to minimize effects

    20. Grief Interventions for Survivors • Provide presence • Active listening, touch, silence, reassurance • Identify support systems • Use bereavement specialists & resources • Normalize & individualize the grief process • Actualize the loss & facilitate living without deceased

    21. Grief Interventions • Identify and express feelings – their story • Special attention to disenfranchised grief • Public funerals, rites, rituals, traditions • Private reflection • Spiritual care • Recognize developmental stage in children • Refer to support group

    22. Completion of the Grieving Process • No one can predict completion • Grief work is never completely finished • Healing occurs when the pain is less

    23. The Nurse: Prevention of Compassion Fatigue Nurses witness: • Medical futility • Prolongation of suffering • Denial of palliative care services • Nurses Experience: • Moral distress Ferrell, 2006

    24. Cumulative Loss

    25. Stages of Adaptation • Nurses new to working with the dying need to emotionally & spiritually adapt • Stages of adaptation • Intellectualization • Emotional survival • Depression • Emotional arrival • Deep compassion • The “doer” Harper, 1994

    26. Factors Influencing the Nurse’s Adaptation • Professional education • Personal death history • Life changes • Support system Vachon, 2006

    27. Systems of Support • Balance • Assessing support systems • Spiritual support • Education in end-of-life care • Self care strategies Vachon, 2006

    28. Conclusion • Nursing care does not end with the death of a patient • Loss, grief and bereavement need to be assessed with ongoing intervention • Nurses must recognize and respond to their own grief • Provide interdisciplinary care

    29. Caring for the Body and Soul