Loss, Death, Grieving Nursing 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.
GRIEF 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).
GRIEF 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.
GRIEF AND THE GRIEVING PROCESS Loss may be • Actual • Perceived • about external objects • about known Environment • about significant others • about an aspect of Self • of Life
GRIEF 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.
GRIEF 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.
GRIEF AND THE GRIEVING PROCESS Types of grief that may be expressed are: • Abbreviated grief-brief but genuine • Disenfranchised grief-grief that cannot be acknowledged openly • Complicated grief-unhealthy grief; inhibited, delayed, exaggerated, unresolved/chronic
GRIEF 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.
Kubler-Ross Stages of Grief The Stages Manifestations • Denial Anger • Muscular weakness, clammy sensation, inability to think, feel, or move; may report having dreams in which the deceased was alive • Anger towards the deceased, towards God, caregivers and jealousy towards those who still have their loved ones alive
Kubler-Ross Stages of Grief Stage • Bargaining Depression Acceptance Manifestations • Trying 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
Engel’s Stages of Grieving • Shock and disbelief • Developing awareness • Restitution • Resolving the loss • Idealization • outcome
Expression of Grief • There 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.
GRIEF AND THE GRIEVING PROCESS The nature and extent of grief is influenced by • Age • Nature of the loss • Cultural and spiritual beliefs • Gender roles • Socio-economic status/social support systems
The Dying Patient Loss 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 society • Loss of independence, self esteem and integrity. • Loss of job • Loss of the ability to live without interruptions of frequent hospitalization and painful treatments. • Loss of friends and love ones
Fears of the dying client These loses may arouse fears in the patient • Fear of Loneliness • Distancing by support people and caregivers can occur • Debilitation, pain, and incapacitation • Hospital, a place that can be very lonely • Fear of dying alone
Fears of the dying client • Fear of Sorrow • Sadness • Letting go of hopes, dreams, the future • Awareness of own mortality • Grief about future losses • Anticipatory grief that involves mourning, coping skills • Grief related to diagnosis that has a long term effect on the body such as cancer • Patient may feel well at time of diagnosis
Fears of the dying client • Fear of the unknown: • Death is an unknown state • What will happen after death? • What will happen to loved ones, those left behind
Dying with Dignity • Dying Persons’ Bill of Rights (look for) • Promotion of comfort • Maintenance of independence • Prevention of loneliness and isolation • Promotion of spiritual comfort • Support for the grieving family • Hospice Care
Approaching Death: Some Physical Changes • Dying person turns toward light - sees only what is near • Can only hear what is distinctly spoken • Touch is diminished - response to pressure last to leave • Dying person might turn toward or speak to someone not visible to anyone else • Eyes may remain open even if unconscious • Person might rally just before dying
Approaching Death: Some Physical Changes • Temperature may increase or decrease • Pulse may be fast, irregular, weak, difficult to find • Respirations may be rapid, shallow, noisy, Cheyne-Stokes • BP decreases • Peripheral circulation is impaired
Approaching Death: Some Physical Changes • Thirst; dry mouth • Sight fails • Asphagia • Mental alertness varies • Hearing- supposed to be last sense to be lost • Relaxation of muscles
Approaching Death: Some Physical Changes • Pupils might react sluggishly or not at all to light • Pain might be significant • Assess for pain if person unable to talk: restlessness, tight muscles, facial expressions, frowns • Provide pain medication as needed
Approaching Death: Some Physical Changes • Death is the end, as we know it, for that person • We can only support, listen therapeutically, • Make the person as physically comfortable as possible • We can also use our knowledge and expertise to strengthen, support, and prepare the family
Some Changes After Death • Physical Changes After Death • Pupils- Fixed and dilated • Algor Mortis- Rapid cooling of the body • Rigor Mortis- Stiffening of the body, develops 2-4 hours after death • Livor Mortis- Purple discoloration of skin in dependent areas
Some Changes After Death • Certification of death by the physician • performance of last offices