LOSS, DEATH: GRIEF AND THE GRIEVING

PROCESS

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 –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

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 GriefThe 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 GriefStage

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 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

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