Competency 6: Loss, Grief, & Death Developed by: Dede Carr, BS, LDA Karen Neu, MSN, CNE, CNP 1

1

Awareness & Sensitivity to Client’s Health Care Needs

Competency 6: Loss, Grief, & Death

Developed by:Dede Carr, BS, LDA

Karen Neu, MSN, CNE, CNP

U.S. Department of Labor Grant“This workforce solution was funded by a grant awarded by

the U.S. Department of Labor’s Employment and Training Administration. The solution was created by the grantee and does not necessarily reflect the official position of the U.S. Department of Labor. The Department of Labor makes no guarantees, warranties, or assurances of any kind, express or implied, with respect to such information, including any information on linked sites and including but not limited to, accuracy of the information or its completeness, timeliness, usefulness, adequacy, continued availability, or ownership. This solution is copyrighted by the institution that created it. Internal use, by and organization and/or personal use by an individual or non-commercial purposes, is permissible. All other uses require the prior authorization of the copyright owner.”

2

3

Competency 6: Death & Dying

Define the stages & processes of death & dying & influences those stages have on clients & familiesList the emotional stages of grief that occur in

death & dyingList the needs of the dying client & their familyList the different types of death & how they

may affect the client & the family’s ability to move through the stages of death

4

Lifetime Losses & Grieving Everyone experiences loss, grieving, & death at some

time during his/her life.People may suffer loss of: Valued relationships through moving from one city or

state to another, separation, divorce, or the death of a family member (parent, grandparent, sibling, spouse) or friend

Changing life roles as they watch grown children leave home or retire from lifelong work,

Employment or ability to drive a vehicle safelyValued material objects through theft, natural disastersPets (Berman et al., p. 1081)

5

Loss in Health Care Settings Healthcare workers interact with dying

clients & their families or caregivers in a variety of settings from a death of an unborn child, to the adolescent victim of an automobile collision, to the elderly client who dies from a chronic illness

There are many influences on the dying process: legal, ethical, religious, spiritual, biological, personal

It is important that the healthcare worker provides sensitive, skilled, & supportive care to all those affected (Berman et al., p. 1081)

6

Loss in Health Care Settings Healthcare workers encounter clients who may be

experiencing grief to declining health, loss of a body part, terminal illness, or impending death of self or significant other, loss of function, loss of independence,

In home healthcare or community, healthcare worker may work with clients grieving losses related to personal crisis (divorce, separation) or disaster (tornadoes, floods, fire)

It is important to understand the significance of loss & develop an ability to assist clients as they work through the grieving process (Berman et al., p. 1081)

7

LossLoss: The actual or potential situation in which

something that is valued is changed & no longer available

People can experience the loss of body image, a significant other, a sense of well-being, a job, personal possessions, or beliefs

Illness & hospitalization often produce losses (Berman et al., p.

1081)

8

DeathDeath is a fundamental loss for the dying person &

for those who surviveDeath can be viewed as the dying person’s final

opportunity to experience life in ways that bring significance & fulfillment

People experiencing loss search for the meaning of the event, & it is generally accepted that finding the meaning is needed in order for healing to occur

However, persons can be well adjusted without searching for meaning, & even those who find meaning may not see it as an end point but rather an ongoing process (Berman et al., p. 1081)

9

Types of Losses1. Actual Loss: Loss that can be recognized by others2. Perceived Loss: Loss experience by one person but

cannot be verified by anotherExample: A woman who leaves her employment to care

for her children at home may perceive a loss of independence & freedom

Both actual & perceived losses can be anticipatory loss

Anticipatory Loss: Loss that is experienced before the loss actually occursExample: A woman whose husband is dying may

experience the actual loss in anticipation of his death (Berman et al., p. 1082)

10

Types of LossesLoss can be viewed as situational or developmentalDevelopmental Losses: Losses that occur during the

process of normal development, such as grown children leaving home, retirement from a career, death of aged parents (these generally can be anticipated & prepared for)

Many sources of loss: Loss of an aspect of self: a body part, a physiologic function (no longer able to bear a child) or a psychological attribute; loss of an object external to oneself; separation from an accustomed environment; loss of a loved or valued person (Berman et al., p. 1081)

11

Loss & DeathSituational Losses: loss of one’s job, death of a child,

or loss of functional ability because of acute illness or injury

Types of DeathUnexpected death that leaves families feeling shocked

& bereaved; Examples might be death due to a heart attack

Traumatic death which can lead to complicated grief: Examples: suicide or homicide

Anticipated death from a chronic or prolonged illness; families may be physically & emotionally exhausted from caring for the family member prior to death (Berman et al.)

12

Grief, Bereavement, MourningGrief: “The total response to the emotional

experience to loss” “Grief is manifested in thoughts, feelings, & behaviors associated with overwhelming distress or sorrow”

(Berman et al., p. 1082)

Bereavement: “The subjective response experienced by the surviving loved ones after the death of a person with whom they have shared a significant relationship”

(Berman et al., 1082)

Bereavement: “A common depressed reaction to the death of a loved one” (Kochrow & Christensen, p. 190)

13

Grief, Bereavement, MourningMourning: “The behavioral process through

which grief is eventually resolved or altered; it is often influenced by culture, spiritual beliefs, & custom” (Berman et al., p. 1082)

Mourning: “(reaction activated by a person to assist in overcoming a personal loss) refers to culturally defined patterns for expressions of grief; mourning patterns include funerals, wakes, memorials, black dress, & defined time of social withdrawal”

(Kochrow & Christensen, p. 190)

14

Grief, Bereavement, MourningGrief & mourning are experienced by the

person who faces the death of a loved one AND by the person who suffers other kinds of losses (includes healthcare workers)

Grieving is important for one’s physical & mental health

Grieving permits individuals to cope with the loss gradually & accept it as part of reality

Grief is a social process & is best shared & carried out with the assistance of others (Berman et al., p. 1082)

15

Grief, Bereavement, MourningHealthcare workers who work with the terminally ill &

bereaved often develop a heightened empathy & identification with their patients

This occurs because the loss experience is so universal that everyone has experienced its impact

Previous losses can prepare people for the ultimate loss of death

Grief is a normal & universal response to lossThere are many examples of increased illness or an abnormal

condition (both physical & mental) after significant losses in the survivors, especially caregivers

Research indicates that there are increases in breakups in marriages & other significant relationships after the loss of a child or when one partner suffers a loss of a body part or function (Kochrow & Christensen, p. 190)

16

Grief, Bereavement, MourningGrief involves thought, feelings, & behaviors & has a

useful function when allowed to operate normallyThe goal of the grieving process is to resolve the hurt

& to reestablish one’s lifeGrief comes & goes with a person’s life experiences

& many years later an event reminds the person of the loss & the feelings return

Such events might include encounters with smells, places, foods, dates, holidays, clothing, music, & other people

Grief is not an episode; it is a process, sometimes one that goes on forever (e.g. parents grieving for a child)

(Kochrow & Christensen, p. 190)

17

Grief, Bereavement, MourningGrieving persons try a variety of strategies to copeTasks of grief that facilitate healthy adjustment to loss

Accepting the reality of the lossExperiencing the pain of griefAdjusting to an environment that no longer includes the lost

person, lost object, or the lost aspect of selfReinvesting emotional energy into new relationships

The successful completion of these tasks leads to the passage from grief to closure

These tasks do not necessarily occur in a specific order or sequence; people may work all tasks of grief at the same time or only one or two may be priorities

Healthcare workers can assist patients & their families in working through these tasks (Kochrow & Christensen, p. 190)

18

Grief, Bereavement, MourningWorking through one’s grief is important because

bereavement may have devastating effects on healthSymptoms that may accompany grief are:Anxiety, * Excessive sweatingDepression * Menstrual disturbancesSwallowing difficulties * PalpitationsVomiting * Chest painFatigue * Changes in libido Headaches * Alterations in communicationDizziness * Difficulty in concentrationFainting * Disturbances in eating patternsBlurred vision * Alterations in sleeping patternsSkin rashes * Changes in activityShortness of breath (Berman et al., p. 1082)

19

Types of Grief

20

Grief, Bereavement, MourningIt’s important to differentiate the expression of

grief as a normal healthy response to loss (needs support & public acknowledgement) from grief as a response of greater distress & personal disruption (requires intensive intervention/assistance)

There are different types of grief1. Normal grief2. Complicated grief3. Anticipatory grief4. Disenfranchised grief

21

Grief, Bereavement, MourningAlthough bereavement can threaten health, a positive

resolution of the grieving process can enrich the individual with new insights, values, challenges, openness, & sensitivity (Berman et al., p. 1082)

There is no right or wrong way to grieve; theories of grief are only tools that can be used to anticipate the emotional needs of patients/families & plan ways to help them understand their grief & deal with it

Healthcare workers’ roles are to observe & assess grieving behaviors, recognize the influence of grief on behaviors, & provide empathetic support

(Kochrow & Christensen, pp. 190-191)

22

Normal GriefNormal grief (uncomplicated grief)-most common type of grief) is

when grieving people are in the process of coping with the death of a loved one (Potter & Perry, p. 463)

Coping styles, such as hardiness & resilience & a personal sense of control, the ability to make sense of the loss, & to find benefit in the loss are factors found to be helpful (Holland & others, as cited in (Potter & Perry, p. 463)

Normal grief is a complex response with emotional, cognitive, social, physical, behavioral, & spiritual concepts

Feelings of acceptance, disbelief, yearning, anger, & depression were displayed as normal bereavement (Maciejewski & others, 2007 as cited in Potter & Perry, p. 463)

Yearning (longing & searching for the deceased person) was the most common negative feeling, peaking at 2 months after the loss;

Acceptance was the strongest initial response & grew increasingly over time

Negative emotions (anger & depression) peaked around 4 months & were in decline by 6 months (Potter & Perry, p. 463)

23

Complicated GriefFor a minority of people, normal grief adjustment does not occurIn complicated (dysfunctional) grief, the grieving person has a

prolonged or significantly difficult time moving forward from the loss

Those with a complicated grief after the loss of a loved one experience a chronic & disruptive yearning for the deceased & are likely to have trouble accepting the death & trusting others, feel excessively bitter, or are uneasy about the future; they may feel emotionally numb

This type of grief usually occurs in situations of conflicted relationships with the deceased, prior or multiple losses or stressors, mental health issues, or lack of social support

Loss associated with homicide, suicide, sudden accidents, or loss of a child may become complicated

Symptoms & disturbances of complicated grief last at least 6 months after a loss & interrupt every dimension of the person’s life

(Potter & Perry, p. 463)

24

Anticipatory GriefAnticipatory grief: The unconscious process of disengaging or

“letting go” before the actual loss or death occurs, especially in long or predicted loss (Corless, as cited in Potter & Perry, p. 463)

When grief extends of a long period of time, people absorb the loss gradually & begin to prepare for the inevitability; they experience more intense responses to grief (shock, denial, tearfulness) before the actual death occurs & often relief when it happens

Anticipatory grief may be a forewarning to give families time to prepare for death & to complete related tasks to the impending death (may not apply in every situation though)

For some others, the stress & strain of a terminal illness (ruptures in spousal intimacy, separation anxiety, security threats, & traumatic helplessness of watching a loved one die) may outweigh the benefits of anticipatory grieving (Potter & Perry, p. 463)

25

Disenfranchised GriefPeople experience disenfranchised grief

(known as marginal or unsupported grief) when their relationship to the deceased person is not socially sanctioned, cannot be openly acknowledged or publicly shared, or seems of lesser significance (Hooyman & Kramer, as cited in Potter & Perry, p. 463)

Examples include death of a very old person, an ex-spouse, a gay partner, or even a loved pet (Potter & Perry, p. 463)

26

Stages of Grieving/Dying

27

Stages of Grieving/DyingKübler-Ross (1969) describes five stages of dyingAlthough these stages are listed in order,

grieving people do not experience them in any particular order for any length of time & often move back & forth between stages

Five Stages of DyingDenial StageAnger StageBargaining StageDepression StageAcceptance Stage (Potter & Perry, p. 464)

28

Stages of Grieving/DyingDenial & Isolation Stage: a person acts as though

nothing has happened & refuses to accept the fact of the loss; person shows no understanding of what has

occurred (Potter & Perry, p. 464)

This stage serves as a buffer to the patient to shield self until the individual is able to mobilize alternate defenses

Reaction: “No-not me.” “There must be a mistake.”

(Kockrow & Christensen, p. 193)

29

Stages of Grieving/DyingAnger Stage of adjustment to loss, a person

expresses resistance & sometimes intense anger at God, other people, or the situation (Potter & Perry, p. 464)

Hostility may be directed toward caregivers or loved ones

Reactions: “Why me?” (Kockrow & Christensen, p. 193)

30

Stages of Grieving/DyingBargaining Stage cushions & postpones awareness

of the loss by trying to prevent it from happeningBargaining Stage : Grieving or dying people make

promises to self, God, or loved ones that they will live or believe differently if they are spared the dreaded outcome

(Potter & Perry, p. 193)

Bargaining is often made with God. It is an attempt to post pone death & is a positive way to maintain hope

Reactions: “Yes, but…….” (Kockrow & Christensen, p. 193)

31

Stages of Grieving/DyingDepression Stage occurs when a person realizes the full

impact of the lossDepression Stage: Some feel an overwhelming sense of

sadness, hopelessness, & loneliness; resigned to the bad outcome, they sometimes withdraw from relationships & life (Potter & Perry, p. 464)

Sadness & grief; time of introspection; usually request only significant others to be with them

The patient struggles with painful realities of life & prepares for death

Reactions: “Yes, me.” (Kockrow & Christensen, p. 193)

32

Stages of Grieving/DyingAcceptance Stage: the person

incorporates the loss into life & finds ways to move forward (Potter & Perry, p. 464)

Resolved to the fact that death is imminentPeaceful acceptance & positive feelings are

often presentReactions: “I am ready.”


33

Factors Influencing Loss & Grief Responses

34

Factors Influencing Loss & GriefMultiple variables influence the way a person

perceives & responds to lossVariables areHuman developmental factorsPersonal relationshipsNature of the lossCoping strategiesSocioeconomic statusCultural influencesSpiritual influences (Potter & Perry, pp. 465-467)

35

Human Developmental FactorsClient’s age & stage of development affect the

grieve responseToddlers do not understand loss or death, but

feel anxiety & sometimes express the sense of absence with changes in eating & sleeping patterns, fussiness, or bowel & bladder disturbances

School-age children understand permanence & irreversibility, but do not understand the causes of a loss; some have intensive emotional expressions

(Potter & Perry, pp. 465-467)

36

Human Developmental FactorsYoung adults have developmental losses as they leave home

and or form significant relationships; illness or death disrupts one’s future & the necessary tasks of establishing an autonomous sense of self

Midlife adults experience major life transitions: caring for aging parents or dealing with their death, dealing with changes in marital status, losses resulting from impaired health or body functions, & adapting to new family rolesResponse influenced by previous loss experiences, person’ s

self-esteem, & strength & availability of support

Older adults deal with losses related to the aging process & may have more skills dealing with death learned from multiple previous experiences with loss (Berman et al., p. 1084-1085)

37

Personal RelationshipsThe quality & meaning of the lost relationship (if

very close, well-connected) influences the grief Grief resolution may be hampered by regret or a

sense of unfinished business when people are closely related but did not have a good relationship at the time of death

Social support & the ability to accept help from others are critical variables in recovery from loss & grief

If clients do not receive supportive understanding & compassion the grief becomes complicated or prolonged (Potter & Perry, pp. 465-466)

38

Nature of the LossExploring the meaning of the loss for a client helps the healthcare

worker understand the impact of loss on client’s behavior, health, & well-being (Corless, as cited in Potter & Perry, p. 466)

Highly visible losses generally stimulate a helping response from others, the community, & government, such as homes lost by tornados, but more private losses, such as a miscarriage brings much less support

Stressors from a sudden & unexpected death pose different challenges than those anticipated by a debilitating chronic illness

In cases of sudden & unexpected death, survivors do not have time to let go

In cases of chronic disease & death, survivors have memories of prolonged suffering, pain, & loss of function

Death by violence or suicide or multiple losses by their very nature complicate the grieving process in unique ways

(Stroebe & Schut, as cited in Potter & Perry, p. 466)

39

Cause of Loss or DeathIndividual & societal views on the cause of a loss or

death may influence the grief response or processSome diseases are considered “clean” & endear

compassion while others may be viewed as repulsive & unfortunate

A loss or death beyond the control of those involved may be more acceptable than one that is preventable, such as a drunk driver collision

Injuries & death occurring during respected activities, such as “in the line of duty” are considered honorable, whereas those occurring during illicit activities may be considered the individual’s just reward (Berman et al., p. 1086)

40

Coping StrategiesLife experiences shape coping strategies one uses to deal

with the stress of lossOne always relies first on familiar coping strategies after a

loss; when the usual strategies do not work, one needs new ones

Emotional disclosure (venting or talking about one’s feelings) is viewed as an important way to cope with loss

Recent research suggests that the focus should be on positive emotions & optimistic feelings rather than negative feelings or the expression of anger associated with the loss for a more successful bereavement coping strategy (Ong & Others, 2004, as cited in Potter & Perry, p. 466)

Emotional disclosure is often accompanied by having people write about their feelings (Potter & Perry, p. 466)

41

Socioeconomic StatusSocioeconomic status influences a person’s

ability to access support & resources for coping with loss & physical responses to stress

(Cohen, Doyle, & Baum, as cited in Potter & Perry, p. 466)

When people lack financial, educational, or occupational resources, the burdens of loss multiply

Example: a client with limited finances is not able to replace a car demolished in a collision & pay for the associated medical expenses (Potter & Perry, p. 466)

42

Culture & EthnicityOne’s culture & other social structures (family or

religious affiliation) influence the interpretations of loss, establish expressions of grief, & provide stability & structure amid the chaos & loss)

Expressions of grief in one person’s culture may not make sense to persons from another culture

Healthcare workers should try to understand & appreciate each client’s cultural values related to loss, death, & grieving

American cultural values of individualism & self-determination are in contrast with communal, family, or tribal ways of life

43

HopeHope: a multidimensional component of

spirituality, energizes & provides comfort to individuals experiencing personal challenges

Hopefulness gives one the ability to see life as enduring or as having meaning or purpose

As a future-shaping, motivating force, hope helps clients maintain anticipation of a continued good, an improvement in their circumstances, or a lessening of something unpleasant; with hope, a client moves from feelings of weakness & vulnerability to living as fully as possible

(Arnaert, Filteau, & Sourial, as cited in Potter & Perry, p. 467)

44

HopeMaintaining a sense of hope depends on a

person having a strong relationships & emotional connectedness to others

Healthcare workers help provide the sense of belonging, which is so essential to hope

The experience of spiritual distress often arises from a client’s inability to feel hopeful or foresee any favorable outcomes.

Spirituality & hope play a vital role in a client’s adjustment to loss (Potter & Perry, p. 467)

45

GenderGender roles into which people are socialized in US &

Canada affect their reactions at times of lossMen are frequently expected to “be strong” & show very

little emotion during grief, whereas it is acceptable for women to show grief by crying

Often the when the wife dies, the husband (chief mourner) is expected to repress his own emotions & comfort sons & daughters in their grieving

Gender roles also affect the significance of body image changes to clients

A man may consider a facial scar to be “macho,” but a woman might consider hers ugly; thus the woman, not the man, would see the change as a loss (Berman et al., p. 1086)

46

Support SystemPeople closest to the grieving individual are often the

first to recognize & provide the needed emotional, physical, & functional assistance

There are many people who are uncomfortable or inexperienced in dealing with losses so the usual people withdraw from the grieving individual

Support may be available when the loss is first recognized but as the support people return to their usual activities, the need for ongoing support is unmet

Sometimes the grieving individual is unable or unready to accept support when it is offered (Berman et al., p. 1086)

47

Survivor’s Manifestations of Grief & Bereavement

48

Normal Manifestations of GriefManifestations of grief that are considered

normal include the verbalization of loss, crying, sleep disturbances, loss of appetite, & difficulty concentrating (Berman et al., p. 1084)

49

Survivors’ Manifestations of Grief & Bereavement

According to Martocchio there are five stages of the survivor’s reaction to grief & bereavement:

Five Stages of Survivors’ Manifestations of Grief & Bereavement

1. Shock & disbelief2. Yearning & protest3. Anguish, disorganization, & despair4. Identification of bereavement5. Reorganization & restitution


50


Shock & DisbeliefSurvivors feel a sense of unrealityOften reject offers of comfort & supportDisbelief may remain even though death is

comprehended intellectuallyReactions: “Maybe this is not happening.”

“This is just a dream/nightmare.” (Kockrow & Christensen, p.

193)

51


Yearning & ProtestSurvivors may express anger toward the

deceased for leaving themReactions: “Why do I feel this way?”Anguish, Disorganization, & DespairReality & permanency of the loss are

recognizedReactions: “Living is a chore.”

“All the joy is gone out of life.”


52


Identification in bereavementBereaved may adopt behavior, ideals, mannerisms, or

goals of the deceased: “I will carry on her (dying person’s) goals.”

Reactions: “I am just like him (dying or deceased person).”

Reorganization & RestitutionLife stabilizes but some of the pain of loss may remain

for a lifetimeReactions: “Life goes on.”

“The sun has risen on a new day.”


53

Dimensions of Clients’ Needs

54

Dimensions of Clients’ of NeedsTo give compassionate care & support to the

family & dying patient during the grieving & dying process, the healthcare worker should consider the five aspects of human functioning:

PhysicalEmotionalIntellectualSocialSpiritual (Kockrow & Christensen, p. 195)

55

Physical Dimension Review the physical needs, such as sleeping

patterns, body image, activities of daily living (ADLs), mobility, general health, & pain

What are the basic needs of nutrition, elimination, oxygenation, activity, rest, sleep, & safety (Maslow’s Hierarchy of Needs)

Some goals are to provide comfort measures, energy conservation, pain reduction techniques, promotion of sleep & rest, & increasing self-esteem through body image acceptance (Kockrow & Christensen, p. 195)

56

Emotional DimensionPreparing for death is a personal endeavor filled with

anxiety & fearCheck the patient’s & family’s anxiety level, anger, level

of acceptance, & identificationMajor fears of dying include fears of abandonment

(dying alone), loss of control, pain & discomfort, & fears of the unknown

Healthcare workers shouldAccept the patient’s/family’s individual feelingsOffer encouragement & supportGive the patient “permission to die” by assisting the

patient in saying good-bye (Kockrow & Christensen, p. 195)

57

Emotional DimensionUse silence & personal presence along with techniques of

therapeutic communication (enhances the exploration of feelings & lets the client know that you acknowledge their feelings)

Acknowledge the grief of the client’s family & significant others (family support persons are part of the grieving client’s world)

Offer choices that promote client autonomy (client’s have a need of a sense of control over their own lives at a time when much control is not possible) for example: allow the client to choose when she/he wants his bath

Provide appropriate information regarding access to resources, such as clergy, support groups, & counseling services (Berman et al., p. 1089)

58

Intellectual DimensionConsider the patient’s/family’s level of education,

their knowledge & abilities, & expectations they have in regard to how & when death will occur

There can be changes in the intellectual dimensions during the dying process because of physiological changes, medications, the patient’s emotional state, or the disease process; Be alert to changes if the patient’s memory or if sensations are decreased

Provide patient/family education (what they can expect) & support;

Keep patient/family informed of procedures, changes in the patient’s condition (check hospital policies for tasks appropriate to your position)


59

Social DimensionCheck to see what involvement the family wishes to do in

providing care of their dying loved oneAssisting with the patient’s cares, such as a bath may give

the family a sense of control– it is important to check what tasks might be done by the family and what will be done by the healthcare worker

Important to make needs & wants clear to improve in trust & reduce hostility between family & healthcare workers

Each family & each individual member are unique in what they wish to do so don’t assume, but ask

Family is important, but it’s important to learn from the patient whom he/she considers significant others—who does the patient consider the most supportive person in his/her life? (It may be a friend, coworker, or church member


60

Spiritual DimensionHealthcare worker should assess the patient’s

philosophy of life, religious resources, & how the rituals of the particular faith group have significance in dealing with the patient’s death

What are the client’s feelings related to death & dying experiences

Do not judge or use tendencies to interpret & analyze; instead create an atmosphere of openness to discuss the patient’s spiritual concerns

Resources can come from clergy, friends, family, healthcare providers, & significant others

It is important to support the patient’s/family’s belief system & values (Kockrow & Christensen, p. 195)

61

Spiritual DimensionOne aspect of the belief system is hope & can take

many formsHope is multidimensionalHope is a common thread in all stages of griefIt is characterized by a confident yet uncertain

expectation of achieving a goal; it not a single act, but a complex series of thoughts, feelings, & actions that change often

The strength of religious connections & performance of family role responsibilities are significantly related to hope & coping (Kockrow & Christensen, p. 195)

62

Spiritual DimensionIt is difficult to maintain hope during the dying

processAs the person’s condition deteriorates, the health

care worker assists the family in translating hope of a cure into realistic hopes that are focused on short-term, achievable goals, such as a comfortable & a pain-free life or the decision to live long enough to participate in an important family event, such as a wedding of a child

A total loss of hope leads to distress of the human spirit & the relinquishment of hope is rapidly followed by death (Kockrow & Christensen, p. 198)

63

ReferencesBerman, A., Snyder, S.J., Kozier, B., & Erb, G. (2008). Loss,

grieving, & death. In A. Berman, S.J. Snyder, B. Kozier, & G. Erb (Eds.). Kozier & Erb’s Fundamentals of nursing: Concepts, process, and practice (8th ed.) (pp. 1080-1101). Upper Saddle River, NJ: Prentice Hall

Kockrow, O.E. & Christensen, B.L. (2006).Loss, grieving, dying, & death. In B.L. Christensen & E. O. Kockrow (Eds.). Foundations and adult health nursing (5th ed.) (pp. 188-216). St. Louis, MO: Elsevier, Mosby

Juliar, K. (2003) Minnesota Healthcare Core Curriculum (2nd ed.). Clifton Park, NY: Delmar Publishers

Potter, P.A. & Perry, A.G. (2009). The experience of loss, death, & grief. In P.A. Potter & A.G. Perry (Eds.). Fundamentals of nursing (7th ed.) (pp. 461-484). St. Louis, MO: Elsevier, Mosby

Documents

Competency 6: Loss, Grief, & Death Developed by: Dede Carr, BS, LDA Karen Neu, MSN, CNE, CNP 1