THE EXPERIENCE LOSS, DEATH & GRIEF

The Role of the NursesPrevent illness, injury and help patients return to health

Help patients and family cope with things they can not change and facilitate a peaceful death

LOSSDefinitionAn actual or potential situation in which something that is valued, is changed, no longer available or gone. People grieve the loss of multiple things.

Types of LossNecessary loss a part of life as people move forward in life may be permanent or for the better

Maturational loss includes all normally expected life changes across the life span

Types of LossSituational Loss can be caused by sudden, unpredictable external events e.g. income, physical change as a result of injury

Types of LossActual can be identifiedby othersPerceived cannot beverified by others.Anticipatory is experiencedbefore it really occurs

Types of LossDeathThe ultimate lossGenerates anxiety, fear and uncertaintyPermanently separates people physicallyApproach to death is influenced by values, culture, previous experience and social support

GRIEF Grief the emotional response to the loss, manifested in ways unique to an individual and based on personal experience, cultural expectation and spiritual beliefs

Mourning

Mourning the outward, social expression of grief and the behavior associate with loss

Influenced by culture, religious experience and customs.

BereavementBereavement encompasses both grief and mourning and includes the emotional response and outward behaviors of a person experiencing loss

Types of GriefNormal AnticipatoryDisenfranchisedAmbiguous lossComplicatedExaggeratedDelayedMasked

Mourning/Grief ResponseMourning Period of acceptance after a lossGrief response Depends on cause of death Sudden deathDeath from socially stigmatized illnessInfant, miscarriageViolent

Grief ResponseAccidental death Feelings of bad luck Guilt response Line of DutyDeath while defending is viewed as honorable SoldiersPolice Suicide Religious implications

Stagesof DyingKubler-Ross (1969)Five StagesDenialAngerBargainingDepressionAcceptance

Kulber-Rosss Stages of DyingDenial and isolation

Anger Why me?

Bargaining

Depression

Acceptance

Factors Influencing Loss and GriefHuman Development

Personal Relationship

Nature of the loss

Coping Strategies

Factors Influencing Loss and GriefSocioeconomic Status

Culture and Ethnicity

Spiritual and Religious Beliefs

Factors Influencing Grief:

Age

Sex roles

Social support

Nature of loss

Dying persons grief

Factors Influencing Grief

Family

Socioeconomics

Culture/Religion

Nature of relationship

Nursing ProcessAssessmentNature of RelationshipSocial Support SystemNature of the LossCultural and Spiritual BeliefsLife GoalsFamily Grief PatternSelf CareHope

Nursing ProcessNursing DiagnosisGrievingHopelessnessIneffective denialFearImpaired ComfortReadiness for enhanced spiritual well-being

Nursing ProcessPlanning Goals and OutcomesEncourage patients and family members to share their priorities for care at the end of life

Nursing ProcessImplementationHealth PromotionPalliative Care in Acute and Restorative settingsHospice CareUse Therapeutic CommunicationProvide Psychosocial Care

Nursing ProcessImplementation contdManage SymptomsPromote Dignity and Self-EsteemMaintain a Comfortable and Peaceful EnvironmentPromote Spiritual Comfort and HopeProtect Against Abandonment and Isolation

Nursing ProcessImplementation contdSupport the Grieving FamilyAssist with End of Life Decision MakingFacilitate MourningCare After Death

Nursing ProcessEvaluationThe success of the evaluation process depends partially on the bond that you formed with the patient

A patients response and perceptions of the effectiveness of nursing interventions determines if the existing plan of care is effective or needs to be revised

Once Death Occurs.Care of the body - viewingTubes, dressingsFamily, loved ones timeIdentification of bodyPastoral, psychosocial support

Nursing Responsibilities:Medical Examiner (county coroner)AutopsyNo consent needed ifDeath caused by accidentSuicideHomicideIllegal therapeutic practiceSudden unexplained death

Care of Self

Importance of Nurses Self Care Nurses can not give fully engaged, compassionate care to others when you feel depleted or do not feel cared for yourself

Nurses who practice self-care are more likely to experience professional and personal growth and find meaning in their work.

Advance DirectivesLiving Will / D.N.R.

Durable Power of Attorney

Health Care Surrogate designation

Advance DirectivesAging with Dignitywww.AgingWithDignity.org

End of Life Issueswww.FloridaHealthStat.com