Grief, Loss,Death And Dying

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    22-Jan-2015

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  • 1. Mariane T. Sibala, RN Larmen de Guia Memorial College 2009
  • 2.
    • Loss is a universal experience that occurs throughout the lifespan.
    • Grief is a form of sorrow involving feelings, thoughts and behaviors caused by bereavement.
    • Responses to loss are strongly influenced by ones cultural background.
  • 3.
    • The grief process involves a sequence of affective, cognitive and psychological states as a person responds to and finally accepts a loss.
  • 4.
    • LOSS = something of value is gone
    • GRIEF = total response to emotional experience related to loss
    • BEREAVEMENT = subjective response to by loved ones
    • MOURNING = behavioral response
  • 5. Stages Behaviors D A B D A Refuses to believe that loss is happening Retaliation Feelings of Guilt, punishment for sins Laments over what has happened Begins to plan (e.g. wills, prosthesis)
  • 6.
    • The end of life
    • The full cessation of vital actions
    • Permanent state in the field of biology
    • All living things eventually die
    • What are the persons feelings towards death?
  • 7.
    • Present generation may be unaware of feelings
    • Prolonging life
    • Common fears
    • Behaviors of health care professionals
  • 8.
    • No, not me
    • After the initial shock has worn off, the next stage is usually one of classic denial, where they pretend that the news has not been given.
    • They effectively close their eyes to any evidence and pretend that nothing has happened.
  • 9.
    • Do not interfere unless it becomes destructive
    • Do not support denial; conversations should include reality
    • Continue to teach and encourage self care activities.
  • 10.
    • Why me?
    • This stage often occurs in an explosion of emotion, where the bottled up feelings of the previous stages are expulsed in a huge outpouring of grief.
    • Whoever is in the way is likely to be blamed.
  • 11.
    • Give space allowing them to rail and below. The more the storm blows the sooner it will blow itself out.
    • Try not to respond in kind
    • When anger is destructive , it must be addressed directly. Remind the person of appropriate and inappropriate behavior.
  • 12.
    • Yes me, but
    • The patient attempts to negotiate a postponement with God and is generally kept a secret.
  • 13.
    • Spend time with patients
    • Discuss importance of valued objects and people.
  • 14.
    • The inevitability of the news eventually (and not before time) sinks in and the person reluctantly accepts that it is going to happen.
  • 15.
    • Be available
    • Dont attempt to cheer person up
    • Find out any religious support
  • 16.
    • Restful time, but not necessarily happy.
    • Often begin putting their life in order, sorting out wills and helping others to accept the inevitability.
  • 17.
    • Plan care to allow the person with whom patient is comfortable to care for him or her
    • It is important that you dont withdraw
  • 18.
    • May have increased hallucinations
    • Decreased appetite
    • May have temperature spikes
    • Incontinent for stool and urine 24 to 72 hours prior to death
    • Pain may be more intense
    • Restlessness is common 12 to 24 hours prior to death
  • 19.
    • Changes in respiratory status
    • Increase in chest fluids
    • Grunting and moaning on expiration
    • Skin changes
  • 20.
    • The role of the nursing staff is fundamentally supportive
    • Accept the physical and mental state he is in
    • Show him that they will not abandon him
    • Responds to the persons needs in a physical, psychological, social and intellectual level
  • 21.
    • Biological needs, reduction and control of pain
    • Pain is a subjective experience
    • Acute pain: usually temporary
    • Chronic pain: interrupts normal everyday functioning
    • Medication is more effective in the context of a holistic intervention
  • 22.
    • Feelings of anger, sadness, depression are part of a wider process of anticipatory grief, useful for the patients psychological preparation to die
    • Nursing staff has to comprehend and the person to express these feelings
    • The only way for the person to reconcile with these feelings is to talk to someone who is willing to listen
    • Support has to respond to the persons need for safety, autonomy and self-control
  • 23.
    • Emotional and social withdrawal
    • Need of emotional withdrawal co-exists with the need of belonging to an accepting and supportive social environment
    • When family/medical nursing staff keep their distance in order to protect themselves, the person experiences a social death, which is sometimes more painful than the actual death
    • Nursing staff must treat the dying person without fear, encourage relatives to be close to him, act as a liaison with the outside world
  • 24.
    • The new reality: irrational, unfair, difficult
    • why
    • Need to evaluate his life as meaningful, important, useful
    • Nursing staff should stand by him without being judgmental, let him decide where he wants to spend his last days, and interact with him as a person who LIVES
  • 25.
    • Nurses need to take time to analyze their own feelings about death before they can effectively help others with terminal illness
    • Understand that you may experience grief
    • Nurses have to be strong to control their feelings to be able to tolerate pain, illness, and death, and to keep their distance
  • 26.
    • Provide relief from illness , fear and depression
    • Help clients maintain sense of security
    • Help accept losses
    • Provide physical comfort
  • 27.
    • 1-5 immobility and inactivity; wishes and unrelated action responsible for action
    • 5-10 final but can be avoided
    • 9-12 understands own mortality and fears death
    • 12-18 fears and fantasizes avoidance
    • 18- 45 increased attitude awareness
    • 45-65 accepts mortality
    • Above 65 multiple meanings; encounters and fears
  • 28.