The Experience of Loss, Death, and Grief
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Types of loss
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Possession Known Environment Significant other An aspect of self Loss of Life
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Types of loss
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Necessary Maturational Situational Actual Percieved
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Grief
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response to emotional loss (mourning and bereavement) individualized according to personal loss normal
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Anticipatory Grief
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\"letting go\" if prolonged, have grief responses before death (shock, denial, tearfulness) feel \"relief\" when over
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Disenfranchised grief
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unsupported grief can't be openly acknowledged (examples: ex-spouse, patner, pet, during commission of a crime, stigmatized illness (Alcoholism) Ambiguous loss
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Complicated grief
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not a normal grief process prolonged period, difficulty moving forward lasts at least six month after loss often occurs when relationships have been complicated/unhealthy or if loss is associated with homicide, suicide, accident, loss of a child
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Theory's of the Grieving Process
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Kubler-Ross's stages of dying Bowlby's Worden's
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Factors that affect grief
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where you are at in life personal development/coping skills nature of loss coping strategies social support systems cultural and spiritual beliefs personal goals hope
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Grief reactions/Physical sensations
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headache nausea/appetite disturbances tightness in chest and throat Insomnia Oversensitivity to noise Depersonalization feeling short of breath muscle weakness lack of energy dry mouth
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Grief reactions/emotional
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Sorrow fear anger guilt anxiety loneliness fatigue helplessness/hoplessness yearning relief
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Grief reactions/thought processes
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Disbelief confusion or memory problems problems with decision making inability to concentrate feeling the presence of the deceased
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Grief reactions/behaviors
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crying and frequent sighing distancing from people absentmindedness dreams of the deceased keeping the deceased's room intact loff of interest in regular life events wearing objects that belonged to the deceased
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What is death
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occurs when all vital organs and body systems cease to function. It is irreversible cessation of cardiovascular, respiratory and brain function not a medical event it is a personal event belongs to the person and their family
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The dying process: Cardiovascular
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heart rate increases B/P lowers skin is cool edema is present in extremities
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The dying process: Respiratory
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Shortness of breath (pain, anxiety, ascites, tumor pressure, fluid overload, arrhythmias \"Death rattle\"- accumulation of fluids in the back of the pharynx
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Death rattle
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accumulation of fluids in the back of the pharynx
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The dying process: GI
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nausea decrease in nutrition is natural, tastes/desire for dood declines continues to make stool (even if not eating or drinking) must aggressively treat constipation
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The dying process: Urinary
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output will decrease may become incontinent, little bladder sensation
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The dying process: Musculoskeletal
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muscles weaken, falls increase extremities look \"wasted\" due to muscle and weight loss
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The dying process: Sensory
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vision blurs taste changes touch can be distorted or heightened hearing may be the last sensation to go
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The dying process: mental changes
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confusion withdrawn restless increased agitation
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The dying process: Psychosocial
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financially draining may cause disruption in family roles/responsibilties
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The dying process: spiritual
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Where is God facing death/loss of everyone and everything grieving for loss of \"things to come\"
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Palliative care
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alleviating the symptoms of the illness, focus on quality of life rather than the aggressive treatment of illness
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Nursing care
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Therapeutic communication Promote hope maintain self-esteem/Promote dignity Promote return of life Listen Promote comfort maintain comfortable and peaceful environment manage symptoms maintain independence prevent loneliness and isolation Promote spiritual comfort Support grieving family
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Pain
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it is whatever the experiencing person says it is, existing whenever the experiencing person says it is believe the patient impairs the quality of life don't be afraid to treat it
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Care after death
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Organ/tissue donation Physiological changes Autopsy Family viewing Preparation of the body/Postmortem Documentation
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Nurse's experiences with Grief and death
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past experiences present experience feelings and emotions comfort level
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Necessary loss
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losses that everyone experiences
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Maturational loss
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a form of necessary loss and includes all normally expected life changes across the life span
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Situational loss
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sudden, unpredictable external events that bring about some form of loss
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Actual loss
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occurs when a person can no longer feel, hear, see, or know a person or object
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Percieved loss
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defined by the person experiencing the loss and is less obvious to other people
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Mourning
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the outward, social expression of grief and the behavior associated with loss
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Bereavement
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ecompasses both grief and mourning and includes the emotional responses and outward behaviors of a person experiencing loss
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Normal grief
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a common universal reaction characterized by complex emotional, cognitive, social, physical, behavioral, and spiritual responses to loss and death feeling of acceptance, disbelief, yearning, anger, and depression are displayed
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Ambiguous loss
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a type of disenfranchised rief, occurs when the lost person is physicaaly present but not physiologically available as in cases of severe dementia and brain injury
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Exaggerated Grief
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often exhibits self-destructive or maladaptive behavior, obsessions, or psychiatric disorders
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Delayed grief
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grief is postponed often because the loss is so overwhelming that the person must avoud the full realization of the loss
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Masked grief
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person behaves in a way that interfere with normal functioning but is unaware that the disruptive behavior is a result of the loss and ineffective grief resolution
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Kubler-Ross's stages of dying
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Denial Anger Bargaining Depression Acceptance
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Denial stage
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cannot accept the fact of the loss
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Anger stage
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a person expresses resistance and somtimes feels intense anger at God, other people, or situation
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Bargaining Stage
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cushions and postpones awareness of the loss by trying to prevent it from happening
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Depression stage
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feel overwhelming sad, hopeless, and lonely
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Acceptance Stage
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the person incorporates the loss into life, develops the capacity to have a breadth of emotions, even positive ones, and finds ways to move forward
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Bowlby's Attachement Theory
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Four stages of mourning: numbing yearning and searching disorganization and despair reorganization
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Numbing
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the shortest of the mounring stages, may last for a few hours to a week or more feel \"stunned\" or \"unreal\" protects the person from the loss
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Yearning and searching
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Emotional outbursts of tearful sobbing and acute distress characterize this stage stage lasts for months or longer separation anxiety
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Disorganization and despair
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a person examines why and how the loss occurred or expresses anger at anyone who seems responsible for the loss the person retells the loss story time and time again until they realize the loss is permanent
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Reorganization
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takes a year or more, the person begins to accept change, assume unfamiliar roles, acquire new skills, and build new relationships
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Worden's Grief task model
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Four tasks
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Task 1
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accept the reality of the loss: involves the process of accepting the person or object is gone and will not return
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Task 2
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Experience the pain of grief: people react with sadness, loneliness, despair, or regret and work through painful feelings using coping skills most comfortable to them
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Task 3
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Adjust to a world in which the deceased is missing:
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Task 4
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emotionally relocate the deceased and move on with life
