Intervening with Death and Dying

Anita Rhodes, RN, MSN

Grief, Bereavement, and Mourning

• Grief- is the total response to the emotional experience to related to loss.

• Bereavement-is the subjective response experienced by the surviving loved ones after the death of a person with whom they have shared a significant relationship.

• Mourning-is the behavioral process through which grief is eventually resolved or altered; it is often influenced by culture, spiritual beliefs, and custom.

Types of Loss and Grief

• Sudden or Acute

• Anticipatory

• Dysfunctional

• Chronic Sorrow

• Complicated Grief

• Absent, Covered

• Grief Work

Stages of Dying

• Denial, Shock

• Anger, Volatile Emotions

• Guilt

• Bargaining

• Depression, Loss and Loneliness

• Acceptance, Relief and Re-establishment

• Shadow Grief

Common Issues

• Family• Loss of Control• Pain and Discomfort• Helplessness• Peaceful Death• Fatigue• Guilt

• Patient

• Fear

• Body Image

• Control

• Separation from family

• Life Review

• Pain

• Irritable and Withdrawn

Communication Principles

• Be Available• Listen• Give Factual Information• Use correct terms but avoid medical terminology• Help make plans and mend relations• Be empathic• Avoid false reassurance• Remember that hearing is the last sense loss

Factors Influencing the Loss and Grief Responses

• Age– Childhood– Early and Middle Adulthood– Late Adulthood

• Significance of the Loss• Culture• Spiritual Beliefs• Gender

Nursing Care

• Where• Hospice• Home• Residential• Acute• Advance Directives• Living Will• Organ Donation

• Cure vs. Care• Identify Individual and

Family Needs• Hydration• Nourishment• Elimination• Hygiene• Positioning• Comfort• Involving the Family

Factors Influencing the Loss and Grief Responses

• Socioeconomic Status

• Support System

• Cause of Loss or Death

Definitions and Signs of Death

• Clinical Signs of Death– Total lack of response to external stimuli– No muscular movement, especially breathing– No reflexes– Flat encephalogram

• Cerebral Death or Higher Brain Death

Legalities Related to Death

• Advance Directives• Certification of Death• Labeling the Deceased• Autopsy• Organ Donation• Inquest• Euthanasia• Do-Not-Resuscitate Orders