Loss, Grief and Dying Patient

FOUNDATION OF NURSING 212

LOSS AND GRIEF

Loss :

Is an actual or potential situation in which something that is valued is changed or 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 and hospitalization often produces losses .

TYPES OF LOSS:

There are only two types of losses :

1- Actual loss:

Which can be recognized by others .

2- Perceived loss :

Is experienced by one person but cannot be verified by others .

SOURCES OF LOSS

There are many sources of loss : 1-Aspect of self : the loss of an aspect of self changes

a person’s body image .

2-External objects : such as a loss of money ,…

3- Familiar environment : Separation from an environment and people who provide security

4- Loved ones : The loss of a loved or valued person through illness , divorce , separation or death.

GRIEF

Grief : Is the total response to the

emotional experience related to loss . Grief is manifested in thoughts , feeling and behaviors associated with overwhelming distress or sorrow .

TYPES OF GRIEF RESPONSES 1- Abbreviated grief :

Is brief but genuinely felt . This can occur when the lost object is not significantly .

2- Anticipatory grief :

Is experienced in advance of the event

3- Disenfranchised grief:Occur when a person is unable to acknowledge

the loss to others .

TYPES OF GRIEF

4- Complicated grief ( unhealthy grief ) :

Exists when the strategies to cope with the loss are maladaptive .

Causes of complicated grief :

1- fail to grief.

2-avoidance of visiting the grave and refuse to participate in memorial services

3- Developing the guilt feeling and lowered self esteem

4- Lack of support system

STAGES OF GRIEVING Many authors have described stages or phases

of grieving :

A- kubbler –Ross’s Stages of Grieving :

1- Denial

2- Anger

3-Bargaining

4-Depression

5- Acceptance

STAGES OF GRIEF

B- Engel’s Stages of grief :

1- Shock and disbelief

2-Developing awareness

3- Restitution resolving the loss.

4- Idealization

5-Outcome

FACTORS AFFECTING THE LOSS & GRIEF 1- Age

2- Significance of the loss

3- Culture

4- Gender

5- Socio-economic Status

6-Support system

7- Causes of loss or death

Nursing Management

I- Assessment :

Nursing Assessment of the client experiencing a loss

includes three major components :

A- Nursing history

B- Assessment of personal coping resources

C- Physical assessment .

II-NURSING DIAGNOSISNursing diagnosis may include :

1- Grieving .

2- Complicated grieving

3- Interrupted family processes

4- Risk- prone Health behavior

5- Risk for loneliness

PLANNING

-The overall goals for clients who are grieving the loss of body part are to adjust to the changed ability and to redirect both physical and emotional energy into rehabilitation

- The goals for clients who are grieving the loss of a loved one or thing are to remember them without feeling of intense pain and to redirect emotional energy into one’s own life and adjust to the actual or impending loss .

IMPLEMENTATION

The skills most relevant to situation of loss and grief are:

1- Attentive listening

2-silence, open questions .

3- paraphrasing

4- clarifying and reflecting the feeling

5- Summarizing

6- Be less advisable

IMPLEMENTATION

Facilitating Grief work :- Explore and respect client’s and family culture , ethnic and

religion .

- Teach client and family the expected processes of grief .

- Encourage patient to express and share grief with support people .

- Teach family member to encourage the client’s family expression of grief .

- Encourage the client to resume normal activities on a schedule that promotes physical and psychological health .

IMPLEMENTATION

Providing Emotional support :

1- Use silence and personal presence along with technique of therapeutic communication .

2- Acknowledge the grief of the client’s family and significant others .

3- Offer choices that promote client autonomy .

4- Provide appropriate information regarding how to access community resources .

EVALUATION

Evaluating the effectiveness of nursing care of the grieving client is difficult because of long – term nature of the life transition .

Criteria for evaluation should be based on goals set by the client and the family .

DYING

The concept of death is developed over time , as the person grows , experiences various losses and thinks about concrete and abstract concepts .

Indications of death :

- Total lack of response to external stimuli .

- No muscular movement , especially respiration – No reflexes

- Flat encephalopathy ( Brain waves )

NURSING CARE OF DYING CLIENT

The major nursing responsibilities for client who are dying is to assist the client to peaceful death . More specific responsibilities :

1- To minimize loneliness

2- To maintain the client’s sense of security , self confidence , dignity and self- worth .

3- To help the client accept losses

4- to providing spiritual support

5- Meeting the physiologic needs of the dying client

6- Supporting the family .