N250 week 7 grief, death, and loss vopp

Grief, Death, and LossGrief, Death, and LossChapter 36

Cheryl Smythe-Padgham DNP, RN,WHNP-BC

Grief, Death and LossGrief, Death and LossNurses play an important role in

helping clients and families cope with things that cannot be changed and facilitate a peaceful death

Health care professionals sometimes resist feeling the uncomfortable emotions associated with grief and death and view death as a personal and professional failure

Grief, Death and LossGrief, Death and LossClients and families need expert

nursing care through grief and death, perhaps more than at any other time

Scientific Knowledge BaseScientific Knowledge BaseLossLoss

Necessary losses◦ Life changes as we move forward in life

Maturational losses◦ Normally expected life changes

Situational losses◦ Sudden unpredictable external events

Actual losses◦ Death of loved one, loss of body part, loss of

job

Perceived losses◦ Uniquely defined by the person

Scientific Knowledge BaseScientific Knowledge BaseGriefGriefEmotional response to loss,

mourning is a form of coping with grief.

Normal (uncomplicated)

Complicated (dysfunctional)

Scientific Knowledge BaseScientific Knowledge BaseGriefGriefAnticipatory

Disenfranchised

Theories of Grief and Theories of Grief and MourningMourningKubler-Ross’s stages of dying (1969)

◦Denial◦Anger◦Bargaining◦Depression◦Acceptance

Grieving people do not experience the stages in any particular order or length of time

Theories of Grief and Theories of Grief and MourningMourningBowlby’s attachment theory (1980)

◦Numbing Protects person from the full impact of

loss

◦Yearning and seeking Tears, sobbing and acute distress

◦Disorganization and despair Examines loss and expresses anger

◦Reorganization Person begins to accept change, new role

or skills

Theories of Grief and Theories of Grief and MourningMourningWorden’s grief tasks model (1982)

◦Task 1- accept the reality of the loss ◦Task 2- work through the pain of

grief◦Task 3- adjust to the environment in

which the deceased is missing◦Task 4- emotionally relocate the

deceased and move on with life

Nursing Knowledge BaseNursing Knowledge BaseFactors Influencing Loss and Factors Influencing Loss and GriefGriefHuman development

◦ Age and stage of development affect the grief response

Personal relationships◦ The quality and meaning of the lost

relationship influences the grief responseNature of the loss

◦ There are different challenges and stressors when loss is sudden versus a debilitating chronic illness

Factors Influencing Loss and Factors Influencing Loss and GriefGriefCoping strategies

◦ Life experiences shape the coping strategies a person uses

◦ Emotional disclosure (like venting, talking about one’s feelings) is an important way to cope with loss

◦ Support systems◦ Prior experience with loss

Socioeconomic status◦ The ability to access support and resources

for coping with loss

Factors Influencing Loss and Factors Influencing Loss and GriefGriefCulture and Ethnicity

◦ Culture influences the interpretations of loss, establishes acceptable expressions of grief and provides stability and structure

Spiritual and religious beliefs◦ Spiritual resources include faith in a higher

power, community, friends, religious practices

Hope◦ Energizes and provides comfort

Critical ThinkingCritical ThinkingNursing Code of EthicsThe Dying Person’s Bill of RightsAmerican Society of Pain

Management Nurse Guidelines

Nursing Process and Nursing Process and Grief AssessmentGrief AssessmentEstablish a trusting helping

relationshipUse open ended questionsAssess the client’s coping style,

the nature of family relationships, personal goals, cultural and spiritual beliefs, support systems

Grief reactionsClient expectationsEnd of life decisions

Nursing DiagnosisNursing DiagnosisRisk for complicated grieving

related to the permanent loss of mobility

Death anxietyComplicated grievingSpiritual distressHopelessness

Nursing ProcessNursing ProcessPlanningPlanningGoals/outcomes

◦Client will be able to discuss expected course of disease within 1 week

◦Maintain a sense of controlSetting prioritiesCollaborative care- nurses,

physicians, social workers, pharmacist, clergy, hospice care

ImplementationImplementationHealth Promotion

◦Grant time for the grieving process◦Focuses on facilitating coping and

optimizing physical, emotional, and spiritual health

◦Therapeutic communication◦Provide psychosocial care- provide

information that help clients understand their condition, course of disease

◦Manage symptoms

ImplementationImplementationHealth promotion continued

◦Promote dignity and self-esteem◦Maintain comfortable and peaceful

environment◦Promote spiritual comfort and hope

ImplementationImplementationHealth promotion continued

◦Protect against abandonment and isolation

◦Support the grieving family◦Assist with end of life decision

making◦Facilitate mourning◦Hospice care◦Care after death- organ and tissue

donation, autopsy, postmortem care

Palliative carePalliative careThe prevention, relief, reduction or

soothing of symptoms of disease or disorders throughout the entire course of illness including care of dying and bereavement follow-up for the family.

Improves the quality of life of clients and families facing end of life issues

Hospice care is final phase of palliative care.No further medical care aimed towards cure is

given. Instead the focus becomes symptom relief and enhancing the quality of life remaining.

EvaluationEvaluationThe success of the evaluation

process depends partially on the bond you have formed with the client

Care for the Grieving Care for the Grieving NurseNurseNurses need to assess

their own emotional well-being

Self-reflection is a part of critical thinking that assesses whether sadness is related to caring or unresolved personal experiences

Being a professional is knowing when to get away from the situation to care for yourself