DEATH & GRIEF

When you were born, you cried and the world rejoiced.

Live your life in a manner so that when you die the world cries and

you rejoice.

Strange as it may seem, death is a part of living. Where did you learn your ideas or views about death?

Family

Religious beliefs

Superstitions

Experiences with death

Media

Science

…

Let's talk with a few questions death and grief.

1. How would you define Death? 2. Why do most people dislike talking and thinking about death? 3. What positive and negative statements could you make about your life thus far? 4. What are some ways people deny that death is part of everyone's life? 5. What do you fear most about dying?

Everyone has different thoughts about death.

Grief “Grief is the emotion people feel

when they experience a loss. There are many different types of loss, and not all of them are related to death. For example, a person can also grieve over the breakup of an intimate relationship or after a parent moves away from home.”

“Grief is a natural reaction to the loss of someone important to you. Grief

is also the name for the healing process that a person goes through after someone close has died. The

grieving process takes time, and the healing usually happens gradually.”

*“Although everyone experiences grief when they lose someone, grieving affects people in different ways.”

*Depends on relationship with person.

*Circumstances under which they died.

*Knowing someone is going to die can give us time to prepare.

*If they were suffering, it can mean a sense of relief.

*If the person that died was young, we may feel it was unfair.

“Losing someone suddenly can be extremely traumatic, though, no

matter how old that person is. Maybe someone you know died unexpectedly

- as a result of violence or a car accident, for example. It can take a long time to overcome a sudden loss

because you may feel caught off guard by the event and the intense feelings

that are associated with it.”

*Grief can make us feel guilty.

*Some people might blame themselves or think they could have done something to stop the death.

“Others might think if only they had been better people, than their loved

ones might not have died. These things aren't true, of course - but

sometimes feelings and ideas like this are just a way of trying to make sense

of something that's difficult to understand.”

Grieving Process

Denial

Denial In this stage we refuse to believe what

has happened. We try in our mind to tell ourselves that life is as it was before our loss.

We can even make believe to an extent by re enacting rituals that we used to go through with our loved one.

We set an extra plate at the table.

We expect them to be there when we get home.

We flash back to memories and conversations.

These are all part of this stage.

Anger

Anger We get angry.

The anger can manifest itself in many ways.

We blame others for our loss.

We become easily agitated having emotional outbursts.

We can even become angry at ourselves.

Care must be taken here not to turn the anger inwards.

Release of this anger is essential!

Bargaining

Bargaining Bargaining can be with ourselves or if you are

religious with your god.

Often we will offer something to try to take away the reality of what really happened.

We may try to make a deal, to have our loved one back as they were before the tragic event occurred.

It is only human to want things back as they were before.

Depression

Depression Depression is a very likely outcome for

all people that grieve for a loss.

This is the most difficult of the stages to deal with.

There can be a feeling of listness and tiredness.

Outbursts of tears may occur.

You may feel like there is no purpose to your life anymore.

You may feel like you are being punished.

Pleasure and joy may be difficult to express.

There may even be thoughts of suicide.

If you at any time in this stage, feel like doing yourself harm, professional counseling should be sought.

Acceptance

Acceptance This is the final stage of grief.

It happens when you know that you have to go on.

You can accept your loss and now be able to regain your energy and goals for the future.

It may take some time to get to this stage..but you will get there!

Coping with Crisis

Physical Reactions

Unfeeling

Tired Can’t Sleep

Tightness in Throat

Disinterest in Eating

Emotional Reactions

Stabbing Pain

Feeling of Relief

Anger

Hostility

Anxiety

Fear

Mourning Process

Shock Occurs between the

time of death and time of the final arrangements.

During “Shock” one may even deny that the death has occurred.

Intense Feeling of Loss/Pain

Usually occurs two to three months after the loss.

The bereaved person may withdraw from the world.

Resolution

One starts living a regular life.

Anticipatory Grief

The mourning process that occurs prior to death in cases of terminal illnesses.

Nursing Process

Nursing Diagnose: GRIEVING

DEFINITION: A normal comlex process that includes emotional, physical, spiritual, social, and intellectual responses and behaviors by which individuals, families, and communities incorporate an actual, anticipated, or perceived loss into their daily lives.

DEFINING CHARACTERISTICS

Subjective:

Anger

Blame

Detachment

Despair

Experiencing relief

Pain

Personal growth

Psychological distress

Suffering

Objective

Alterations in activity level

Alterations in dream patterns

Alterations in immune function

Alterations in neuroendocrine function

Alterations in sleep patterns

Disorganization

Maintaining the connection to the deceased

Making meaning of the loss

Panic behavior

Related Factors

Anticipatory loss of significant object (e.g. Possesion, job, status, part and processes of body)

Anticipatory loss of significant other

Death of significant other

Loss of significant object (e.g. Possesion, job, status, part and processes of body)

Goals/Evaluation Criteria

Patient successfully resolves Grieving, as demonstrated by successful Adaptation to Physical Disability, Coping, Family Coping, Family Social Climate, Grief Resolution, and psychosocial Adjustment: Life Change

Patient demonstrated Coping. As evidenced by the following indicators (specify 1-5: never, rarely, sometimes, often, or consistently demonstrated):

- Identifies effective coping patterns

- Uses effective coping strategies

- Seeks information concerning illness and treatment

- Uses available social support

- Seeks help from a health care professional as appropriate

- Reports decrease in physical symptoms of stress and in negative feelings

Patient demonstrates Grief Resolution, as evidenced by the folloving indicators (specify 1-5: never, rarely, sometimes, often, or consistently demonstrated):

- Resolves feelings about loss

- Verbalizes reality of loss

- Participates in planning funeral

- Shares loss with significant others

- Progresses through stages of grief

- Maintains grooming and hygiene

- Reports decreased preoccupation with loss

- Reports adequate nutritional intake

- Reports normal sexual desire

Nursing Activities

Assesments

- Assess past experience of patient and family with loss, existing support systems, and current grief work

- Determine cause and length of time since diagnosis of fetal or infant death

- Grief Work Facilitation: Identify the loss

Paitent/Family Teaching

- Teach characteristics of normal and abnormal grieving

- Discuss differences in individual patterns of grieving(e.g. male-female)

- Grief Work Facilitation: Instruct in phases of the grieving process, as appropriate

- Anticipatory Guidance: Provide information on realistic expectations related to the patient’s behavior

Collaborative Activities

- Refer to appropriate resources, such as support groups, legal assistance, financial assistance, social services, chaplain, grief counselor, genetic counselor

- Grief Work Facilitation: Identify sources of community support

Other

- Assist patient and family to verbalize fears and concerns of potantial loss, including impact on the family unit

- Help patient and family to share mutual fears, plans, concerns, and hopes with each other

Home Care

Encourage family caregivers to express concerns and feelings about the client

Arrange for respite care for family caregivers

Encourage family to involve client in as many family routines and activities as possible

For Infants and Children

Provide opportunities for child to talk about concerns and feelings

Base your communication on the child’s developmental stage

Help child to clarify misconceptions about death, dying, or loss

Explain clearly that the child didnot cause the impending death

Cont.

Help parents understand that the child needs to grieve and that they should not try to distract them from it or “make it go away”

Explore the use of music therapy

Help the family to decide whether a child should attend the funeral, making sure a trusted adult is available to care for the child during the funeral

Cont.

For the perinatal loss, encourage parents to hold infant while and after the baby dies, as appropriate

Encourage expression of feelings in ways comfortable to the child, such as writing, drawing, or playing

For Older Adults

Consider referral to a bereavement counselor to help dying clients and their families

Assist with advance directives to ensure that the patient’s preferences for care are known

Exercise

We write our own tombstone !

Are you pleased from writing about ourselves?

I wish that you will be pleased to have a life