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Grief, Death, and Loss Grief, Death, and Loss Chapter 36 Cheryl Smythe-Padgham DNP, RN,WHNP-BC

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  • 1. Grief, Death, and LossGrief, Death, and Loss Chapter 36 Cheryl Smythe-Padgham DNP, RN,WHNP-BC

2. Grief, Death and LossGrief, Death and Loss Nurses 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 3. Grief, Death and LossGrief, Death and Loss Clients and families need expert nursing care through grief and death, perhaps more than at any other time 4. Scientific Knowledge BaseScientific Knowledge Base LossLoss 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 5. Scientific Knowledge BaseScientific Knowledge Base GriefGrief Emotional response to loss, mourning is a form of coping with grief. Normal (uncomplicated) Complicated (dysfunctional) 6. Scientific Knowledge BaseScientific Knowledge Base GriefGrief Anticipatory Disenfranchised 7. Theories of Grief and MourningTheories of Grief and Mourning Kubler-Rosss stages of dying (1969) Denial Anger Bargaining Depression Acceptance Grieving people do not experience the stages in any particular order or length of time 8. Theories of Grief and MourningTheories of Grief and Mourning Bowlbys 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 9. Theories of Grief and MourningTheories of Grief and Mourning Wordens 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 10. Nursing Knowledge BaseNursing Knowledge Base Factors Influencing Loss and GriefFactors Influencing Loss and Grief Human development Age and stage of development affect the grief response Personal relationships The quality and meaning of the lost relationship influences the grief response Nature of the loss There are different challenges and stressors when loss is sudden versus a debilitating chronic illness 11. Factors Influencing Loss and GriefFactors Influencing Loss and Grief Coping strategies Life experiences shape the coping strategies a person uses Emotional disclosure (like venting, talking about ones 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 12. Factors Influencing Loss and GriefFactors Influencing Loss and Grief Culture 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 13. Critical ThinkingCritical Thinking Nursing Code of Ethics The Dying Persons Bill of Rights American Society of Pain Management Nurse Guidelines 14. Nursing Process andNursing Process and Grief AssessmentGrief Assessment Establish a trusting helping relationship Use open ended questions Assess the clients coping style, the nature of family relationships, personal goals, cultural and spiritual beliefs, support systems Grief reactions Client expectations End of life decisions 15. Nursing DiagnosisNursing Diagnosis Risk for complicated grieving related to the permanent loss of mobility Death anxiety Complicated grieving Spiritual distress Hopelessness 16. Nursing ProcessNursing Process PlanningPlanning Goals/outcomes Client will be able to discuss expected course of disease within 1 week Maintain a sense of control Setting priorities Collaborative care- nurses, physicians, social workers, pharmacist, clergy, hospice care 17. ImplementationImplementation Health 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 18. ImplementationImplementation Health promotion continued Promote dignity and self-esteem Maintain comfortable and peaceful environment Promote spiritual comfort and hope 19. ImplementationImplementation Health 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 20. Palliative carePalliative care The 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. 21. EvaluationEvaluation The success of the evaluation process depends partially on the bond you have formed with the client 22. Care for the Grieving NurseCare for the Grieving Nurse Nurses 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