Loss, Grief and Dying Patient F OUNDATION O F N URSING 212

L OSS AND G RIEF 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.

T YPES 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.

S OURCES OF L OSS 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.

G RIEF 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.

T YPES 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.

T YPES OF G RIEF 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

S TAGES OF G RIEVING 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

S TAGES OF G RIEF B- Engel’s Stages of grief : 1- Shock and disbelief 2-Developing awareness 3- Restitution resolving the loss. 4- Idealization 5-Outcome

F ACTORS AFFECTING THE LOSS & G RIEF 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-N URSING D IAGNOSIS Nursing diagnosis may include : 1- Grieving. 2- Complicated grieving 3- Interrupted family processes 4- Risk- prone Health behavior 5- Risk for loneliness

P LANNING - 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.

I MPLEMENTATION 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

I MPLEMENTATION 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.

I MPLEMENTATION 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.

E VALUATION 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.

D YING 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 )

N URSING C ARE OF D YING 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.