2. THE EXPERIENCE LOSS, DEATH & GRIEF

3. The Role of the Nurses Prevent illness, injury and help patients return to health Prevent illness, injury and help patients return to health Help patients and family cope with things they can not change and facilitate a peaceful death Help patients and family cope with things they can not change and facilitate a peaceful death

4. LOSS Definition Definition An actual or potential situation in which something that is valued, is changed, no longer available or gone. People grieve the loss of multiple things.

5. Types of Loss Necessary loss – a part of life as people move forward in life may be permanent or for the better Necessary loss – a part of life as people move forward in life may be permanent or for the better Maturational loss – includes all normally expected life changes across the life span Maturational loss – includes all normally expected life changes across the life span

6. Types of Loss Situational Loss – can be caused by sudden, unpredictable external events e.g. income, physical change as a result of injury Situational Loss – can be caused by sudden, unpredictable external events e.g. income, physical change as a result of injury

7. Types of Loss Actual – can be identified by others Perceived – cannot be verified by others. Anticipatory – is experienced before it really occurs

8. Types of Loss Death Death The ultimate loss The ultimate loss Generates anxiety, fear and uncertainty Generates anxiety, fear and uncertainty Permanently separates people physically Permanently separates people physically Approach to death is influenced by values, culture, previous experience and social support Approach to death is influenced by values, culture, previous experience and social support

9. GRIEF Grief – the emotional response to the loss, manifested in ways unique to an individual and based on personal experience, cultural expectation and spiritual beliefs Grief – the emotional response to the loss, manifested in ways unique to an individual and based on personal experience, cultural expectation and spiritual beliefs

10. Mourning Mourning – the outward, social expression of grief and the behavior associate with loss Influenced by culture, religious experience and customs. Influenced by culture, religious experience and customs.

11. Bereavement Bereavement – encompasses both grief and mourning and includes the emotional response and outward behaviors of a person experiencing loss Bereavement – encompasses both grief and mourning and includes the emotional response and outward behaviors of a person experiencing loss

12. Types of Grief Normal Normal Anticipatory Anticipatory Disenfranchised Disenfranchised Ambiguous loss Ambiguous loss Complicated Complicated Exaggerated Exaggerated Delayed Delayed Masked Masked

13. Mourning/Grief Response Mourning Mourning Period of acceptance after a loss Period of acceptance after a loss Grief response Depends on cause of death Sudden death Death from socially stigmatized illness Infant, miscarriage Violent

14. Grief Response Accidental death Accidental death Feelings of bad luck Feelings of bad luck Guilt response Guilt response Line of Duty Line of Duty Death while “defending” is viewed as honorable Death while “defending” is viewed as honorable Soldiers Soldiers Police Police Suicide Suicide Religious implications Religious implications

15. Stages of Dying Kubler-Ross (1969) Kubler-Ross (1969) Five Stages Five Stages Denial Denial Anger Anger Bargaining Bargaining Depression Depression Acceptance Acceptance

16. Kulber-Ross’s Stages of Dying 1. Denial and isolation 2. Anger “Why me?” 3. Bargaining 4. Depression 5. Acceptance

17. Factors Influencing Loss and Grief Human Development Human Development Personal Relationship Personal Relationship Nature of the loss Nature of the loss Coping Strategies Coping Strategies

18. Factors Influencing Loss and Grief Socioeconomic Status Socioeconomic Status Culture and Ethnicity Culture and Ethnicity Spiritual and Religious Beliefs Spiritual and Religious Beliefs

19. Factors Influencing Grief: Age Age Sex roles Sex roles Social support Social support Nature of loss Nature of loss Dying person’s grief Dying person’s grief

20. Factors Influencing Grief Family Family Socioeconomics Socioeconomics Culture/Religion Culture/Religion Nature of relationship Nature of relationship

21. Nursing Process Assessment Assessment Nature of Relationship Nature of Relationship Social Support System Social Support System Nature of the Loss Nature of the Loss Cultural and Spiritual Beliefs Cultural and Spiritual Beliefs Life Goals Life Goals Family Grief Pattern Family Grief Pattern Self Care Self Care Hope Hope

22. Nursing Process Nursing Diagnosis Nursing Diagnosis Grieving Grieving Hopelessness Hopelessness Ineffective denial Ineffective denial Fear Fear Impaired Comfort Impaired Comfort Readiness for enhanced spiritual well-being Readiness for enhanced spiritual well-being

23. Nursing Process Planning Goals and Outcomes Planning Goals and Outcomes Encourage patients and family members to share their priorities for care at the end of life Encourage patients and family members to share their priorities for care at the end of life

24. Nursing Process Implementation Implementation Health Promotion Health Promotion Palliative Care in Acute and Restorative settings Palliative Care in Acute and Restorative settings Hospice Care Hospice Care Use Therapeutic Communication Use Therapeutic Communication Provide Psychosocial Care Provide Psychosocial Care

25. Nursing Process Implementation cont’d Implementation cont’d Manage Symptoms Manage Symptoms Promote Dignity and Self-Esteem Promote Dignity and Self-Esteem Maintain a Comfortable and Peaceful Environment Maintain a Comfortable and Peaceful Environment Promote Spiritual Comfort and Hope Promote Spiritual Comfort and Hope Protect Against Abandonment and Isolation Protect Against Abandonment and Isolation

26. Nursing Process Implementation cont’d Implementation cont’d Support the Grieving Family Support the Grieving Family Assist with End of Life Decision Making Assist with End of Life Decision Making Facilitate Mourning Facilitate Mourning Care After Death Care After Death

27. Nursing Process Evaluation Evaluation The success of the evaluation process depends partially on the bond that you formed with the patient The success of the evaluation process depends partially on the bond that you formed with the patient A patient’s response and perceptions of the effectiveness of nursing interventions determines if the existing plan of care is effective or needs to be revised A patient’s response and perceptions of the effectiveness of nursing interventions determines if the existing plan of care is effective or needs to be revised

28. Once Death Occurs…. Care of the body - viewing Care of the body - viewing Tubes, dressings Tubes, dressings Family, loved ones time Family, loved ones time Identification of body Identification of body Pastoral, psychosocial support Pastoral, psychosocial support

29. Nursing Responsibilities: Medical Examiner (county coroner) Medical Examiner (county coroner) Autopsy No consent needed if… Death caused by accident Suicide Homicide Illegal therapeutic practice Sudden unexplained death

30. Care of Self…

31. Importance of Nurses’ Self Care Nurses can not give fully engaged, compassionate care to others when you feel depleted or do not feel cared for yourself Nurses can not give fully engaged, compassionate care to others when you feel depleted or do not feel cared for yourself Nurses who practice self-care are more likely to experience professional and personal growth and find meaning in their work. Nurses who practice self-care are more likely to experience professional and personal growth and find meaning in their work.

32. Advance Directives Living Will / D.N.R. Living Will / D.N.R. Durable Power of Attorney Durable Power of Attorney Health Care Surrogate designation Health Care Surrogate designation

33. Advance Directives Aging with Dignity Aging with Dignity www.AgingWithDignity.org End of Life Issues End of Life Issues www.FloridaHealthStat.com