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

2. 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.

3. 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.

4. 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.

5. 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.

6. 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.

7. 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

8. 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

9. 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

10. 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

11. 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.

12. 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

13. 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.

14. 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

15. 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.

16. 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.

17. 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.

18. 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 )

19. 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.