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by Prof. Unn Hidle Updated Spring 2009
Death, Dying & Grief by Prof. Unn Hidle Updated Spring 2009
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Suggested Videos “Dealing with Death and Dying” “The Dying Child”
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Definitions Loss Grief Mourning Bereavement
The absence of a person or possession Grief The emotional response to loss Mourning The outward, social expression of loss Bereavement Grief and mourning combined **ALL STRONGLY influenced by individuality and culture!
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Why do we grieve?
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LOSS Different types of loss:
Death of a parent, grandparent, sibling, partner, child Death of a close friend Loss or break-up of a relationship Loss of friendship Serious illness in self or other Loss of sentimental values
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The Grief Process Each person grieves in their own way
Grief work leads to living with loss Certain factors may influence the grieving process: Personality, coping, relationship to the deceased, type of death, spiritual beliefs, religion Grief assessment: Begins at time of diagnosis or admission Ongoing to detect complicated grief No one can predict completion
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Pablo Perea Emotions
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Types of Grief Anticipatory Grief “Uncomplicated”/”Normal” grief
Complicated Grief Disenfranchised Grief Childrens’ Grief
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Anticipatory Grief Grief before the actual loss
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“Uncomplicated/Normal” Grief
“Normal” feelings, behaviors and reactions to loss Follow the stages of the grieving process
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Complicated Grief Chronic grief Delayed grief Exaggerated grief
Ongoing cycle Delayed grief Exaggerated grief Masked grief Risk factors: Sudden or traumatic death Suicide, homicide Death of a child Multiple loss
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Disenfranchised Grief
When loss cannot be openly acknowledged or socially sanctioned Examples may include death from AIDS, abortion, drugs, suicide, ex-spouse, etc.
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Childrens’ Grief ALWAYS complicated Symptoms unique to children
Based on developmental stages
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Should death be discussed with dying children?
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Special Needs of Children
“Experts” agree that it is best for dying children to discuss death Children of most ages understand that death exist through: Direct information Reasoning about health status and experiences Children express their knowledge: Directly: Words Indirectly: stories, gestures, drawings Silence
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Special Needs of Children
Parents also benefit from discussing death with their dying child: Less regrets after the child is gone Decreased guilt Better communication Closeness / bonding Honesty
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What to expect when grieving
Emotional Symptoms Stages of Grief: Denial This isn’t happening to me! Anger Why is this happening to me? Bargaining I promise I’ll be a better person if ……. Depression I don’t care anymore Acceptance I’m ready for what comes Kubler-Ross, 1969 Physical Symptoms Sleeplessness Sadness Decreased appetite Tearfulness Fatigue Upset stomach Anxiety Dreams/nightmares Lack of concentration
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Bereavement Interventions
Plan of care Anticipatory grief Provide presence Emotional support What to say Active listening, “touch”, reassurance Use bereavement services
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Ways to Help Others Cope with Loss
Ask if they want to talk about their loss Remember, you have to be willing to listen! Just sit with them, you don’t have to say anything to comfort others Allow them to cry and be sad Don’t minimize their feelings Show you care by words and actions Help with practical needs
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Coping Skills Counseling Support groups Talking & listening
Understanding the grieving process Letting others help Taking care of physiological needs (Maslow) Acknowledge pain and allow tears
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When to Get Help You feel you cannot handle this alone
You are loosing weight Your grades, work &/or social life are suffering You have repeated thoughts of death or dying You feel you need to talk and you think your friends are tired of listening
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Nurses’ Death Anxiety Death anxiety Cumulative loss Lack of resolution
Personal death awareness Personal defenses
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Hospice Care Decreased daily physical stress for family members
Support system Peace for the child
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Advanced Directives What is it?
Health Care Proxy Living Will When should it be offered to the patient? Part of medical record? Legalities Informed consent versus assent DNR versus DNI
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The Dying Process
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“Into the light….”
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The Dying Patient’s Bill of Rights
Be treated as a human being Hope Freedom to express feelings and emotions Medical and nursing care (as indicated) Sensitive care Not to die alone Freedom from pain Honesty Help for self and family in accepting death Die in peace and dignity Retain individuality and beliefs Expect respect of body after death
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Care and Comfort Measures
Pain management Provide comfort Turning and positioning Hygiene / Oral hygiene Communication Attend to psycho-social needs Support: physical, emotional, spiritual
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Impending Signs of Death
“Mental Work” Separation from family and friends Withdrawal from the world and people Less communication Separation from body Going inside of self Decreased PO intake Excessive sleeping > 20 hours/day
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Impending Signs of Death Physical Signs
One to three months Withdrawal One to two weeks Disorientation: hallucinations; picking at clothes Body slows down: Decreased HR, BP, PO Days to hours Surge of energy! Minutes “fish out of water” or “death rattle” breathing “death stool”
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Postmortal Care ALLOW family/friends to spend time with the deceased and initiate the grieving process Postmortal care as per facility procedures Provide privacy, support and comfort Honor last wishes/requests from family members (within reason)
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Can there be a good death?
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