Loss and Grief

NOC standardized outcomes

Communicate openly among themselves and healthcare providers (e.g., express fear, concerns, pain). Obtain satisfactory pain relief and symptom management. Make use of all resources available to assist with coping. Exercise control in the management of care to the extent possible.

Kubler- Ross five stages of death

Denial Anger Bargaining Depression Acceptance

days to hours prior to death

Often a surge of energy brings mental clarity and a desire to eat and talk with family members. However, as death approaches, patients tend to become dehydrated and have difficulty swallowing, which results in decreased blood volume. In the final hours of life, many patients become restless and agitated. This response may be caused by medications, liver failure, cerebral hypoxia, renal failure, stool impaction, distended bladder, increased pain, or unresolved emotional or spiritual issues. Near to the time of death, some people unexpectedly become more coherent and energized for a time. Others become less communicative, quiet, and withdrawn). Fatigue is common.

Factors Affecting Grief

Significance of the loss Support system Unresolved conflict Circumstances of the loss Previous loss Spiritual/cultural beliefs and practices Timeliness of death Developmental stage of the bereaved Nature of loss Socioeconomic status Coping is enhanced by hope

NIC standardized interventions

Some important nursing interventions include therapeutic communication, facilitating grief work, helping families, and specific activities involved in care of the dying person

assisted suicide

The ANA (2013) prohibits nurses' participation in assisted suicide and euthanasia because these acts are in direct violation of the Code of Ethics

higher brain death

The brain stem can still be functioning, so both respiratory and cardiac activity may continue even though the person does not make purposive responses to external stimuli, cephalic reflexes are absent, and the electroencephalogram shows no activity.

1-3 months prior to death

The dying person begins to withdraw from the world and people. Sleep increases; it becomes difficult for the body to digest food, especially meats; and appetite and food intake decrease. Liquids are preferred. Anorexia may be protective. The resulting ketosis can diminish pain and increase the person's sense of well-being.

moments prior to death

The dying person does not respond to touch or sound and cannot be awakened. Typically, there is a short series of long-spaced breaths before breathing ceases entirely and the heart stops beating

whole- brain death

The irreversible cessation of all functions of the brain, including the brain stem. Spontaneous respirations cannot continue once the brain stem stops functioning; however, the heart may continue to beat until it becomes oxygen starved from cessation of respirations.

heart-lung death

The irreversible cessation of spontaneous respirations and circulation.

loss of aspects of self

This includes physical losses such as body organs, limbs, body functions, and/or body disfigurement. Psychological and perceived losses in this category include aspects of one's personality, developmental change (as in the aging process), loss of hopes and dreams, and loss of faith.

loss of significant relationships

This includes, but is not limited to, actual loss of spouses, siblings, family members, or significant others through death, divorce, or separation

environmental loss

This involves a change in the familiar, even if the change is perceived as positive. Examples include moving to a new home, getting a new job, and going to college. These losses can be perceived or actual.

uniform determination of death act

This provides a highly reliable means of declaring death for respirator-maintained bodies—loss of brain stem function.

mourning

action associated with grief

external loss

actual losses of objects that are important to the person because of their cost or sentimental value (e.g., jewelry, pets, a home). These losses can be brought about by theft, destruction, or disasters such as floods and fire.

internal loss

another term for perceived or psychological loss

chronic

begins as normal grief but continues long term, with little resolution of feelings and inability to rejoin normal life.

Engel

believed that uncomplicated grief has a clear onset and a predictable course, modified mainly by the abruptness and significance of the loss and the preparedness of the bereaved person. Uncomplicated grief is universal and does not require treatment.

postmortem care

care of the patient's body after death and fulfilling any legal obligations, such as arranging transportation to the morgue or funeral home and determining the disposition of the patient's belongings.

Death

cessation of the flow of vital bodily fluids

Psychological loss

challenge our belief system. They are commonly seen in the areas of sexuality, control, fairness, meaning, and trust. Some losses may be mixed.

euthanasia

deliberate ending of a life of someone suffering from a terminal or incurable illness

Worden

described the tasks a grieving person must achieve. They progress from an initial numbness or denial through experiencing and working through pain and grief and eventually moving on with life.

Bowlby

drawing on attachment theory, suggested that grief occurs when the bereaved learn that the object of their attachment is lost.

anticipatory

experienced before a loss occurs. The potential negative outcome of anticipatory grief is that the survivor may detach from a dying person too early in the dying process, leaving the person without emotional support during that period. This does not always happen, of course.

disenfranchised

experienced in connection with a loss that is not socially supported or acknowledged by the usual rites or ceremonies. Disenfranchised grief may be experienced by a man whose wife has had a miscarriage, a mistress whose lover dies, or a bereaved partner in a homosexual relationship not recognized by the families. In each of these instances, the bereaved person lacks the communal support that is helpful in grieving.

delayed

grief that is put off until a later time (e.g., "I'll think about it later. Right now, I'm busy trying to keep a roof over our heads and care for my children.").

advance directives

group of instructions (written or oral) stating a person's wishes regarding his or her healthcare if he or she were incapacitated or unable to make that decision. An ordinary power of attorney does not give another person the right to make healthcare decisions for the patient; only a durable power of attorney for healthcare decisions can do that.

hospice care

holistic care of dying clients

palliative care

holistic comfort care

Physical Loss

includes (1) injuries (e.g., when a limb is amputated); (2) removal of an organ (e.g., hysterectomy); and (3) loss of function (e.g., loss of mobility).

Actual Loss

includes the death of a loved one (or relationship), theft, deterioration, destruction, and natural disaster. Actual loss can be identified by others, not just by the person experiencing it (e.g., hair loss during chemotherapy).

Perceived Loss

internal; it is identified only by the person experiencing it

complicated

is distinguished from uncomplicated grief by length of time and intensity of emotion. The person's responses are maladaptive, dysfunctional, unusually prolonged, or overwhelming. Complicated grief results when the grieving process has been impeded for some reason (e.g., something keeps the person "stuck" in the grief process).

autopsy

medical examination of the body to determine the cause of death that involves removals of the organs and extractions of tissue samples. Autopsies have also provided relevant data about disease processes and causes. It requires signed permission from the next of kin

Bereavement

mourning and adjustment time following a loss

active euthanasia

occurs as a result of a direct action (overdose)

passive euthanasia

occurs as a result of a lack of action

masked

occurs when the person is grieving but expressing the grief through other types of behavior

grief

physical, psychological, and spiritual responses to a loss THIS IS A NURSING DIAGNOSIS

Rando

stands for Recognizing the loss (awareness); Reacting to the separation (feeling the emotions); Recollecting memories of the deceased (remembering, reliving); Relinquishing the old attachment (new ways of living without the deceased); Readjusting to the new environment (new coping skills); Reinvesting self (energy once turned inward on grief begins to be focused outward again).

uncomplicated (normal) grief

the natural response to a loss. The bereaved person experiences the feelings, behaviors, and cognitions that are expected in light of his or her culture, social status, and relationship to the lost person or object. The emotions are intense but gradually diminish over time (several months to several years). Some emotions will always be present, but the intensity will change.

Loss

the undesired change or removal of a valued object, person, or situation

1-2 weeks prior to death

A host of physical changes indicates the body is beginning to lose its ability to maintain itself.