Module 5: Loss, Grief and Bereavement

You are making a bereavement visit to the 35-year-old daughter and primary caregiver of a female patient who died three months ago. The daughter reports she is experiencing mild breathlessness, loss of appetite, and difficulty concentrating. You should recognize that the daughter is experiencing:

A normal grief reaction

You are caring for a number of patients and family members who are facing loss or death. In speaking with them about grief, you correctly convey that grief:

Begins before a loss or death, as people consider a pending loss

You are talking with the staff on your unit about the emotional challenges of working with dying patients and their families. Which of the following is an appropriate response to the grief the staff has been experiencing recently?

Consult with the hospital chaplain or spiritual care counselor for staff support.

Which of the following demonstrates good self-care that may help you in preventing compassion fatigue and burnout when taking care of many patients with serious illness and their families?

Establish healthy eating, sleeping, and exercise habits especially when rotating shifts.

A year after the loss of her son to suicide, Mrs. Phelps expresses to you that she is still terrified that her surviving son will also commit suicide. Mrs. Phelps reports continuing to have nightmares in which this happens. What type of grief is Mrs. Phelps experiencing?

Exaggerated grief

John is a 70-year-old male whose wife died from COPD two months ago. They were very close, married for 52 years, and had no children. He comes by the nursing unit to bring you all candy and a thank you note for all the times you cared for her the past year. He tells you he is struggling to want to eat since she always was the cook, and is just not ready to go out to dinner with his buddies, even though they keep asking him. Your assessment is that John is:

Experiencing normal grief after his wife died two months ago

You are assessing Mrs. Smith's husband's well-being during Mrs. Smith's recent hospitalization. He tells you he has had trouble with heart failure this past year and then says, "All that matters is my wife. I don't have time to go to my doctor even though my prescriptions have run out. Don't you realize how many medications I have to give my wife around the clock? I can't deal with any more medications. I will have time to take care of myself later on." Your best response is:

I am concerned about you too. Keep in mind you can't take care of Mrs. Smith if you get sick; you need to get your prescriptions filled.

You are talking with the wife of a patient who died recently. Which statement can you make that would be most helpful?

It must be hard to accept that this has happened.

You are providing bereavement support to an 8-year-old child whose father just died on your unit. Which of the following statements would be appropriate for you to use?

Let him know you wish that his father had not died.

You and your nurse colleagues on your unit have all been talking about how hard it is in the ICU to see so many patients who have stated they didn't want any more aggressive treatment be admitted to the ICU. You found one of your colleagues was crying in the bathroom stating, "I can't stand this anymore - I just admitted another patient who told me last time he never wanted to come back here." Your best intervention is to:

Listen to her and suggest you both talk with the ICU manager about the unit needing the chaplain or psychiatric nurse liaison for emotional support.

You are caring for a 55-year-old female patient with metastatic breast cancer. During a home visit, you find the patient's 22-year-old daughter weeping at the kitchen table. The daughter explains that she just realized that her mother will not be alive when she gets married or has children of her own. Recognizing anticipatory grief in the young woman, the best first intervention is:

Provide active listening and therapeutic presence.

Mr. C's family tells you they are very worried about his granddaughter who is 13 years old. She has lived with her mother and grandparents since she was three and seems to be having a hard time accepting that her grandfather is near end of life. The granddaughter is acting out in school, not doing her homework, and has been bullying friends. Mr. C has end-stage heart failure and will be discharged home tomorrow with home hospice care. What should you say to Mr. C's family regarding his granddaughter?

Some children display a change in their behavior when they are experiencing grief. Would you like me to contact our child life worker to speak with you today?

You have been working on the end-stage heart failure unit for eight months. Many of your patients have died awaiting transplant. You are aware that you are not sleeping well at night and dread going to work each day. Many of your colleagues are irritating you and you are moody when at home. Which of the following would be best to do first?

Speak with your nurse manager about how you are feeling and ask for help.

The hospice interdisciplinary team is creating a bereavement plan for the family of Mr. A, a 50-year-old patient with advanced HIV/AIDS. The patient defines his family as consisting of his partner, his parents, four siblings, as well as his two closest friends. In creating the plan, each member of the interdisciplinary team understands that bereavement interventions must:

Take into account each survivor's cultural practices in mourning and grief reactions.

Which of the following family members is at greatest risk for complicated grief?

The daughter who has a long history of substance use and has just recently returned home to be at her dying mother's bedside.

You are caring for a 65-year-old male patient who has just died. In planning for follow-up bereavement care, which person is at risk for disenfranchised grief?

The ex-wife of the patient who lives nearby

You are speaking with the sister of a male patient who died after suffering fatal injuries in a car accident. In order to plan for bereavement follow-up for the patient's family, it is important that you assess:

The family support system

Mr. C, whose wife of 14 years died five months ago, returns to your unit to thank you all for your great care. He states, "I still can't get through a week without crying sometimes. I know I should be at least starting to move on a bit." Your best response would be:

This is very hard; can you tell me a bit about what moving on means to you?

You are caring for a patient with end-stage liver disease. He tells you that he knows he only has a few weeks to live and is so sad that he won't be around to see his daughter graduate next year from college. You listen attentively and then respond:

Would it be helpful to write a letter to her or a card that can be given on that special day?

The parents of a 2-year-old child who is dying from leukemia tell you they are so afraid that they will forget who their child was years after he dies. How should you respond?

Would you like me to call our child life team who can help you with some memory making activities?