death and dying ii

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DEATH and DYING

Loss an actual or

potential situation in which something that is valued is changed, no longer available, or gone. - loss of body image, significant other, a sense of well being, a job, personal possessions, etc

Grief the total response to the emotional experience related to loss which is usually resolved within 6 months to 2 years. - sorrow manifested in thoughts feelings and behavior occurring as a response to an actual or perceived loss.

Grieving Process

Sequence of affective, cognitive and physiological states through which the person responds to and finally accepts an irretrievable loss

Grief Work

Adaptation process of mourning a loss, distress, disengagement, reinvestment and resolution. Parallel to the grieving process. Process include separating from the person who died, readjusting to a world without him/her and forming new relationships.

Bereavement

The subjective response experienced by the surviving loved ones after the death of a person with whom they have shared a significant relationship. Experience alteration in libido, concentration, patterns of eating, sleeping, activity and communication

Sources of Loss1. Loss of an aspect of life any change the person perceives a s negative in the way the person relates ton the environment is loss of self. - include physical loss (loss of body part) physiological function ( loss of urinary bowel) or psychological function (loss of memory)

2. External Objects loss of inanimate object that has importance to he person (jewelry, money) Extent of Grieving Depends a. objects material value b. the sentiment the person attaches to the object c. the objects usefulness

3. Accustomed Environment - separation from an environment and people who provide security (city, country) 4. Loved Ones loss of valued person or loved one through illness, separation, divorce, broken relationship, moving, running away, promotion at work, or death.

5. Loss of Life physical death, brain death, ability reason - concern is not about death itself but about pain and loss of control, fear of separation, abandonment, loneliness or mutilation

For the nurse to be able to accurately analyze and identify appropriate nursing diagnosis for clients experiencing losses and grieving. The nurse needs to recognize the following:

A. State of Awareness of the client and the family2.

Closed Awareness - client and family are unaware of impending death, either they do not understand completely why the cline is ill and they believe the client will recover

2. Mutual Pretense - the client, the family and health personnel know that the prognosis is terminal but do not talk about it and make an effort not to raise the subject - permits the client a degree of privacy and dignity, but it places a heavy burden on the dying person, who then has no one in whom to confide fears

3. Open Awareness - the client and people around know about the impending death and feel comfortable about discussing it, even it is difficult. - provides the client an opportunity to finalize affairs and even participate in planning funeral arrangements.

B. Symptoms of Grief1. 2. 3. 4. 5.

Repeated somatic distress Tightness in the chest Choking or shortness of breath Dryness of the mouth and throat Sighing

6. Empty feeling in the abdomen 7. Loss of muscular control 8. Uncontrolled trembling 9. Loss of appetite 10. Sleep disturbance 11. Intense Subjective distress

C. Factors influencing a Loss Reaction:1.

Significance of the loss -depends on the perceptions of the individual experiencing the loss.

Factors Affecting Significance of Loss Age of the person Value placed on the lost person, body part, etc Degree of change required because of loss Persons belief and values Expectations

2. Culture - recognizes that the grief reaction expressed may not be indicative of the clients true feelings but rather the expressions expected by his culture. - values, attitudes, beliefs, and customs determines how grief is experienced

3. Spiritual Beliefs - most religious groups have practices related to dying . - include practices, rites and rituals directed toward loss experiences and the grieving.

4. Sex Role - influenced by the social expectations of the male and female roles, men are expected to be strong and show very little emotion during grief but its acceptable for women to show grief by crying.

5. Socio-economic status - affects support system available at a time of loss - influences the familys ability to utilize resources and available support mechanism in coping with the loss. 6.Growth and Development

Concepts which help the Nurse to Plan for Intervention:1. Mourning the behavioral process through

which grief is eventually resolved or altered - process by which people adapt to a loss which is influenced by cultural. - customs, ritual and societys rules for coping with loss. - it is often influenced by culture, religious experience and custom.

2. Hope characterized by a confident, yet uncertain expectation of achieving a goal. 3. Closure the point at which the loss has been resolved and the grieving individual can move on with life without focusing on the loss.

Type of Loss1. Personal Loss

- any significant loss of someone or something that can no longer be seen or felt, heard, known or experience \d and that requires individual adaptation through the grieving process ( perceived beauty, roles, pleasure, satisfaction with life).

2. Perceived Loss - loss that is less tangible and uniquely defined by the grieving client ( loss of confidence, prestige) - experienced by one person but cannot be verified by others . - psychological losses as a women who leaves her employment to care for her children at home may perceive a loss of freedom and independence.

3. Maturational Loss - change on developmental process that is normally expected during a lifetime - loss that occur on the process of normal development (departure of grown children from the home, retirement from a career, death of aged parents)

4. Situational Loss - loss of a person, thing, or quality resulting from a change on a life situation, including a changes related to illness, body image, environment and death. - any sudden, unexpected and definable event that is not predictable (loss of ones job, death of child, etc)

5. Actual Loss - can be identified by others and can arise either in response to or anticipation of a situation. - any loss of a person or object that can no longer be felt, heard, known or experienced by the individual.

Randos Phase of GrievingPhase 1. Avoidance Behavioral Response - Shock, denial ,confusion, numbness, withdrawal, disbelief and disorganization are well to temporarily avoid the loss.

Phase 2. Confrontation

Behavioral Response- Client is in a highly

charged emotional state, in which the client repeatedly faces his or her loss - Grief is most intense and felt most acutely. - exhibit emotions such as anxiety, fear, anger, etc. - anger may be turned inward or unto others

Phase 3. Accommodation

Behavioral Response-Includes a gradual decline

of acute grief and the beginning of an emotional and social reentry into the everyday world. - client learns to live or adapt to the loss - individual is able to invest energy in new persons, things and ideas.

Types of Grief Abbreviated Grief

- grief which is brief but genuinely felt - lost objects may not have been sufficiently important to the grieving person or may have been replaced immediately by another, equally esteemed object.

Anticipatory Grief-

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Process of accomplishing part of the grief work before actual loss Grief response in which the person begins the grieving process before an actual loss. Normal mourning that occurs when a patient or family expecting a death.

Disenfranchised Grief- occurs when societal norms do not define the loss as a loss within its traditional definition. - client is not acknowledged for the loss and does not gain support form others, changes n grades, interest, relationships, death of a same-sex lover, loss of innocence. - survivors grief must be hidden to avoid negative social pressures.

Dysfunctional Grief/ Pathologic Grief - Occurs when there is prolonged emotional instability, withdrawal from usual task or activities that previously gave pleasure and the lack of progression from one level to successful coping with the loss. - Extended grief, unsuccessful use of intellectual and emotional responses by which individual attempt to work through the process of modification. - Manifested as exaggerated, prolonged or absence of grief. - Unresolved or inhibited

Characteristic of Pathological Grief Reaction1. Delusions 2. Hallucinations 3. Phobias 4. Obsessions 5. Isolation 6. Conversion hysteria 7. Agitated depression 1. Delay grief work 2. Suicidal indications 3. Difficulty crying/

controlling crying 4. Loss of control of environment 5. Intense reactions loner than 6months with few sigh of relief 6. Restriction of pleasure

Dysfunctional Grief is inferred from:Client fails to grieve following death of a loved one b) Client becomes recurrently symptomatic on anniversary of a loss or during holidays c) Client avoids visiting the rave and refuses to participate in religious memorial services of a loved one d) Client develops persistent guilt and lowered selfesteem e) Client continues to search for the lost person (suicide to effect reunion) f) Minor event trigger symptoms of griefa)

a) Client is unable to discuss the deceased

with equanimity even after a period of time. b) Interview with client is characterized by