death, dying & grief by prof. unn hidle updated spring 2009

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  • Slide 1
  • Death, Dying & Grief by Prof. Unn Hidle Updated Spring 2009
  • Slide 2
  • Suggested Videos Dealing with Death and Dying The Dying Child
  • Slide 3
  • Definitions Loss 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
  • Slide 9
  • Pablo Perea Emotions
  • Slide 10
  • Types of Grief Anticipatory Grief Uncomplicated/Normal grief Complicated Grief Disenfranchised Grief Childrens Grief
  • Slide 11
  • Anticipatory Grief Grief before the actual loss
  • Slide 12
  • Uncomplicated/Normal Grief Normal feelings, behaviors and reactions to loss Follow the stages of the grieving process
  • Slide 13
  • Complicated Grief Chronic grief Ongoing cycle Delayed grief Exaggerated grief Masked grief Risk factors: Sudden or traumatic death Suicide, homicide Death of a child Multiple loss
  • Slide 14
  • Disenfranchised Grief When loss cannot be openly acknowledged or socially sanctioned Examples may include death from AIDS, abortion, drugs, suicide, ex- spouse, etc.
  • Slide 15
  • Childrens Grief ALWAYS complicated Symptoms unique to children Based on developmental stages
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  • Should death be discussed with dying children?
  • Slide 18
  • 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
  • Slide 19
  • 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
  • Slide 20
  • What to expect when grieving Emotional Symptoms Stages of Grief: Denial This isnt happening to me! Anger Why is this happening to me? Bargaining I promise Ill be a better person if . Depression I dont care anymore Acceptance Im 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
  • Slide 23
  • 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 dont have to say anything to comfort others Allow them to cry and be sad Dont minimize their feelings Show you care by words and actions Help with practical needs
  • Slide 24
  • 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
  • Slide 27
  • 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
  • Slide 32
  • The Dying Process
  • Slide 33
  • Into the light.
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  • The Dying Patients 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
  • Slide 35
  • 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
  • Slide 38
  • 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
  • Slide 39
  • 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)
  • Slide 40
  • Can there be a good death?