Grief, Loss,Death And Dying
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Post on 22-Jan-2015
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- 1. Mariane T. Sibala, RN Larmen de Guia Memorial College 2009
- Loss is a universal experience that occurs throughout the lifespan.
- Grief is a form of sorrow involving feelings, thoughts and behaviors caused by bereavement.
- Responses to loss are strongly influenced by ones cultural background.
- The grief process involves a sequence of affective, cognitive and psychological states as a person responds to and finally accepts a loss.
- LOSS = something of value is gone
- GRIEF = total response to emotional experience related to loss
- BEREAVEMENT = subjective response to by loved ones
- MOURNING = behavioral response
- 5. Stages Behaviors D A B D A Refuses to believe that loss is happening Retaliation Feelings of Guilt, punishment for sins Laments over what has happened Begins to plan (e.g. wills, prosthesis)
- The end of life
- The full cessation of vital actions
- Permanent state in the field of biology
- All living things eventually die
- What are the persons feelings towards death?
- Present generation may be unaware of feelings
- Prolonging life
- Common fears
- Behaviors of health care professionals
- No, not me
- After the initial shock has worn off, the next stage is usually one of classic denial, where they pretend that the news has not been given.
- They effectively close their eyes to any evidence and pretend that nothing has happened.
- Do not interfere unless it becomes destructive
- Do not support denial; conversations should include reality
- Continue to teach and encourage self care activities.
- Why me?
- This stage often occurs in an explosion of emotion, where the bottled up feelings of the previous stages are expulsed in a huge outpouring of grief.
- Whoever is in the way is likely to be blamed.
- Give space allowing them to rail and below. The more the storm blows the sooner it will blow itself out.
- Try not to respond in kind
- When anger is destructive , it must be addressed directly. Remind the person of appropriate and inappropriate behavior.
- Yes me, but
- The patient attempts to negotiate a postponement with God and is generally kept a secret.
- Spend time with patients
- Discuss importance of valued objects and people.
- The inevitability of the news eventually (and not before time) sinks in and the person reluctantly accepts that it is going to happen.
- Be available
- Dont attempt to cheer person up
- Find out any religious support
- Restful time, but not necessarily happy.
- Often begin putting their life in order, sorting out wills and helping others to accept the inevitability.
- Plan care to allow the person with whom patient is comfortable to care for him or her
- It is important that you dont withdraw
- May have increased hallucinations
- Decreased appetite
- May have temperature spikes
- Incontinent for stool and urine 24 to 72 hours prior to death
- Pain may be more intense
- Restlessness is common 12 to 24 hours prior to death
- Changes in respiratory status
- Increase in chest fluids
- Grunting and moaning on expiration
- Skin changes
- The role of the nursing staff is fundamentally supportive
- Accept the physical and mental state he is in
- Show him that they will not abandon him
- Responds to the persons needs in a physical, psychological, social and intellectual level
- Biological needs, reduction and control of pain
- Pain is a subjective experience
- Acute pain: usually temporary
- Chronic pain: interrupts normal everyday functioning
- Medication is more effective in the context of a holistic intervention
- Feelings of anger, sadness, depression are part of a wider process of anticipatory grief, useful for the patients psychological preparation to die
- Nursing staff has to comprehend and the person to express these feelings
- The only way for the person to reconcile with these feelings is to talk to someone who is willing to listen
- Support has to respond to the persons need for safety, autonomy and self-control
- Emotional and social withdrawal
- Need of emotional withdrawal co-exists with the need of belonging to an accepting and supportive social environment
- When family/medical nursing staff keep their distance in order to protect themselves, the person experiences a social death, which is sometimes more painful than the actual death
- Nursing staff must treat the dying person without fear, encourage relatives to be close to him, act as a liaison with the outside world
- The new reality: irrational, unfair, difficult
- Need to evaluate his life as meaningful, important, useful
- Nursing staff should stand by him without being judgmental, let him decide where he wants to spend his last days, and interact with him as a person who LIVES
- Nurses need to take time to analyze their own feelings about death before they can effectively help others with terminal illness
- Understand that you may experience grief
- Nurses have to be strong to control their feelings to be able to tolerate pain, illness, and death, and to keep their distance
- Provide relief from illness , fear and depression
- Help clients maintain sense of security
- Help accept losses
- Provide physical comfort
- 1-5 immobility and inactivity; wishes and unrelated action responsible for action
- 5-10 final but can be avoided
- 9-12 understands own mortality and fears death
- 12-18 fears and fantasizes avoidance
- 18- 45 increased attitude awareness
- 45-65 accepts mortality
- Above 65 multiple meanings; encounters and fears
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ADULT GRIEF & LOSS *Living & dying with cancer* DR JEFFREY STREIMER AT-P CORE PSYCHOTHERAPY PROGRAM PSYCHOTHERAPY PROGRAM