loss, grief and dying patient f oundation o f n ursing 212
TRANSCRIPT
Loss, Grief and Dying Patient
FOUNDATION OF NURSING 212
LOSS AND GRIEF
Loss :
Is an actual or potential situation in which something that is valued is changed or no longer available . People can experience the loss of body image , a significant other, a sense of well being , a job , personal possessions or beliefs . Illness and hospitalization often produces losses .
TYPES OF LOSS:
There are only two types of losses :
1- Actual loss:
Which can be recognized by others .
2- Perceived loss :
Is experienced by one person but cannot be verified by others .
SOURCES OF LOSS
There are many sources of loss : 1-Aspect of self : the loss of an aspect of self changes
a person’s body image .
2-External objects : such as a loss of money ,…
3- Familiar environment : Separation from an environment and people who provide security
4- Loved ones : The loss of a loved or valued person through illness , divorce , separation or death.
GRIEF
Grief : Is the total response to the
emotional experience related to loss . Grief is manifested in thoughts , feeling and behaviors associated with overwhelming distress or sorrow .
TYPES OF GRIEF RESPONSES 1- Abbreviated grief :
Is brief but genuinely felt . This can occur when the lost object is not significantly .
2- Anticipatory grief :
Is experienced in advance of the event
3- Disenfranchised grief:Occur when a person is unable to acknowledge
the loss to others .
TYPES OF GRIEF
4- Complicated grief ( unhealthy grief ) :
Exists when the strategies to cope with the loss are maladaptive .
Causes of complicated grief :
1- fail to grief.
2-avoidance of visiting the grave and refuse to participate in memorial services
3- Developing the guilt feeling and lowered self esteem
4- Lack of support system
STAGES OF GRIEVING Many authors have described stages or phases
of grieving :
A- kubbler –Ross’s Stages of Grieving :
1- Denial
2- Anger
3-Bargaining
4-Depression
5- Acceptance
STAGES OF GRIEF
B- Engel’s Stages of grief :
1- Shock and disbelief
2-Developing awareness
3- Restitution resolving the loss.
4- Idealization
5-Outcome
FACTORS AFFECTING THE LOSS & GRIEF 1- Age
2- Significance of the loss
3- Culture
4- Gender
5- Socio-economic Status
6-Support system
7- Causes of loss or death
Nursing Management
I- Assessment :
Nursing Assessment of the client experiencing a loss
includes three major components :
A- Nursing history
B- Assessment of personal coping resources
C- Physical assessment .
II-NURSING DIAGNOSISNursing diagnosis may include :
1- Grieving .
2- Complicated grieving
3- Interrupted family processes
4- Risk- prone Health behavior
5- Risk for loneliness
PLANNING
-The overall goals for clients who are grieving the loss of body part are to adjust to the changed ability and to redirect both physical and emotional energy into rehabilitation
- The goals for clients who are grieving the loss of a loved one or thing are to remember them without feeling of intense pain and to redirect emotional energy into one’s own life and adjust to the actual or impending loss .
IMPLEMENTATION
The skills most relevant to situation of loss and grief are:
1- Attentive listening
2-silence, open questions .
3- paraphrasing
4- clarifying and reflecting the feeling
5- Summarizing
6- Be less advisable
IMPLEMENTATION
Facilitating Grief work :- Explore and respect client’s and family culture , ethnic and
religion .
- Teach client and family the expected processes of grief .
- Encourage patient to express and share grief with support people .
- Teach family member to encourage the client’s family expression of grief .
- Encourage the client to resume normal activities on a schedule that promotes physical and psychological health .
IMPLEMENTATION
Providing Emotional support :
1- Use silence and personal presence along with technique of therapeutic communication .
2- Acknowledge the grief of the client’s family and significant others .
3- Offer choices that promote client autonomy .
4- Provide appropriate information regarding how to access community resources .
EVALUATION
Evaluating the effectiveness of nursing care of the grieving client is difficult because of long – term nature of the life transition .
Criteria for evaluation should be based on goals set by the client and the family .
DYING
The concept of death is developed over time , as the person grows , experiences various losses and thinks about concrete and abstract concepts .
Indications of death :
- Total lack of response to external stimuli .
- No muscular movement , especially respiration – No reflexes
- Flat encephalopathy ( Brain waves )
NURSING CARE OF DYING CLIENT
The major nursing responsibilities for client who are dying is to assist the client to peaceful death . More specific responsibilities :
1- To minimize loneliness
2- To maintain the client’s sense of security , self confidence , dignity and self- worth .
3- To help the client accept losses
4- to providing spiritual support
5- Meeting the physiologic needs of the dying client
6- Supporting the family .