Grief Process, Death and Dying

Grief Process, Death and Dying Nur 102 Fundamentals of Nursing Roark, 2004

LOSS • Actual • Perceived • External Objects • Known Environment • Significant Other • Aspect of Self • Life Roark, 2004

Kubler-Ross Stages of Grief • Denial • Anger • Bargaining • Depression • Acceptance Roark, 2004

Death and Dying • Assisting the patient to “Live well” and “Die well” What does this mean to you? Roark, 2004

Common fears of the dying patient • Fear of Loneliness • Distancing by support people and caregivers can occur • Debilitation, pain, and incapacitation • Hospital, a place that can be very lonely • Fear of dying alone Roark, 2004

Fears of the dying client • Fear of Sorrow • Sadness • Letting go of hopes, dreams, the future • Awareness of own mortality • Grief about future losses • Anticipatory grief that involves mourning, coping skills • Grief related to diagnosis that has a long term effect on the body such as cancer • Patient may feel well at time of diagnosis Roark, 2004

Fears of the dying client • Fear of the unknown: • Death is an unknown state • What will happen after death? • What will happen to loved ones, those left behind Roark, 2004

Fears of the dying client • Loss of self concept and body integrity • Mutilation via therapy • Body image changes • Loss of role or status • Loss of standard of living Roark, 2004

Fears of the dying client • Fear of Regression • Ego is threatened • Physical deterioration may occur • Mental deterioration may occur • Unable to care for self • Become dependent on others for care Roark, 2004

Fears of the dying client • Fear of Loss of Self Control • Loose ability to control life decisions • Loose ability to control ADL’s • Loss of control of body functions • Loss of control of emotions • Loss of independence Roark, 2004

Fears of the dying client • Fear of Suffering and Pain • May be many different types of pain or suffering such as physical, emotional, social, or spiritual in nature • Altered relationships with others • Anxiety related to the disease and consequences of the disease Roark, 2004

Child’s Response to Illness and Death • Infant • Toddler • Preschool • School Aged • Adolescent Roark, 2004

Cultural Backgrounds Affect Beliefs Concerning Death • Beliefs, attitudes, and values that stem from the patient’s cultural background will strongly influence their reaction to loss, grief, and death • Expressions of grief are governed by what is acceptable by the family and within the cultural context • Comfort may be found through spiritual beliefs, and finding comfort in specific rites, rituals, and practices Roark, 2004

Cultural Backgrounds Affect Beliefs Concerning Death • Organized religious practices • Nurses need to be in tune with patients’ spiritual needs • Becoming familiar with cultural views will help… • Can you name some cultural practices associated with loss, grief, and death? Roark, 2004

Support the client • Nurses can help to identify coping mechanisms, and encourage effective coping mechanisms • Allow client/family to visit the chapel if desired • Allow family members around • Client may have problems with conflicting feelings that do not align with culture or religious practices-nurse can evaluate coping and guide the client to appropriate interventions Roark, 2004

Role of the Chaplain • Can be a member of the health care team • Assist with religious practices • Perform rites • Provide prayer, support, and comfort • Assist with mobilizing other support systems that are important to the client • Support family members Roark, 2004

Nurses response to the dying patient • Nurses grieve also • Nurses need to come to terms with personal meanings of life and death • Best prepared to work with terminal clients when the nurse has been given the time to come to terms with own mortality • Common feelings • Develop personal/professional support systems Roark, 2004

Rationale for Communicating Truthfully about Terminal Illness • Right to know • Time frame • Nurse needs to assess whether or not the patient/family have been told and what was told to them • THE PHYSICIAN WILL TELL THE CLIENT FIRST, NOT THE NURSE Roark, 2004

Communicating Terminal Illness, continued • The nurse: • Clarifies what was said • Listens to concerns • Fosters communication between MD, client, and family • Allows patient to express loss • Facilitate grief through nursing process • Be available for patient • Assist patient to identify needs/hopes for remainder of life • Connect patient with proper resources Roark, 2004

List nursing strategies appropriate for grieving persons • Open ended statements • Patient sets the pace • Accept any grief reaction • Be aware—nurse may be target of anger • Remove barriers • Avoid giving advice • Allow patient to talk • Allow patient to express signs of hope • Support hope by helping focus Roark, 2004

Assist Family to Grieve • Explain procedures and equipment • Prepare them about the dying process • Involve family and arrange for visitors • Encourage communication • Provide daily updates • Resources • Do not deliver bad news when only one family member is present Roark, 2004

Choices of Care Setting • Families have choices of where to care for the dying loved one • Ask the patient and family preferences • Support whatever the choice • Hospital, Home/Hospice Roark, 2004

Elements of Hospice Care • Home care coordinated with hospital • Control of symptoms holistically • Physician directed care • Utilization of variety of health care professionals • Bereavement follow up care • Acceptance based on need, not $ Roark, 2004

Nursing strategies to meet physical and psychosocial needs of the dying patient • Thorough pain control • Maintain independence • Prevent isolation • Spiritual comfort • Support the family Roark, 2004

Signs/Symptoms of Approaching Death • Motion and sensation is gradually lost • Increase in temperature • Skin changes-cold, clammy • Pulse-irregular, and rapid • Respirations-strenuous, irregular, Cheyne stokes • “Death rattle” • Decrease Blood Pressure • Jaw and Facial muscles relax • MOST POSITIVE SIGN OF DEATH=Absence of brain waves (Need two MDs to sign off) Roark, 2004

Nursing care after death • Autopsy: examination performed after a person’s death to confirm or determine cause of death • For tissue and organ removal: • Keep CV system going • Call donor bank representative • Must be agreed on by all family members • Or, patient decision before death Roark, 2004

Nursing care after death Legally, a person is considered dead when there is a lack of brain waves even though other body organs continue to function This definition allows for harvesting of organs and tissue for donation Vital organs are: heart, liver, kidney, lung, pancreas Non-vital organs are: eye corneas, long bones, middle ear bones, and skin Roark, 2004

Deceased patient, before viewing the body • Check orders for special requests • Remove equipment • Remove supplies • Change soiled linens and cleanse patient • Use room deodorizer • Place patient in supine position, with small pillow under head • Insert dentures Roark, 2004

Deceased patient, before viewing the body continued • Remove valuables and give to family • Stay with family, if requested After the family leaves: • Tag patient according to hospital/agency policy • Wrap body in shroud • Put ID tag on shroud • Transfer to morgue • Document Roark, 2004

Describe response of family to dying process • Related to cultural background • Unresolved grief issues • Emotions • Requests • Physical symptoms may occur • Reorganization • Individualized grief patterns Roark, 2004

Behavioral responses that obstruct the expression of grief • Sudden, unexpected death • Lengthy illness resulting in death • Loss of a child • Perception that the death was preventable • Unsteady relationship with deceased • Mental illness of survivor • Lack of social support Roark, 2004

Thanatology • Thanatology= study of death • The description of study of the phenomena of death, and of psychological mechanisms for coping with death Roark, 2004

Grief Process, Death and Dying