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Module 7: Loss, Grief, and Bereavement

Module 7: Loss, Grief, and Bereavement. Loss, Grief and Bereavement. Veterans, their families, and nurses all experience losses Veteran’s grief can be unique Stoicism An interdisciplinary care approach is vital. Nurse’s Role. Assess the grief Type Reaction Influencing factors

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Module 7: Loss, Grief, and Bereavement

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  1. Module 7:Loss, Grief, and Bereavement

  2. Loss, Grief and Bereavement • Veterans, their families, and nurses all experience losses • Veteran’s grief can be unique • Stoicism • An interdisciplinary care approach is vital

  3. Nurse’s Role • Assess the grief • Type • Reaction • Influencing factors • Assist with the grief • Support survivors • Know goals of care Corless, 2010; Glass et al., 2010; NCP, 2009

  4. The Grief Process:Basic Principles • Begins prior to the death • Not orderly/predictable • Series of stages/tasks • No one “gets over it” • Living with and accepting the loss Chan et al., 2004; Doka, 2006

  5. Loss, Grief, Mourning, and Bereavement • Loss: A person, thing, relationship, or situation • Grief: Emotional response to loss • Mourning: Expression of loss • Stoicism-affects the expression • Bereavement: Reaction to the death • Be aware of and respect culture Corless, 2010; D’Avanzo, 2008; Mazanec & Panke, 2010

  6. Influence of the Military on Bereavement Care (Veterans) • Stoicism • “For cry-babies” or a “pity party” • Death of a loved one can trigger PTSD or activate grief • Brotherhood • Estrangements, forgiveness/reconciliation issues. Grassman, 2009

  7. Influence of the Military on Bereavement Care (Veterans) (Cont) • Isolation • Past experiences with violent/mutilating death • No time to mourn the death of comrades • Anger/bitterness towards how they have been treated • Free burial at a national cemetery Grassman, 2009

  8. Influence of Military on Bereavement: Family Members • Stoicism • Frequent relocation • Identify PTSD Grassman, 2009

  9. Complications of Bereavement • Traumatic grief • Increased vulnerabilities • Suicidal ideation

  10. Specific Losses Experienced by Veterans in End of Life • Life-time friends, comrades • Body part(s) • Overall health • Financial security • Dreams • Profession • Sexuality

  11. Various Types of Grief • Anticipatory • Normal • Complicated • Disenfranchised

  12. Traumatic Grief:Specific to Veterans • Sudden loss of close attachment • Experiences multiple losses • Exposure to large number of civilian deaths • Death from friendly fire • Concerns of causing death or harm to civilians Pivar, 2004

  13. Survivors of Traumatic Events:Acute Symptoms Pivar, 2004

  14. Assessment and Treatment:Acute Grief of Veterans • Intense feelings are normal in the early stage of grief • Assess ability to cope • Respect their feelings • Open communication • Acknowledge their loss • Encourage relaxation • Permission to grieve Pivar, 2004; Grassman, 2009

  15. Meeting the Needs Related to Grief in Vulnerable Populations • Homeless • Prisoners • Mentally ill • Substance abusers

  16. Remember the Children:They Grieve, Too • Based on developmental stages • Can be normal or complicated • Symptoms unique to children

  17. Stages and Tasks of Grief • Stage 1: Notification and Shock • Stage 2: Experience the Loss • Stage 3: Reintegration Corless, 2010

  18. Factors Influencing the Grief Process • Survivor personality • Coping skills/patterns • History of substance abuse • Relationship to deceased • Spiritual beliefs • Type of death • Survivor ethnicity and culture

  19. Bereavement Interventions • Plan of care • Attitude • Cultural practices • What to say • Anticipatory grief • Grief work is never completely finished • This can be NURSING AT ITS FINEST!

  20. Nurses Experience Losses:Prevention of Compassion Fatigue • Nurses witness • Medical futility • Prolongation of suffering • Denial of palliative care services • Nurses experience • Cumulative loss • Moral distress Ferrell, 2006; Ferrell & Coyle, 2008

  21. Cumulative Loss • Succession of losses • Unable to resolve loss before another occurs • Anticipatory and normal grief simultaneously • Unable to resolve the grief issues in between deaths

  22. Factors Influencing the Nurse’s Adaptation • Professional education • Personal death history • Life changes • Support systems Vachon & Huggard, 2010

  23. Systems of Support • Balance • Assessing support systems • Spiritual support Vachon & Huggard, 2010

  24. Developing Self-Awareness and Practicing Self-Care • Self-Awareness: Innate psychological function that allows you to expand your choices and provide more creative responses • Self-Care: Protection from occupational stressors and allow for renewal Kearney et al., 2009

  25. Conclusion • Care does not end with the death • Assessment is on-going • Nurses must recognize and respond to their own grief • Interdisciplinary care

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