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Chapter 10 Nurse-Patient Relationships During Grief, Mourning, and Loss

Chapter 10 Nurse-Patient Relationships During Grief, Mourning, and Loss. Grieve big and small losses throughout life. Weddings, graduations; off to kindergarten, college Divorce Loss of a job (financial security) Loss of loved ones

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Chapter 10 Nurse-Patient Relationships During Grief, Mourning, and Loss

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  1. Chapter 10Nurse-Patient Relationships During Grief, Mourning, and Loss

  2. Grieve big and small losses throughout life • Weddings, graduations; off to kindergarten, college • Divorce • Loss of a job (financial security) • Loss of loved ones • Losses associated with illness (self-esteem, belief systems, faith, hope, dreams) • Often producing feelings of guilt

  3. Patient-Safe Strategies for Crying • Use empathy: “I can see you’re upset” • Allow emotional release through tears and words • Raging and crying—allow patient to regain control (blow off steam); keep silent and accept response • Quiet crying—sit on same level, hold hand, offer tissues

  4. Encouraging Emotional Release Using Tears: “ A Good Cry” • Tears reduce emotional pain levels • Release of stress-related tensions and hormones in tears • Relieve feelings of loss, sadness, grief, frustration and anger • Initial release of catecholamines increases heart rate and blood pressure, followed by parasympathetic response generating systemic relaxation

  5. What not to say….. • “There’s no need to cry. You’re doing fine.” (stop) • “Please stop crying now.” • “Get hold of yourself.” (stop) • “Think positive.” (advice) • “Think of your family.” (guilt) • “You must be strong.” • “You must be a man about this.” • “It’s time to get on with your life.” • “I know how you feel.”

  6. Gender Differences • Women vent tensions, anger, and frustrations by crying; across cultures, women cry more than men • Men more often yell or shout • Pressure for men not to cry for fear of being labeled “sissy” or “crybaby”: “You’re a big boy. Big boys don’t cry.” • Men generally tend not to express emotions as much as women

  7. Why Do Women Cry and Express Themselves More Freely? • Socialization? Girls encouraged to express themselves and cry • Physiological? Women secrete a hormone prolactin (30 times more than men) involved in tear production

  8. Grief Associated With Death and Significant Loss Shock, disbelief, denialAnger—Lack of controlGuilt and fear—Am I being punished?Depression and sadness—Nothing will ever be the same againCome to terms with loss and make plans

  9. Before helping others grieve/mourn losses: • You must recognize your own vulnerability to loss and pain • Acknowledge you can never be in “total” control of your life • Acknowledge your own mortality • Anticipatory grieving—emotional responses to potential loss

  10. Grief work: After death of loved one, intense and painful • Loss of pet—20 hrs crying • Spouse, parent, friend, child—200 to 300 hrs crying • Talk through tears; review good and bad memories • Restructure and rebuild lives without the loved one

  11. Grief work takes 1-3 years • People, events, objects evoke memories of the deceased, bringing on feelings of sadness, depression, tears • Holidays, special events • Dysfunctional grieving: Unsuccessful responses at working through the process of loss • Sadness turns into depression • Emotional depression – unable to function in personal lives or jobs • Physiological depression of immune system

  12. Successful Resolution of Grief • Never forget but go on without the other • Become actively involved in meaningful activities once more; still see purpose in life • Greater understanding of life, greater compassion for suffering and the needs of others

  13. Emotions are contagiousWe feel the same emotions as those around usWe must acknowledge and accept the emotions in ourselves and our patients

  14. Health-Care Providers Cry, Too! • When caring for patients and families, you will become close to some and experience grief along with them. • Crying with a family member or patient is fine, as long as the other cries first. • Avoid crying unless the patient cries first. If you are upset, you may need to excuse yourself and go to a private place. • Discuss your feelings with a trusted nursing student/ faculty. • Journaling to express feelings.

  15. Non-emotional health-care provider doing tasks, procedures, paperwork comes across as uncaring, task-oriented, too busy to be bothered

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