Coping with Loss, Grieving, & Death

Definition:

1. Loss- is an actual or potential situation in which a valued object, person, or the like is inaccessible or changed so that it is no longer perceived as valuable.2. Bereavement is the subjective response to a loss through the death of a person w/ whom there has been a significant relationship.

3. Grief is the total response to the emotional experience of the loss & is manifested in thoughts, feelings, & behaviors.4. Mourning is the behavioral process through which grief is eventually resolved or altered; it is often influenced by culture & custom.

Stages of Grieving:• Kubler- Ross Stages of Grieving1. Denial – Refuses to believe that loss is happening, is unready to deal w/ practical

problems, may assume artificial assume artificial cheerfulness2. Anger- Client or family may direct anger at nurse or hospital about matters that

normally would not bother them3. Depression- grieves over what has happened & what cannot be4. Acceptance- comes to terms w/ loss, may have decreased interest in surroundings & support persons, may wish to begin making plans5. Bargaining – Seeks to bargain to avoid loss, May express feeling of guilt or fear of punishment for past sins, real or imagined

Martocchio’s Five Clusters of Grief

1. Shock & disbelief2. Yearning & protest3. Anguish, disorientation, & despair4. Identification in bereavement5. Reorganization & restitution

• Engel’s Stages of Grieving

1. Shock & disbelief – refusal to accept loss2. Developing awareness – anger may be directed at hospitals, nurses3. Restitution - mourning4. Resolving the loss – attempts to deal w/ painful void5. Idealization – produces image of dead persons that almost devoid of undesirable features6. Outcome – importance of the lost object as source of support

Symptoms of Grief

1. Repeated somatic distress 2. Tightness in chest3. Choking or shortness of breath4.Sighing5. Empty feeling in the abdomen6. Loss of muscular power7. Intense subjective distress

Assisting Clients w/ their Grief1. Provide opportunity for the persons to tell their story.2. Recognize & accept the varied emotions that people express in relation to a significant loss.3. Provide support for the expression of difficult feelings, such as anger & sadness4. Include children in their grieving process.5. Encourage the bereaved to maintain established relationships.6. Acknowledge the usefulness of mutual help groups7. Encourage self-care by family members particularly, the primarily caregivers.8. Acknowledge the usefulness of counseling for especially difficult problemsNursing Diagnosis: Clients w/ Grief & Loss1. Anticipatory grieving related to: perceived potential loss of loved one2. Dysfunctional grieving related to: multiple past or current losses3. Impaired adjustment related to: disability requiring change in life –style4. Social isolation related to: inability to engage in satisfying personal relationshipsCare of the Dying Client

Signs of Impending Clinical Death1. Loss of muscle tone

– relaxation of the facial muscles(jaw may sag)– difficulty speaking– difficulty swallowing & gradual loss of the gag reflex– decreased activity of the GIT– possible urinary & rectal incontinence– diminished body movement

2. Slowing circulation– diminished sensation– mottling & cyanosis of the extremities– cold skin, first in the feet & later in the hands, ears, & nose

3. Provide spiritual support• need for love

• need for hope