Loss and Grief for NUR 134

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Loss and Grief : 

Chapter 23 Loss and Grief

Loss : 

Types of Loss actual-any loss that the indiv. can no longer feel, hear, know or experience. maturational-any change in developmental process ; normally expected during life time (menopause) situational-often sudden, unpredictable, external event. (may include multiple loss- automobile accident) Perceived –any loss that is uniquely defined by the grieving patient Loss

Grief : 

An emotional and behavioral response to loss Mourning Outward social expression of a loss Bereavement (a process) Includes grief and mourning Inner feelings and outward reactions of the survivor Nonlinear nonsequential Grief

Kubler-Ross’s Stages of Dying : 

Denial Anger Bargaining Depression Acceptance Kubler-Ross’s Stages of Dying

Types of Grief : 

Normal (Box 23-3) Anticipatory The process of letting go that occurs before an actual loss or death has occurred Complicated Chronic- continue over long period of time Delayed- suppression of normal grief Exaggerated-overwhelmed to point can’t function Masked-don’t realize that behavior is a result of their loss Disenfranchised- can not openly acknowledge loss Not socially acceptable Not to be publicly shared Types of Grief

Factors Influencing Loss and Grief : 

Human development Psychosocial perspectives Socioeconomic status Personal relationships Nature of loss Culture and ethnicity (Box 23-1) Spiritual beliefs Factors Influencing Loss and Grief

Coping with Grief and Loss : 

Hope The anticipation of continued good, and improvement or lessening of something unpleasant Milestones Significant events Relief of pain or discomfort Coping with Grief and Loss

End of Life Decisions : 

Family members must face end-of-life decisions Deciding to withdraw life support Aggressive versus palliative care End of Life Decisions

Nurse’s Experience with Grief : 

Assess their own emotional well-being Self- reflection to determine if sadness is related to caring or unresolved personal experiences Know when to get away from a situation to care for yourself Nurse’s Experience with Grief

Nurse’s Role in Grief and Loss : 

Provide personal connectedness essential to hope Hope is an energizing resource for the patient Empathy – understanding Offer information-resources Assist patient in returning to healthy behaviors Assess family and patient’s wishes Nurse’s Role in Grief and Loss

Nurse’s Role in Grief and Loss : 

Help patient to accept loss as real Support efforts to live without deceased Encourage the establishment of new relationships Allow time to grieve Interpret normal behavior Provide continuing support Be alert for signs of ineffective coping Nurse’s Role in Grief and Loss

Palliative Care : 

To prevent, relieve, reduce, or soothe symptoms of disease or disorders without effecting a cure Affirm life and regard dying as a normal process Neither hasten nor postpone death Provide relief from pain Integrate psychological /spiritual care Offer support to patient and family Enhance the quality of life Palliative Care

Hospice Care : 

An alternative for the terminally ill who have less than 6 months to live A concept of family-centered care Emphasizes palliative care with family and patient as active participants Interdisciplinary hospice team provides psychological and physical resources needed for family support Hospice Care

Postmortem Care : 

Treat patient with dignity and respect (Box 23-2) Federal and state legislation requires health care facilities to formulate policies and procedures Organ and tissue donation Account for cultural and religious customs Postmortem Care