Loss and Grief Chapter_26 - 1

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Chapter 2 6 Loss and Grief


Objectives Discuss five categories of loss. Review grief and loss theories. Describe types of grief. Discuss variables that influence a person’s response to grief. Identify assessment parameters in a patient experiencing loss and grief. Identify nursing interventions for helping patients cope with loss, death, and grief. 2


Objectives Develop a care plan for a patient and family members experiencing loss and grief. Discuss principles of palliative and hospice care. Identify ways to educate and involve family members in providing palliative care. List the steps in caring for a body after death. Discuss nurses' experiences of loss when caring for dying patients. 3

Scientific Knowledge Base: Loss:

Scientific Knowledge Base: Loss Types of losses Necessary Actual Perceived Maturational Situational

Scientific Knowledge Base: Grief:

Scientific Knowledge Base: Grief Grief E motional response to a loss Mourning B ehaviors associated with loss Bereavement Includes grief and mourning I nner feelings and outward behaviors of a survivor

Kübler-Ross’ Stages of Grief:

Kübler -Ross’ Stages of Grief Denial Anger Bargaining Depression Acceptance

Bowlby’s Four Phases of Mourning:

Bowlby’s Four Phases of Mourning Numbing Periods of intense emotion and reports feeling “stunned” or “unreal” Yearning and searching Emotional outbursts, sobbing, and acute distress Disorganization and despair Person examines loss and expresses anger Reorganization Person begins to accept change, new role or skills

Worden’s Four Tasks of Mourning:

Worden’s Four Tasks of Mourning Task I: Accept the reality of the loss. Task II: Experience the pain of grief. Task III: Adjust to a world in which the deceased is missing. Task IV: Emotionally relocate the deceased and move on with life,

Additional Grief Theories:

Additional Grief Theories Rando’s “R” Process Model Recognizing the loss Reacting to the pain of separation Reminiscence Relinquishing old attachments Readjusting to life after loss Post modern grief theories Movement back and forth between stages Every person experiences grief differently.

Types of Grief:

Types of Grief Normal or uncomplicated grief Anticipatory grief Complicated grief Chronic Delayed Exaggerated Masked Disenfranchised grief

Nursing Knowledge Base:

Nursing Knowledge Base Factors influencing loss and grief Human development Psychological perspectives on grief and loss Socioeconomic status Nature of personal relationships Nature of the loss Culture and ethnicity Spiritual beliefs

Critical Thinking:

Critical Thinking Knowledge Grief and loss theories, therapeutic communication, disease processes, culture, principles of caring and family dynamics Experience Personal and patient experiences Attitudes Confidence and humility Standards Guide you during the assessment phase of the nursing process

Nursing Process:

Nursing Process

Nursing Process: Assessment:

Nursing Process: Assessment Type and stages of grief Coping resources Patient and family End-of-life decisions Advance directives Durable power of attorney Older adult considerations Risk for impaired grieving Patient expectations

Nursing Process: Diagnosis:

Nursing Process: Diagnosis Death Anxiety Ineffective Denial Fear Grieving Hopelessness Risk for Loneliness Social Isolation Spiritual Distress Readiness for Enhanced Spiritual Well-Being

Nursing Process: Planning:

Nursing Process: Planning Goals and outcomes Consider available resources Goals may be short-term or long-term Setting priorities Address the most urgent needs first Assess patient expectations Collaborative care

Nursing Process: Implementation:

Health promotion Palliative care Hospice care Communicate therapeutically Nursing Process: Implementation

Nursing Process: Implementation (Cont.):

Nursing Process: Implementation (Cont.) Promote hope and spiritual well-being. Facilitate mourning. Manage symptoms. Maintain dignity and self-esteem.

Nursing Process: Implementation (Cont.):

Prevent feelings of abandonment and isolation. Provide a comfortable and peaceful environment. Support family members. Nursing Process: Implementation (Cont.)

Nursing Process: Implementation (Cont.):

Nursing Process: Implementation (Cont.) Provide care after death. Organ donation Postmortem care Autopsy Documentation


Evaluation Patient care Use observation to evaluate coping and grief. Revise the care plan as needed. Patient expectations Maintain open lines of communication. Nurses’ self-evaluation Nurses are at risk for compassion fatigue. Frequently evaluate your own emotional well-being. Take care of yourself.

Quick Quiz!:

Quick Quiz! You are caring for a patient who is depressed because the only child has gone away to college. The nurse will assess this type of depression as A. Actual loss. B. Perceived loss. C. Situational loss. D. Maturational loss.

Quick Quiz!:

Quick Quiz! As a first-year nursing student, you are assigned to care for a dying patient. To best prepare you for this assignment, you will want to A. Complete a course on death and dying. B. Control your emotions about death and dying. C. Compare this experience to the death of a family member. D. Develop a personal understanding of your own feelings about grief and death.

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