Loss and Grief with voice

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Loss and Grief : 

Loss and Grief

Loss : 

Loss Loss is any situation in which a valued object is changed or is no longer accessible to the individual.

Loss : 

Loss Maturational loss occurs as a result of moving from one developmental stage to another. Situational loss occurs in response to external events.

Types of Loss : 

Types of Loss Actual loss Perceived loss Physical loss Psychological loss

Types of Loss : 

Types of Loss Categories of Loss Loss of an external object Loss of familiar environment Loss of aspect of self Loss of significant other

Types of Loss : 

Types of Loss Loss as Crisis Loss precipitates anxiety and a feeling of vulnerability, which may lead to crisis. When an individual is overwhelmed and his or her usual coping mechanisms are no longer effective, crisis occurs.

Types of Loss : 

Types of Loss All Americans experienced significant loss as a collective, as a result of a terrorist attack in the World Trade Center on September 11, 2001.

Grief : 

Grief Grief is a normal, natural, necessary, and adaptive response following a loss. Bereavement is the period of grief following a significant loss, especially death of a person or pet. Mourning is the period of time during which the grief is expressed. Mourning is an adaptive response to loss.

Grief : 

Grief Theories of the Grieving Process Lindemann coined the phrase grief work. Engle described three stages of mourning. Shock and Disbelief Developing Awareness Restitution and Resolution Worden identified four tasks in dealing with a loss.

Grief : 

Grief Types of Grief Uncomplicated grief Dysfunctional grief Anticipatory grief Complicated grief

Types of Grief : 

Types of Grief Persons experiencing dysfunctional grief do not progress through the stages of overwhelming emotions associated with grief, or they may fail to demonstrate any behaviors commonly associated with grief.

Types of Grief : 

Types of Grief Disenfranchised grief is grief experienced in situations where grief is discouraged and social supports are absent.

Types of Grief : 

Types of Grief Anticipatory grief is the occurrence of grief work before an expected loss. Promotes adaptive grieving by freeing up the mourner’s emotional energy. Complicated grief is experienced following a loss that is traumatic, complicated, violent, or unanticipated.

Factors Affecting Grief : 

Factors Affecting Grief Developmental Considerations Childhood Adolescence Early Adulthood Middle Adulthood Older Adulthood

Children : 

Children Concept of death varies with the child’s developmental level. Children need to be included in mourning rituals as appropriate to their developmental level. Children need explanations about death that are honest and comprehensible.

Adolescence : 

Adolescence Adolescents perceive themselves as being invulnerable and death as something that will not happen to them.

Middle Adulthood : 

Middle Adulthood The death of peers forces acknowledgement of one’s own vulnerability to death. Other losses during middle age are those associated with changes in employment and relationships.

Older Adulthood : 

Older Adulthood Most older adults recognize the inevitability of death. Older adults commonly experience the loss of loved ones and friends, occupational role, material possessions, dreams and hopes, and physical and cognitive function.

Factors Affecting Grief : 

Factors Affecting Grief Religious and cultural beliefs Relationship with the lost entity

Factors Affecting Grief : 

Factors Affecting Grief Cause of Death Anticipated death Unexpected death Traumatic death Suicide

Nursing Care of theGrieving Person : 

Nursing Care of theGrieving Person Assessment Determination of the personal meaning of the loss Understanding that the stages of grief the client is experiencing are not necessarily sequential

Nursing Care of theGrieving Person : 

Nursing Care of theGrieving Person Nursing Diagnoses Dysfunctional Grieving Anticipatory Grieving

Outcome Identification and Planning : 

Outcome Identification and Planning Verbalization of feelings of grief Sharing grief with significant others Acceptance of the loss Renewal of activities and relationships

Implementation : 

Implementation Listening to gain understanding of the significance of the client’s loss A nonjudgmental, accepting attitude while the bereaved expresses anger Appropriate referrals to community support groups

Evaluation : 

Evaluation Resolution of the loss is generally a process of life-long adjustment. The nurse has a unique opportunity to lay the foundation for adaptive grieving. Goals mutually established with client and family are the foundation for evaluation.

Death : 

Death Stages of Death and Dying (Elizabeth Kubler-Ross) Denial Anger Bargaining Depression Acceptance

Ethical and Legal Issues Related to End of Life : 

Ethical and Legal Issues Related to End of Life End-of-Life Care Physician-Assisted Suicide

Nursing Care Plan of the Dying Client : 

Nursing Care Plan of the Dying Client Assessment Client’s and family’s knowledge about the nature of terminal illness Availability of support systems Physical condition and symptoms Emotional status including depression

Assessment : 

Assessment Presence of advance directives for health care decisions Concern about unfinished business Client priorities and preparation needs

Nursing Diagnoses : 

Nursing Diagnoses Powerlessness Helplessness High Risk for Spiritual Distress Altered Family Processes

Outcome Identification and Planning : 

Outcome Identification and Planning Promoting an optimal quality of life Treating client and family respectfully Providing a safe environment Meeting the holistic needs and goals of client and family

Implementation : 

Implementation Sitting with the client, touching the client, and being physically present are often the most effective in communicating a caring, compassionate, and accepting attitude.

Nursing Care Plan of the Dying Client : 

Nursing Care Plan of the Dying Client Implementation Palliative Care Focus is on symptom management. The most common symptoms are pain, dyspnea, anxiety, and fatigue.

Implementation : 

Implementation Physiological Needs Nutrition Breathing Elimination Comfort Mobility

Implementation : 

Implementation Promoting Comfort Pain relief Keeping client clean and dry Providing a safe, nonthreatening environment

Implementation : 

Implementation Hospice Care Concept of allowing individuals to die with dignity and be surrounded by those who love them An interdisciplinary team is essential for delivering quality, compassionate care.

Implementation : 

Implementation Psychosocial Needs Clients may fear helplessness, dependence on others, loss of abilities, mutilation, uncontrollable pain. Spiritual Needs Dying can be a time of spiritual crisis.

Implementation : 

Implementation Support for the Family Learning Needs of Client and Family Client’s physical condition Treatment regimen How to handle medical crises Emergency care

Evaluation : 

Evaluation Evaluating the death experience for the family and friends Determining if the goals for a peaceful death and provision of a supportive environment were met Discussing the process in order to assist in providing care for future dying clients

Care After Death : 

Care After Death Care of the Body Physiological changes Algor mortis Liver mortis Rigor mortis Autopsy Organ donation Care of the Family

Nurse’s Self-Care : 

Nurse’s Self-Care Grief is a common experience for many nurses who are confronted with death and loss daily. To cope with their own grief, nurses need support, education, and assistance in coping with the death of clients.

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