Grief, Loss and Dying Flashcards
Loss
an actual or potential situation
where something of value is changed or. gone or no longer available
Types of Loss
Actual –
Perceived –
Anticipatory/Maturational -
Situational-
can be identified by others.A response to a situation: Death of loved one, theft, destruction, natural
disaster
experienced by 1 person but can’t be
verified by others (internal loss) psychological loss:
woman gives up career to stay home with children
preparing before loss happens; caregiver/spouse of. terminal patient
sudden, unpredictable external
events: accident, physical changes, loss of
income, life goals
EXAMPLES OF ACTUAL LOSS (5)
- Aspect of self- body parts, loss of function/mobility, organ
- External Objects- theft-house, job, finance, pet
- Familiar Environment- leaving home for nursing home,
getting a new job - Loved Ones- death, separation, illness, change in
personality - Developmental Loss- progression through life, different
stages of life
GRIEF (4)
Intense emotion
The physical, psychological and spiritual
responses to a loss
Grief process allows person to metabolize
the grief
begin resolution
Mourning –
consists of ACTIONS associated with grief such as wailing, wearing black clothing
Bereavement –
period of mourning and adjustment time after a loss. Encompasses both grief and mourning, includes the emotional responses and outward behaviors of a person experiencing loss
Factors that affect the grieving process (12)
Significance of the Loss – meaning attached to loss
Support System – people to lean on
Unresolved Conflicts – may lead to complicated grief
Circumstances of the Loss – manner of death, feel guilty,
unprepared, violent death
Previous Loss – sustained several losses in a short period
Spiritual/Cultural Beliefs and Practices – ability to express
grief
Timeliness of the Death – age of deceased, child too young
Factors
Age – each developmental age views loss differently
Sex – Men and Women grieve DIFFERENTLY!!!
Socioeconomic variables – economic hardships, loss of
loved one’s income, social security benefits, change in
lifestyle (couple > single, dual income > single income)
Coping mechanisms - Positive: seeking out others,
expressing feelings, support groups.
Negative: social
isolation, repressing feelings, refusal to acknowledge the
loss.
Types of Grief (4)
a.
b. Remember the subcategories
c.think of kamar instagram name
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A. Uncomplicated (normal Grief): common, natural response to a loss,
experiences the feelings, behaviors, physical, and spiritual
responses of his/her culture. Intensity of grief will diminish over time
- ACCEPTS NEW INSIGHTS INTO OWN LIFE
-ACCEPTS LOSS
B. Complicated: prolonged or significantly difficult time moving forward after a loss.
- MORE THAN 1 DEATH
1a.CHRONIC
2b. MASKED
3c. -DELAYED
4d. EXTENDED LENGTH OF TIME
FEELINGS OF “STUCKNESS”
C. Disenfranchised: experiences a loss that is not socially supported or
acknowledged by the usual rites or ceremonies (Ex: miscarriage,
death of mistress)
D. Anticipatory: experienced before the loss occurs, Ex: caring for a
loved one with Alzheimer’s disease, terminal illness
Characteristics of complicated grief
- extended length of time engages in detrimental behavior
- often “stuck
- little time/ energy for normal life
s/s assessments of complicated grief 6
somatic sx
- aches and pain
- SOB
- tightness
- sleep disturbances
- no adl
- lower self esteem
(masked grief)
Engages in detrimental behavior: drinking, drug use,
isolation, poor self-care
(complicated grief )
(delayed
grief)
Person uses energy to suppress grief rather than
releasing it: avoidance of grief process
Medical Treatment for pts( 4)
Professional help required: possible in-house
treatment or outpatient
Medications – anti- depressants
Psychotherapist, psychiatrist
Grief support groups: widows, children,
parent, loss from trauma
Medications (3)
a.citalopram hydrobromide- Celexa
b.sertraline hydrochloride-
Zoloft)
c. anti-anxiety drugs: (lorazepam-Ativan)
Stages of Grief Using Grief Wheel
Model (6)
1.Shock and disbelief: refusing to believe
2.Developing Awareness: reality of loss begins,
anger, feeling of sadness
3.Restitution: funeral rites, ceremonies
4.Resolving the loss attempts to deal with painful
loss, accepts the grieving process that must be
gone through, work through it
5.Idealization: emphasis on the positive aspects of
the loved one
6.Outcome – positive or negative
“Magical thinking”
believe they are the
cause of events.
school-age children grief
Interventions (6)
For disorganization:
For reorganization
BE THERE !!! : overwhelming process
LISTEN !!! : with acceptance, grieving people do not
hear advice, can not be cheered up
Normalize the process: normal for everyone
For protest/anger: utilize TCT, support systems, good
health habits, avoidance of drugs and alcohol
For disorganization: encourage personal counseling,
support groups, may need help putting event in
perspective, spiritual/religious support
For reorganization: career counseling, educational
programs promoting patient well-being, social
activities, journal writing
Types of Death (2)
Heart(Lung Death):
-Irreversible cessation of
spontaneous respirations
and circulation
-No respirations
-No pulse or BP and ECG
shows no heartbeat
activity
-Cells no longer capable of
life, necrosis of organs
occur
- longterm care/ dnr
Higher (Brain death)
-Irreversible cessation of all higher brain
functions
-Electroencephalogram (EEG) shows no brain
wave activity
-Cerebral cortex and brain stem are
irreversibly destroyed
- machine keeps pt alive
- doctor make choice
- accidents/ several mi/icu
Organ, Eye, Tissue Donation
Recovery of organs,
eyes, or/and tissues to
enhance or save the lives
of others.
Patient request, use of
donor card (driver
license), honor his/her
request but may not if
strong family objection
5 stages of Dying
Individual Proceess.
a. denial
b.anger
c. bargaining
d. depression
e. acceptance
Denial ( define / nursing interventions)
Just found out about terminal illness/ Stunned, shock, emotions overwhelming, act like a
“zombie”
assume artificial cheerfulness
Nursing interventions: Active listening, responses
translated into feelings “ This must be very difficult for you
to understand and come to terms with”. Offer silence,
just be with patient, encourages patient to express their
thoughts and feelings. Help establish support system
Anger ( define/ nursing interventions)
“why me?’’
Nursing interventions: Don’t take anger personally.
Be there (power in presence). Allow patient to
express themselves, anger not rational. Help
patient find an outlet for anger – journal writin
Bargaining ( define/ nursing interventions)
Asking intervention by another – 2nd opinion doctor, new
treatment options(holistic, research/trial meds), God
- Attempting to negotiate a trade with God or Fate
-Trying to delay the inevitable
Nursing interventions: Listen and offer support. Patient
and family probably getting exhausted at this stage due to
the grief process. Encourage talking. Ask about
spiritual support
Depression ( define/ nursing interventions)
“down” time, expected sadness, change in interactions
Sets in when defense mechanisms (denial, bargaining)
are no longer working
Great sense of loss, no longer deny illness or the
situation.
Nursing interventions: Allow patient to express their
feelings. Be there without having to carry on a
conversation. Allow time to grieve, do not chit chat
about unimportant things. Use sense of touch
