Loss and Grief : Chapter 43 Flashcards
Loss
Actual or potential situation in which something that is valued is changed or no longer available
Types of Loss
Actual - recognized by others
Perceived Loss - experienced by one person, but cannot be verified by others ; psychological loss (not directly verifiable)
Anticipatory Loss - before loss occurs ; can be actual or perceived ex…woman expects husband to die
Situational Loss - loss of job, death of child
Developmental Loss -losses during normal development, departure of children from home, retirement, health, and physical activity
Sources of Loss
Aspect of Self - body image ex…scarred burn
Loss of an Object External to Oneself - loss of inanimate objects that are important ex…$, burning down a house, loss of pets
Separation From an Accustomed Environment - departure from things that provide security ex…leaving home for the 1st time to go to college
Loss of a Loved One - loss of a valued person through illness, divorce, death
Grief
total response to the emotional experience related to loss. Grief is manifested in thoughts, feelings, and behaviors with overwhelming distress or sorrow
Bereavement and Mourning
Bereavement - subjective response experienced by the surviving loved ones.
Mourning - is the behavioral process through which grief is eventually resolved or altered, influenced by culture, spiritual belief and custom
Types of Grief
Abbreviated Grief - brief but genuinely felt. Loss is not important or person or thing may be replaced immediately
Anticipatory - in advance of grief ex…wife grieves before husband dies
Disenfranchised - person is unable to acknowledge the loss to other people ex…suicide, abortion, adoption
Complicated (pathologic) - unhealthy, strategies to cope with the loss are maladaptive. lasts more than 6 months and leads to reduced functional ability due to sudden death, strained relationships
Inhibited - normal symptoms of grief are suppressed somatic effects are experienced instead
Delayed - feelings are purposefully suppressed until a much later time
Exaggerated - survivor who uses dangerous activities as a method to lessen the pain of grieving
Kubler-Ross’ Stages of Responses
Denial - Refuses to believe that loss is happening ex..unable to deal with prosthesis after amputation.
*Nurse’s Role - verbally support, but don’t reinforce denial
Anger - client or fam may direct anger at the nurse about matters that wouldn’t normally bother them
*Nurse’s Role - help client understand anger is a normal response, don’t take it personal,provide security
Bargaining - avoids loss ex…“let me just live if __ and then i’ll be ready to die”
*Nurses Role - listen attentively, encourage client to talk, offer spiritual support
Depression - grieves over what has happened and what can’t, talks freely (past losses such as money, or job), withdrawl
*Nurses Role - allow client to express sadness, communicate nonverbally by sitting quietly w/o expecting convo
Acceptance - comes to terms w/ loss, decreased interest in being around people, makes plans (prosthesis, will, altered living arrangements)
*Nurses Role - help family to understand the clients decreased need to socialize, encourage the client to participate as much as possible
Factors that Affect Grief
Age - affects a person’s understanding of and reaction to loss
- Children - loss can affect the ability to develop, and regression may occur
- Early and Middle Adulthood - viewed as normal development
- Late Adulthood - loss of health, immobility, independence, and work role. Health problems increase. after death of spouse.
Significance of Loss - depends on individual
- importance of the lost person, object, or function
- degree of change is required because of the loss
- the person’s beliefs and values
Culture
Spiritual
Factors that Affect Grief (2)
Gender - Men are expected to be “strong” and show little emotion, women are allowed to show grief by crying. Man may consider his facial scar macho and women may consider her ugly.
Socioeconomic Status - a pension plan or insurance can offer a widowed or disabled person a choice of ways to deal with a loss. A person confronted w/ severe loss and economic hardship may not be able to deal w/ either
Support System - often the closest to the grieving are the 1st to recognize and provide assistance, but because many people are uncomfortable or inexperienced w/ dealing w/ loss they may withdraw, unready to receive support when offered, support decreases as the support people return to daily lives
Cause of Loss or Death - loss that is beyond the control those involved may be more acceptable than one that is preventable such as drunk driving. “Line of Duty” deaths are considered honorable.
Measures that Facilitate the Grieving Process
- Explore and respect culture, religion, and personal values
- Teach what to expect in the grief process
- Encourage the client to express and share grief w/ support people
- Teach family members to encourage the client’s expression of grief
- Encourage the client to resume activities on a schedule that promotes physical and psychological health
Death and Dying
Grieving - denial, guilt, anger, despair, feelings of worthlessness, crying, and inability to concentrate
Fear - feeling of disruption that is related to an identifiable source. Same characteristics as grief. Increased pulse and respiration, anorexia, dry mouth, insomnia and nightmares
Hopelessness - no solution to problem, death is inevitable and person see’s no way to get past death. Apathy, pessimism, and inability to make decisions
Powerlessness - solution to the problem but doesn’t believe that it is possible to implement solution. Loss of control is manifested by anger, violence, acting out or depression and passive behavior.
Signs of Death and Dying
- Total lack of response to external stimuli
- No muscular movement (breathing)
- No reflexes
- Flat encephalogram (brainwaves)
Traditional signs of death - cessation of apical pulse, respirations, and BP (heart-lung death)
cerebral death or higher brain death - higher brain center, the cerebral cortex, is irreversibly destroyed.
Death Related Religious and Cultural Practices
Some cultures believe that the prognosis should not be told to the client. They believe the clients last days should be free of worry.
Some believe that patient should die in the comfort of their own home
Autopsy - is prohibited by Easter Orthodox, Muslims, Jews, Jehovah’s Witness, and Orthodox Jews.
Organ Donation - prohibited by Jehovah’s Witness, and Muslims, whereas Buddhists in American consider it an act of mercy and encourage it
Cremation - prohibited by Mormon, Eastern Orthodox, Islamic, and Roman Catholic. Hindu’s prefer cremations and cast the ashes in a holy river
Prolongations of Life - Christians and Jews don’t recommend it. Buddhists permit euthanasia in hopeless illness
Hospice and Palliative Care
Hospice - focuses on support and care of the dying person and family, with the goal of facilitating a peaceful and dignified death. Improves quality of life rather than cure and supports the family and client through the dying process. Symptom control and pain management.
Palliative Care - improves quality of life just as hospice but the patient is not believed to be dying imminently.
End-of-Life Care - care provided in the final weeks before death includes hospice and palliative care.
