Module 7 End of Life Care, Death and Dying Flashcards
how does grief affect survivors?
physically, psychologically, socially, and spiritually because of very real concrete and perceived losses
describe the nurses role in facilitating the grief process?
includes assisting survivors to feel the loss, express the loss, and complete the stages of the grief process
what must nurses have a thorough understanding of in relation to death and dying?
must have a thorough understanding of a patients loss, its significance and meaning to the patient and family, and how It affects the patient’s and family’s ability to carry on
what are the ways people can experience loss?
-absence of an object, person, body part, child, relationship, or role at work
describe a perceived loss and give example
Perceived loss is any loss that is defined uniquely by the grieving patient, it may be less obvious to others
ex. loss of confidence or prestige
describe a maturational loss and give example
Maturational loss is any change in the developmental process that is normally expected during a lifetime
ex. parents feeling of loss as a child goes to school for the first time
what are maturational losses?
they are part of normal life transitions
describe a situational loss and give exmaple
Situational loss is any sudden, unpredictably external event. Often this type of loss includes multiple losses rather than a single loss
ex. Car accident may leave a driver paralyzed, and grieving over the death of a passenger in the accident
what does the type and perception of loss determine?
the type of loss and perception of loss influences the depth and duration of grief that a person experienes
what is it incorrect to assume about a loss?
that the loss of an object does not generate the same level of grieving as the loss of a loved one
what is the ultimate loss?
death
what is something that all want to do once death is imminent?
nearly all want companionship and want to strengthen relationships with significant others
what are the factors that are influenced by the way someone approaches dying?
influenced by personal fundamental beliefs and values, past experiences with death, culture, spirituality, and the quality of the human emotional support available
what is the emotional response to death?
grief
what are grieving differences based on?
individual experience, previously established coping strategies, cultural expectations, and spiritual beliefs and involve the process of mourning and the process of adapting to a loss
describe bereavement
includes grief and mourning; it is the state of having lost a significant other to death
although no one ever “gets over” a loss, what do they do?
the individual can heal and adapt to the loss
what happens during Kubler-Ross’s Stages of grief?
- During denial, an individual acts as though nothing has happened and may refuse to believe or understand that a loss has occurred
- In the anger stage, individual resists the loss and may strike out at everyone and everything
- During bargaining, the individual postpones awareness of the reality of the loss and may try to deal in a subtle or overt way as though the loss can be prevented
- Person finally realizes full impact and significance of the loss during the stage of depression, which may make them feel overwhelming and lonely and withdraw from interpersonal interaction
- During the acceptance stage, the individual accepts the loss and begins to look to the future
Stages and phases of grief may occur nonsequentially or may overlap
describe Bowlby’s phases of mourning
(a person can move back and fourth between any two of the phases while responding to the loss:
1. Numbing phase may last from a few hours to a week or more and may be interrupted by periods of extremely intense emotion. Briefest phase of mourning 2. Yearning and searching arouses emotional outbursts of tearful sobbing and acute distress in most people. It is necessary for the bereaved person to experience the pain of grief in order to finish the work of grief, through finding the meaning of loss a. Therefore, anything that continually allows the person to avoid/suppress the pain can be expected to prolong the course of mourning b. Common physical symptoms: tightening of chest, SOB, feeling of weakness, insomnia, loss of appetite c. Person may also feel an intense yearning for the object or individual who is lost d. This phase may last for months or years 3. Disorganization and despair, an individual may constantly examine how and why the loss has occurred a. Common for the person to express anger at anyone who might be responsible b. This examination gradually gives way to an acceptance that the loss is permanent 4. Reorganization, the person begins to accept unaccustomed roles, acquire new skills, and build new relationships a. People experiencing this phase must be encouraged to find meaning and hope in their loss without lessening its importance
how is attachment described?
instinctive behaviour that leads to the development of affectionate bonds between children and their primary caregiver
describe Worden’s four tasks of mourning
- This usually takes minimum of one year**
Task 1: to accept that the person or object is gone and will not return
Task 2: to work through the pain and grief. It is impossible to experience a loss and work through grief without emotional pain. Individuals who deny or shut off their pain prolong their grief
Task 3: to adjust to the environment in which the deceased is missing. A person does not realize the full impact of a loss for at least 3 months. At this point, many friends/associates make less frequent contact, and the person is left to ponder the full impact of loneliness
Task 4: to emotionally relocate the deceased and move on with life. Goal: not to forget the deceased or give up the relationship with the deceased but to have the deceased take a new, less prominent place in the person’s emotional life. This is often the most difficult task to complete because people fear they’re being disloyal. A person completes this stage once the person realizes it is possible to love other people without loving the deceased less
list the 4 types of grief and why is knowing the different types important for a nurse?
knowledge of types of grief enables a nurse to implement appropriate bereavement therapies
- Normal Grief
- Anticipatory Grief
- Complicated Grief
- Disenfranchised Grief
describe normal grief
Normal to uncomplicated grief consists of the normal feelings, behaviours, and reactions to a loss, including resentment, sorrow, anger, crying, loneliness, and temporary withdrawal from activities
describe anticipatory grief
- The process of disengaging or “letting go”, that occurs before an actual loss or death has occurred is called anticipatory grief
Ex. Once a person or family member receives a terminal diagnosis, they begin the process of saying goodbye and completing life affairs
what is the risk of anticipatory grief?
Family members may withdrawal emotionally from the patient too soon, leaving the patient with no emotional support as death approaches
describe complicated grief and what are the 4 sub types of complicated grief?
- When a person has difficulty progressing through the normal (generally accepted) phases or stages of grieving, bereavement becomes complicated and prolonged
In these cases, bereavement appears to “go wrong” and loss has not been adequately dealt with.- Chronic grief: an active acute mourning characterized by normal grief reactions that do not subside and continue over very long periods and that becomes complicated mourning
a. May also be known as unresolved grief, or complicated grief
b. Coping strategies tend to be maladaptive - Delayed grief: characterized by normal grief reactions that are suppressed or postponed and by the survivor’s conscious or unconscious avoidance of the pain of the loss
a. Active grieving is held back, only to re-surface later, usually in response to a trivial loss or upset - Exaggerated grief: grief that overwhelms people to the point that they cannot function
- Masked grief: lack of awareness by survivors that feel behaviours that interfere with normal functioning are a result of their loss
- Chronic grief: an active acute mourning characterized by normal grief reactions that do not subside and continue over very long periods and that becomes complicated mourning
describe disenfranchised grief
- People experience grief when a loss is experienced and cannot always be openly acknowledged, socially sanctioned, or publicly shared due to stigmatization
Ex. Loss of a partner from an accidental fentanyl overdose, loss of child in utero or at birth, loss of family member through suicide
who does grief theory apply to?
individuals who mourn over lost independence, body integrity, and a change in body image
