Week 3- loss, grief, mourning and bereavement Flashcards
4 key elements of how PC can be used in practice
1 .Decreasing suffering and increasing QOL
2. Holistic care (spiritual, cultural, mental, social, physical)
3. Team based
4. Person and family centered care
Loss=
To be deprived of someone or something important.
anticipatory loss (grief)
- an _______ response to
- can be based on
- An emotional response to expected or impending future losses
- Can be based on the dying person’s or family’s previous losses
Ex. Loss of a long retirement or grandchildren
ambiguous loss
- difficult to
- may be
- difficult to identify, often not tangible
- might be more challenging for family
ex. gradual loss of cognitive function with dementia. person is still alive but not the same
need to support people through loss so they _____
how (3)
don’t develop complicated grief
how: providing support throughout, prepare for loss, open conversations
grief (4)
not necessary to
- natural, healthy response to loss
- whole body experience
- does not end, intensity decreases over time
- everyone grieves differently
- not necessary to alter normal grieving, provide a listening ear, be supportive, provide information
as nurses we can
Acknowledge loss
Assess loss and grief
Education
Leave room for silence
Make space for tears
Lifestyle management
Resources
AAG
Adult attitudes to Grief scale
- assess grief
ask more questions on the areas that scored high
age: 2-4
concept of death (2)
grief response (2)
- seen as abandonment
- seen as reversible
- intensive but brief
- very present oriented
Age 4-7
concept of death
grief response
death is still seen as reversible
A great personification of death
feelings of responsibility because of wishes or thoughts
verbalization
great concerns with person
how, why
7-11
concept of death (3)
grief response (3)
punishment
fear of bodily harm
difficult transition period- still wants to see as reversible
specific questioning
concerned how others are responding (what is the right way)
starting to have ability to mourn
11- 18
concept of death
grief response
- adult approach
ability to abstract
beginning to conceptualize death truly
depression
denial
regression
talk to people outside family
traditional mourning
social, educational, and family factors to help determine grief/bereavement preferences
questions you can ask
- tell me about your family.
- have you or your family had significant experience with someone who has had a serious illness or who has died?, how did that affect you?
cultural, religious and spiritual factors questions to help determine preferences in grief/bereavement discussions
- is there anything I should know about your cultural, religious, or spiritual views about illness or life and death?
freud theory of grief (2)
- The starting point for theories on grief
loss-mourning - Is complete when attachment is severed
bowlby theory on grief (2)
Attachment-based theory
need to detach & sever relationships to complete mourning
Kubler- Ross theory on grief (2)
Proposed stages of grief
-shock and disbelief, anger, bargaining, depression & acceptance
Parkes theory of grief
Healthy grieving includes changing one’s worldview and the way they have dealt with life previously
Klass, Silverman and Nickman theory on grief
Continued bonds
-the ongoing relationship between the bereaved and the deceased is healthy and normal
common normal manifestations of grief
- physical
- social
- emotional
- spiritual
- mental
(sleep, personal hygiene)
(isolate, unable to focus on work, distracting, delaying, denying)
(laughing, crying)
(questioning, strengthening)
( disassociate, anger)
prolonged grief disorder (complicated grief) occurs when
there is a debilitating intensity or duration of “normal” grief responses that adversely affect the ability to cope with normal life events.
vulnerable groups for grief (6)
elderly
children
socially isolated
mentally ill
disenfranchised
culturally diverse groups (new immigrants and the Indigenous)
Risk factors for complicated grief (7)
- Co-morbidities: mental illness; cognitive impairment; substance abuse
- Concurrent stressors: significant other with a life-threatening illness
- Circumstances around the death: perceived as preventable, sudden, unexpected, violent, traumatic or untimely; suicide; found/saw/identified the body; issues with death notification
- Lack of support: social isolation, disenfranchised grief; cultural or language barriers;
- Relationships: anger, ambivalence, resentment; attachment insecurity; high marital dependency;
- Low social support
- Being a spouse or parent of the deceased.
Bereavement:
The state where, following death, the family creates meaning and sense out of the new reality of life without their loved one/person who died.
Bereavement includes the period of
adjustment following a person’s death and it encompasses many elements of grief, including prolonged grief disorder (complicated grief).
___% of grief in bereavement is normal grief, not requiring pharmacological management
85
Management of Bereavement
- at the time of death
- personally contact person/family
- acknowledge the death and reactions including feelings such as guilt, relief or shock
- ascertain and address immediate concerns about care, the death or funeral
- arrange for follow up
After death
self management (3)
- provide info about grief
- provide info about local resources and online resources
- share be gentle with yourself pt handout
after death
- ongoing care contact
- within 2 weeks, acknowledge or contact family
- contact again at 1-2 months, 6 months and 11-12 months (anniversary of the death)
- recognize holidays, birthdays and wedding anniversaries are tough
- be aware that the second year can also be difficult
benzos have a
very limited role in the management of acute grief
melatonin
- non addictive may be helpful sleep aid
- (0.1-10mg)
- 3-10mg hs is commonly used in PC and geriatric settings
treating grief related major depression: antidepressants
treat once you are confident it is pathological
start recommending exercise, counselling, and supports
if symptoms are worse or not improving by 8 weeks post death, start antidepressant medication
treating prolonged grief disorder
- assess in the context of the persons life, personality, culture, and nature of death/illness
- refer to bereavement counsellor, psychologist or psychiatrist who will provide targeted psychotherapy
