Loss, Death, and Grieving.pptx 222222-1.pptx

Study

1. Loss, Death, and Grieving By : Ibne Amin Lecturer , INS Khyber Medical University,Peshawar

2. Objectives 1. Assess the physiologic signs of death. 2. Identify beliefs and attitude about death in relation to age. 3. Discuss the various ways of helping the dying patient meet his/her physiological, spiritual and emotional needs. 4. Discuss care of the body after death. 5. Discuss the legal implications of death. 6. Describe how a nurse meets a dying patient’s needs of comfort. 7. Discuss important factors in caring for the body after death. 8. List changes that occur in the body after death.

3. Objectives 9. Define terms related to loss and grieving. 10. Discuss Kubler-Ross’ theory to assess grieving behaviors. 11. Identify common manifestations of grief 12. Discuss the effects of multiple losses on the grief process 13. Apply the nursing process to grieving clients.

4. Introduction Birth and death are two aspects of life, which will happen to everyone. Dying and death are painful and personal experiences for those that are dying and their loved ones caring for them. Death affects each person involved in multiple ways, including physically, psychologically, emotionally, spiritually, and financially.

5. Definition Death is defined as “The irreversible cessation of all vital functions especially as indicated by permanent stoppage of the heart, respiration, and higher brain function” Death is the cessation or permanent termination of all the biological functions that sustain a living organism. Dying means “approaching death”

6. Physiologic signs of death The four main characteristic changes are ; Loss of muscle tone Slowing of the circulation Changes in the vital signs Sensory impairment. The following guidelines for physicians as indications of death. Total lack of response to external stimuli No musscular movement(esp breathing) No reflexes Flat encephalogram.

7. Beliefs and attitudes about death in relation to age relation to age Infancy to 5 years; Does not understand concept of death,belives death is reversible, temporary departure or sleep. 5 to 9 years; Understand death is final, believes own death can be avoided, believes wishes and unrelelated actions can be responsible for death. 9 to 12 years; Begin to understand own mortality, expressed in after life and fear of death.

8. Conti…. 12 to 18 years; May still hold concept from previous developmental stages, may seem to reach “adult’’ perception of death but be emotionally unable to accept it. 18 to 45 years ; Has attitude towards death influenced by religious and cultural beliefs. 45 to 65 years; Accepts own mortality. encounters death of parents and some peers experiences. 65 years +; Fears prolonged illness, sees death as having multiple meanings,(eg,freedom from pain, reunion with already deceased family

9. Dying Patients We may help the dying patient meet his/her Physiological Needs Spiritual Needs Emotional Needs

10. Meeting physiologic needs of the dying patient. Providing personal hygiene measures Controlling pain Relieving respiratory difficulties Assisting with movement,nutrition,hydration and elimination. Providing comfort to the patient and relieving pain.

11. Spiritual support Identify patient spiritual needs Respect the beliefs of patients Be willing to listen and discuss issues of spirituality. Demonstrate empathy Provide a supportive presence Refer to community resources or spiritual leaders Acknowledge and provide for the rituals

12. Emotional support Compassion (desire to help) Responsiveness to emotional needs Maintain a positive attitude Expressing empathy Attending wishes Being present.

13. Physical Changes After Death Pupils- Fixed and dilated Algor Mortis- Rapid cooling of the body Rigor Mortis- Stiffening of the body, develops 2-4 hours after death Livor Mortis- Purple discoloration of skin in dependent areas

14. Care After Death Death declaration/ Death certificate by physician. Autopsy(written permission) Customs & principles are kept in mind. Positioning- body straitened & arms laid at the side. Eyes are closed as in sleep. Dentures are removed & prop chin in position with bandaging. Remove all appliances used for patient care( e.g - catheter tubing's etc..)

15. Care After Death Remove all the appliances used for patient care. (e.g. Catheter, tubing's, I,V.sets, etc) Remove ornaments and list them to relatives. All orifices are to be plugged with cotton to prevent escape of body discharges. Prevention of spread of diseases (i.e sealing body) Send body clean and neatly dressed. An identification tag If relatives are present then body is handed over them with proper written legal authority permission. Maintain record of death and inform to authority for register of deaths. for body.

16. Legal aspects of death Federal and state law require that institutions develop policies and procedures for certain events that occur after death. 1.Requesting organ or tissue donation 2. Autopsy 3.Certifying and documenting the occurrence of a death. 4.Providing safe and appropriate post mortem care.

17. Legal aspects of death Death must be certified by a physician In unusual death,an autopsy(postmortem examination)may be required. Request family member consent and signature for autopsy. Several reasons for a death becoming a case for the coroner: Death by suspicious means or not under a doctor’s care Death resulting from an accident Client has been hospitalized for less than 24 hours Dying Persons’ Bill of Rights Passive euthanasia California Law (1976)- “Right to Die” bill California Natural Death Act

18. Loss Loss occurs when a valued person, object, or situation is changed. OR Loss can be defined as the undesired change or removal of a valued object ,person or situation Loss is a universal experience that occurs throughout the lifespan.

19. Types of loss 1. Actual Loss can be recognized by others including the person sustaining the loss, ex: a person losing a limb, spouse, valued object, job etc. 2.Perceived loss felt by the person but is intangible to others loss of your youth, financial dependence, loss of confidence or prestige. 3. Anticipated loss the person displays loss and grief behaviors for loss that has yet to take place. EX: families with terminally ill patients and serves to lessen the impact of actual loss

20. Grief Grief is an emotional response to a loss. Grief is a form of sorrow involving feelings, thoughts and behaviors caused by bereavement. Grief is the physical ,psychological and spiritual responses to loss. Grief is a “set of cognitive, emotional and social difficulties that follow the death of a loved one. The grief process involves a sequence of affective, cognitive and psychological states as a person responds to and finally accepts a loss. It is a normal, natural, necessary, and adaptive response to a loss.

21. Loss & Grieving LOSS Something of value is gone GRIEF Total response to emotional experience related to loss BEREAVEMENT Subjective response to by loved ones MOURNING Behavioral response

22. Functions of Grief To make the outer reality of the loss in to an internally accepted reality To lessen the emotional attachment to the lost person or object To make it possible for the bereaved person to become attached to other people or objects

23. Types Of Grief ANTICIPATORY GRIEF NORMAL OR COMMON GRIEF COMPLICATED GRIEF DISENFRANCHISED GRIEF

24. Common Grief Reactions A grief reaction is a set of psychological and somatic (body) symptoms that results from extreme sorrow or loss. These reactions fall into four different categories: Thought Patterns Physical Sensations Emotions Behaviours.

25. Common Clinical Manifestion of Grief Shock and disbelief Sadness Guilt Anger Fear Disorganised behavior Physical symptom Anorexia , GI issues, SOB etc.

26. Stages Of Grief Kubler-Ross, in extensive research with terminally ill patients, identified five stages of feelings and behaviours that individuals experience in response to a real, perceived or anticipated loss. Kubler-Ross Stages of Grieving (1969) Denial Anger Bargaining Depression Acceptance

27. Kubler-Ross Stages of Grieving 1. Denial and Isolation Denial is a conscious or unconscious refusal to accept facts, information, reality, etc., relating to the situation concerned. It's a defence mechanism and perfectly natural.

28. Kubler-Ross Stages of Grieving 2.Anger Anger can manifest in different ways. People dealing with emotional upset can be angry with themselves, and/or with others, especially those close to them. “Why me?” and It’s not fair!” are comments often expressed during anger stage

29. Kubler-Ross Stages of Grieving 3. Bargaining Traditionally the bargaining stage for people facing death can involve attempting to bargain with whatever God the person believes in. For example "Can we still be friends?.." when facing a break-up. Bargaining rarely provides a sustainable solution, especially if it's a matter of life or death.

30. Kubler-Ross Stages of Grieving 4. Depression During this stage, the full impact of the loss is experienced. The sense of loss is intense and feelings of sadness and depression prevail. This is a time of quiet desperation and disengagement from all association with the lost entity.

31. Kubler-Ross Stages of Grieving 5.Acceptance The final stage brings a feeling of peace regarding the loss that has occurred. It is a time of quiet expectation and resignation. The focus is on the reality of the loss and its meaning forthe individuals affected by it.Reaching this stage of mourning is a gift not afforded to everyone.

32. Nursing Implications Nursing care involves providing comfort ,maintaining safety ,addressing physical and emotional needs ,and teaching coping strategies to terminally ill patients and their families . More than ever ,the nurse must explain what is happening to the patient and the family and be a confident who listens to them talk about dying.

33. Nursing Implications Hospice care , attention to family and individual psychosocial issues ,and symptom and pain management are all part of the nurse's responsibilities. The nurse must also be concerned with ethical considerations and quality-of-life issues that affect dying people

34. Nursing Implications Of utmost importance to the patient is assistance with the transition from living to dying, maintaining and sustaining relationships, finishing well with the family, and accomplishing what needs to be said and done. In the hospital, in long-term care facilities, and in home settings, the nurse explores choices and end-of-life decisions with the patient and family.

35. Nursing Implications Referrals to home care and hospice services, as well as specific referrals appropriate for the management of the situation, are initiated. The nurse is also an advocate for the dying person and works to uphold that person's rights. The use of living wills and advance directives allows the patient to exercise the right to have a"good death or to die with dignity.

36. References Kozier & Erb’s Fundamental of Nursing Book, 8 th edition. Potter and Perry (2005) “Fundamentals of nursing” published by most by an imprint of Elsevier, 6th edition. New Delhi. Page no 1068 – 1071  www.google.com

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