Loss, Grief and Death.pptx care for patients

Nursing

1. Loss, Grief and Death Ms. Mogambi

2. I ntroduction Every person who experiences illness and injury will also experience loss or grief. Nurses have a role to help clients and families cope with loss and facilitate peaceful death. Providing end of life care requires knowledge and caring to bring comfort, when hope for cure or continued life is not possible

3. Introduction cont…. A patient needs intensive physical and emotional support as he deals with loss or approaches death. Emotional support for the dying patient and his family usually involves assurance of nurse's physical presence to help ease fear and loneliness. More intense emotional support is important at much earlier stages, especially for patients with long-term progressive illnesses, who can work through the stages of dying .

4. Loss From birth to death, we form attachments and suffer losses. Loss is an actual or potential situation in which something that is valued changes, or is no longer available Loss is experienced when another person, possession, body part, familiar environment, or sense of self changes, or is no longer present.

5. Types of losses Necessary loss; part of life, eventually replaced with something better Maturational loss ; life changes across life span Situational loss; sudden, unpredictable events, not part of expected maturation experience Actual loss ; when a person can no longer feel, hear or know a person or object, and the loss is recognized by others Perceived loss; experiencing loss that is less obvious to others

6. Loss cont.. Each person responds to loss differently The type of loss and person’s perception influence the depth and duration of the grief response. Death is the ultimate loss, it represents the unknown and generates anxiety, fear and uncertainty for many people A person’s spirituality, personal beliefs and values, previous experience with death and degree of social support influences the way they approach death

7. Grief Refers to emotional response to loss This is manifested uniquely by an individual, based on personal experiences, cultural expectations and spiritual beliefs Coping involves a period of mourning ; outward, social expressions of grief and behavior associated with loss It is important to differentiate normal grief from grief as a response to greater stress and personal disruption that requires more intensive intervention

8. Types of grief Normal grief ; involves coping styles such as hardiness, resilience, personal sense of control as well as ability to make sense of loss Complicated grief ; person has a prolonged or significantly difficult time moving forward after a loss. Symptoms of disturbances of complicated grief last at least 6 months after a loss, and may disrupt every dimension of the person’s life Also known as dysfunctional grief

9. Types of grief cont.. Anticipatory grief ; refers to the unconscious process of disengaging or “letting go” before actual death or loss occurs, especially in situations of prolonged or predicted loss Disenfranchised grief ; marginal or unsupported grief, when a person’s relationship to the deceased person is not socially sanctioned and cannot be openly acknowledged or publicly shared

10. Theories of grief and mourning Kubler -Ross (1969) Described five stages in a person’s response to loss or the anticipatory grief of impending death: Denial and isolation Anger Bargaining Depression or sadness Acceptance NB: although listed in order, the stages are not experienced in particular order or for any length of time, and individuals often move back and forth between the stages

11. Theories of grief and mourning Bowlby’s attachment theory (1980) Describes four phases of mourning Numbing; grieving person feels stunned or unreal Yearning and searching; emotional outbursts of tearful sobbing and acute distress accompanied by physical symptoms Disorganization and despair; person tries to make sense and justification of loss Reorganization; begins to accept change

12. Factors influencing loss and grief Client age and stage of development Personal relationships; quality and meaning of the lost relationship influences the grief response Nature of loss Coping strategies Social support Culture and ethnicity Spiritual and religious beliefs

13. Nursing care in grief and loss Health promotion; facilitate successful coping and optimize physical, emotional and spiritual heath Use therapeutic communication Provide psychosocial care Manage symptoms Promote dignity and self esteem

14. Nursing Care in grief and loss…. Maintain a comfortable and peaceful environment Promote spiritual comfort and hope Protect against abandonment and isolation Support the grieving family Assist with end of life decision making Facilitate mourning

15. Definitions and signs of death Heart – lung death: cessation of apical pulse, respirations and blood pressure World medical assembly (1968): Total lack of response to external stimuli No muscular movement, specially breathing No reflexes Flat encephalogram (brain waves) Cerebral death/ higher brain death: irreversible damage of cerebral cortex

16. Signs and symptoms of impending death/ dying Reduced respiratory rate and depth Decreased or absent blood pressure Weak or erratic pulse rate Lowered skin temperature Decreased level of consciousness (LOC) Diminished sensorium and neuromuscular control Diaphoresis Pallor, cyanosis, and mottling

17. Meeting physical needs of a dying patient Take vital signs often, and observe for pallor, diaphoresis, and decreased LOC. Reposition the patient in bed at least every 2 hours because sensation, reflexes, and mobility diminish first in the legs and gradually in the arms . When the patient's vision and hearing start to fail, turn his head toward the light and speak to him from near the head of the bed. Change the bed linens and the patient's gown as needed Observe for incontinence or anuria, the result of diminished neuromuscular control or decreased renal function, provide perineal care to prevent irritation .

18. Suction the patient's mouth and upper airway to remove secretions. Elevate the head of the bed to decrease respiratory resistance. As the patient's condition deteriorates, he may breathe mostly through his mouth. Offer fluids frequently, and lubricate the patient's lips and mouth with petroleum jelly to counteract dryness. In comatose patients, if eyes are open, provide eye care to prevent corneal ulceration. Provide ordered pain medication as needed. Keep in mind that, as circulation diminishes, medications given I.M. will be poorly absorbed. Medications should be given I.V., if possible, for optimum results.

19. Last Offices This refers to meeting the final hygiene needs of a deceased patient This is the last caring act that nurses perform for their patients and is regarded as an expression of holistic care and respect Relatives may find viewing the body of their loved one with a clean and cared for appearance helps them accept the reality of death and aids the grieving process Care of the dead body is also important in reducing potential risks to staff who come into contact with it. Last offices procedures should be performed approximately 30 minutes after a person is certified dead

20. Immediate care after death Protect yourself by donning PPE Close the eyes by gently applying pressure for 30 seconds Lay the person down flat and straighten the body and limbs into neutral position Close the mouth and support the jaw with a pillow, ensure it remains closed

21. Last offices procedure Cover any wound with waterproof dressings Remove all therapeutic devices Pack orifices; nostrils, ears Manually express the urinary bladder into a disposable receiver or bed pan

22. Last offices procedure Dress patient in personal clean clothing Attach identification label to the patient. Wrap body in a clean sheet, securing with a tape Make a list of patient property, pack all patient belongings Inform relatives and the mortuary for collection of the body

23. Assignment Rigor mortis Algor mortis Livor mortis