Ch 37 Death and Grief

1. Necessary
2. Maturation

   Nota:

   • Necessary and normal expected changes throughout life ie: leaving your parent for the first day of school. this help you develop coping skills
3. Perceived

   Nota:

   • someone experiencing a loss and is less obvious to other people 
4. Actual

   Nota:

   • you can no longer feel, hear, see or know of person ie: loss of body part 
5. Situational

   Nota:

   • sudden unexpected.  ie: car accident that causes lose of function or income
6. Death

   Nota:

   • The ultimate loss

Nota:

• normal but bewildering cluster of ordinary human emotions arising in response to a significant loss, intensified and complicated by the relationship to the person or the object lost. everyone experiences this differently 

1. Mourning

   Nota:

   • outward, social expressions of grief and the behavior associated with loss. Culturally influenced 
2. Bereavement

   Nota:

   • encompasses both grief and mourning and includes the emotional responses and outward behaviors of a person experiencing loss 
3. Normal

   Nota:

   • common, universal, with complex emotional cognitive, social and physical behavior to loss and death 
4. Anticipatory

   Nota:

   • this happens before the actual loss or death occurs.  -people grieve when they know someone is going to die  -this can create an emotional roller coaster for some 
5. Disenfranchised

   Nota:

   • -When someone dies and cannot properly grieve the loss of someone because their culture does not acknowledge the loss because it is not "norm" 
   1. Ambigous loss

      Nota:

      • In cases with people with dementia. the person is physically there and not psychologically 
6. Complicated

   Nota:

   • When someone has a difficult time moving on after loss. 
   1. chronic
   2. exaggerated
   3. delayed
   4. masked

Nota:

• Denial, anger, bargaining, depression, acceptance 

1. human development

   Nota:

   • the age and stage of development affects grief response.  -older people deal better with loss because of previous experiences and coping skills
2. personal relationships

   Nota:

   • the quality and meaning of the person loss influences the grief response. 
3. nature of loss
4. coping strategies

   Nota:

   • coping skills are developed from childhood (talking, journaling, sharing their emotions with freinds) -Nurses can assess coping strategies 
5. socioeconomic status
6. culture

   Nota:

   • different cultures grieve differently 
7. Spiritual

   Nota:

   • Provides a framework to navigate understand and heal from loss/death 

Nota:

• -encourage pt to tell his or her story.  -invite them to share experiences  -this helps understand the pts needs 

1. Through the patients eyes

   Nota:

   • -be present for the pt/ -when/if the pt trusts you you can better understand how they grieve and perceive death -speak to pt's family and friends 
2. Griefing variables

   Nota:

   • -convos about the meaning of loss to pt often lead to other important asessments ie coping style, social system and self care
3. grief reactions

   Nota:

   • use physical and psychological assessment skills to assess a patients unique grief response 

Nota:

• - compromised family coping -death anxiety -grieving  -hopelessness -complicated grieving 

Nota:

• have the pt's resources considered such as energy and family support

1. Priorities

   Nota:

   • Have the pt and family/friends help set their priorities for the end of life care.  -pain management for end of life us normally top priority 
2. teamwork

   Nota:

   • A team is a must when trying to deal with grief, loss, death.  -doctors, nurses, PT, OT, family and friends all help with palliative care

1. Palliative care

   Nota:

   • Focuses on prevention, relief, reduction or soothing symptoms of disease or disorders throughout the entire course of an illness 
   1. Hospice care

      Nota:

      • philosophy and model for the care of terminally ill pts and their families at the end of life  -when in this care, pt usually has less than 6 months to live
2. Use Therapeutic Comm.
3. Manage symptoms
   1. Promote self care
4. provide psychosocial care
5. Maintain a comfortable/Peaceful environment
6. Promote Spiritual comfort
7. Support grieving family

   Nota:

   • Educate them -be there for the family and support them as they are going through  -help family make decisions after their loss 
   1. Facilitate mourning
8. Care after death
   1. tissure/organ donation
   2. Documenting

      Nota:

      • Time of death. people notified of death. time of body transfer and destination. special prep of body
   3. Postmortem care

Nota:

• Success of eval process depends somewhat on the bond you formed with the pt.  -example: if the goal was that the pt will communicate a sense of hope to family. eval verbal and nonverbal communication