Death, Loss Grief - notes PDF

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What is it? ❖

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Grief: subjective emotions and affect that are a result of loss. Grief is normal to experience especially after an unexpected death or trauma. Grieving / bereavement: The process in which a person experiencing grief goes through the process of healing. Grief can be expressed in thoughts, feelings, and action Mourning :the outward expression of grief

The process of grieving

Types of grief & Loss ❖

Anticipatory: one is expecting the imminent death of a loved one and has time to make arrangement and go through the grieving process. Disenfranchised grief: grief over a loss that is not or cannot be acknowledged openly, mourned publicly, or supported socially. Circumstances that can result in disenfranchised grief include A relationship that has no legitimacy. The loss itself is not recognized. The griever is not recognized. The loss involves social stigma. (Videbeck 168) Complicated grief : grief lasts long term, may be preceded by mental health conditions. Can cause physiological issues. Physiologic loss: Examples include amputation of a limb, a mastectomy or hysterectomy, or loss of mobility. Safety loss: Loss of a safe environment is evident in domestic violence, child abuse, or public violence. A person’s home should be a safe haven with trust that family members will provide protection, not harm or violence. Loss of security and a sense of belonging: The loss of a loved one affects the need to love and the feeling of being loved. Loss of self-esteem: Any change in how a person is valued at work or in relationships or by himself or herself can threaten self-esteem. Loss related to self-actualization: An external or internal crisis that blocks or inhibits strivings toward fulfillment may threaten personal goals and individual potential.

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Kubler-ross’s 5 stages of grief: DABDA ❖ Denial is shock and disbelief regarding the loss. ❖ Anger may be expressed toward God, relatives, friends, or health-care providers. ❖ Bargaining occurs when the person asks God or fate for more time to delay the inevitable loss. ❖ Depression results when awareness of the loss becomes acute. ❖ Acceptance occurs when the person shows evidence of coming to terms with death. (Videbeck 162) Grieving tasks : The 6 R’s ❖ Recognize: Experiencing the loss, and understanding that it is real, it has happened. ❖ React: Emotional response to loss, feeling the feelings. ❖ Recollect and re-experience: Memories are reviewed and relieved. ❖ Relinquish: Accepting that the world has changed (as a result of the loss), and that there is no turning back. ❖ Readjust: Beginning to return to daily life; loss feels less acute and overwhelming. ❖ Reinvest: Accepting changes that have occurred; re-entering the world, forming new relationships and commitments. (Videbeck 163)

Cognitive Responses to Grief In some respects, the pain that accompanies grieving results from a disturbance in the person’s beliefs. The loss disrupts, if not shatters, basic assumptions about life’s meaning and purpose. Grieving often causes a person to change beliefs about self and the world, such as perceptions of the world’s benevolence, the meaning of life as related to justice, and a sense of destiny or life path. Other changes in thinking and attitude include reviewing and ranking values, becoming wiser, shedding illusions about immortality, viewing the world more realistically, and reevaluating religious or spiritual beliefs (Videbeck 164)

Questioning the loss A client may question the loss or seek answers to the loss to provide themselves with closure. ❖ “Why did this have to happen? He took such good care of himself!” ❖ “Why did such a young person have to die?” ❖ “He was such a good person! Why did this happen to him?” (Videbeck 164) The person experiencing grief may place blame on the lost loved one or thier care providers to seek closure. ❖ “He should have stopped smoking years ago.” ❖ “If I had taken her to the doctor earlier, this might not have happened.” ❖ “It took you too long to diagnose his illness.” (Videbeck 164)

Response to grief ❖

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Cultural considerations ❖

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African American: Mourning also may be expressed through public prayers, black clothing, and decreased social activities. The mourning period may last a few weeks to several years. (Videbeck 166) Muslim: Islam does not permit cremation. It is important to follow the five steps of the burial procedure, which specify washing, dressing, and positioning of the body. The first step is traditional washing of the body by a Muslim of the same gender (Videbeck 166) Chinese American: Burning incense and reading scripture are ways to assist the spirit of the deceased in the afterlife journey. If the deceased and family are Buddhists, meditating before a shrine in the room is important. For 1 year after death, the family may place bowls of food on a table for the spirit. (Videbeck 167) Hispanic Americans; They may pray for the soul of the deceased during a novena (9-day devotion) and a rosary (devotional prayer). They manifest luto (mourning) by wearing black or black and white while behaving in a subdued manner. Respect for the deceased may include not watching TV, going to the movies, listening to the radio, or attending dances or other social events for some time. Friends and relatives bring flowers and crosses to decorate the grave. (Videbeck 167) Orthodox Jewish American: An Orthodox Jewish custom is for a relative to stay with a dying person so that the soul does not leave the body while the person is alone. To leave the body alone after death is disrespectful. (Videbeck 167)

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Spiritual: The grieving person may become disillusioned and angry with God or other religious figures or members of the clergy. The anguish of abandonment, loss of hope, or loss of meaning can cause deep spiritual suffering. (Videbeck 165) Behavioral: Tearfully sobbing, crying uncontrollably, showing great restlessness, and searching are evidence of the outcry of emotions. The person actually may call out for the deceased or visually scan the room for him or her. Irritability and hostility toward others reveal anger and frustration in the process. Seeking out as well as avoiding places or activities once shared with the deceased, and keeping or wanting to discard valuables and belongings of the deceased, illustrate fluctuating emotions and perceptions of hope for a reconnection. (Videbeck 165) Physiologic: may complain of insomnia, headaches, impaired appetite, weight loss, lack of energy, palpitations, indigestion, and changes in the immune and endocrine systems.

Role of the nurse The nurse must encourage clients to discover and use what is effective and meaningful for them. For example, the nurse would ask a Hispanic or Latino client who also is a practicing Catholic if he or she would like to pray for the deceased. If an Orthodox Jew has just died, the nurse could offer to stay with the body while the client notifies relatives. (Videbeck 167) ❖ While observing for client responses in the dimensions of grieving, the nurse explores three critical components in assessment: Adequate perception regarding the loss Adequate support while grieving for the loss Adequate coping behaviors during the procesS

Susceptibility to complicated grief Ambivalent attachment, at least one partner is unclear about how the couple loves or does not love each other. For example, when a woman is uncertain about and feels pressure from others to have an abortion, she is experiencing ambivalence about her unborn child. Dependent attachment, one partner relies on the other to provide for his or her needs without necessarily meeting the partner’s needs. Insecure attachment usually forms during childhood, especially if a child has learned fear and helplessness . (Videbeck 169)...