Grief and Loss (Nursing)

00:02 Hi, today we are going to be talking about Grief and Loss.

00:05 My name is Jill Beavers-Kirby.

00:09 There are different types of grief.

00:11 The first is normal grief.

00:13 This is expected, emotional and behavioral reaction to a loss.

00:20 Next we have anticipatory grief. This occurs before the impending loss. This is the process of letting go.

00:27 The third type of grief is complicated grief and this can be intense long lasting grief.

00:34 The person is unable to move forward.

00:37 And finally disenfranchised grief.

00:40 This is when the heart is grieving but the person is unable to let got.

00:47 Elizabeth Kuler Ross was a psychiatrist who was known for her theory of the 5 stages of the grief.

00:53 The 1st stage is Denial.

00:55 This is a defense mechanism where the person denies that this grief is actually happening.

01:01 This is usually a temporary reaction.

01:04 The next stage is Anger.

01:06 Where the person gets angry toward the actual event, the person, the healthcare workers for the actual disease.

01:13 The 3rd stage is Bargaining.

01:16 This is where the person tries to bargain with the actual event "If only i had taken that patient to the hospital sooner." "If only i hadn't taken that turn we would be in a car accident." The 4th stage is Depression.

01:30 This is the sadness, regret, and worry that goes along during this stage.

01:35 And finally, the last stage is Acceptance.

01:38 This is when you accept the grief and the loss.

01:41 However, not everybody gets to this stage.

01:44 This full grieving process can take up to a year.

01:48 So what are the symptoms associated with Normal Grief? Some of the feelings that a person may experience are: Anger, Depression, Numbness, Guilt, Loneliness.

02:01 Some cognitive changes you may notice.

02:04 The patient may have trouble concentrating.

02:07 It may be disoriented or confuse.

02:09 It may be very forgetful or just feel hopeless.

02:14 Physical signs may include: Fatigues and an Exhaustion.

02:18 Chest tightness and Achy muscles.

02:21 Headaches or just Restlessness.

02:24 And some behavioral symptoms may include: improper sleeping, crying, loss of appetite and very commonly visions or dreams of a diseased.

02:37 So what are legal implications that are associated with loss? Well, there are advance directives.

02:42 One is a living will. A living will allows the person to document their wishes at the end of life.

02:52 This goes into affect when two physicians state that the patient is unable to make decisions for their own and the patient is terminally ill or in a permanent state of unconsciousness.

03:04 Another legal implication is a Medical Power Attorney also known as a healthcare proxy.

03:10 This allows the patient to appoint someone to make their decisions or the patient is unable to make their decisions.

03:18 This goes into effect when a physicians concludes that the patient is unable to make decisions on their own.

03:27 Do Not Resuscitate orders (DNR): These forms vary by individual state.

03:33 A "Do Not Resuscitate" order is a medical order written by a physician and directs the healthcare provider what to initiate or when to initiate cardiopulmonary resuscitation.

03:46 This does not effect any other healthcare modality, such as dialysis or feeding tubes or IV hydration.

03:54 The do not resuscitate order (DRO) is specific to cardiopulmonary resuscitation and only occurs when the patient's heart is stopped or the patient has stopped breathing.

04:07 Autopsies: Autopsies sometimes may be mandated depending upon how the patient died.

04:13 Or they may be requested on the part of the physician and the family to see how the patient died.

04:18 Autopsies can be done for medical or forensic reasons.

04:24 However, there are spiritual, religious or cultural reasons why someone might not want an autopsies.

04:31 For example: Christian Scientist do not advocate for autopsies but if an autopsies is needed they will consent.

04:39 It's important to address these issues with the patient's family.

04:43 Organ donation: If your family is interested in organ donation you want to provide a private area for family to discuss this.

04:52 You gonna have to remember that all family members understand what brain death is.

04:58 There are people who are specially trained to discuss organ donation with the families.

05:04 These may include transplant coordinators or social workers.

05:09 For patient to donate major organ such as the heart liver, or lungs. These organs must be kept in working order until donation.

05:19 There are state, logo and organs specific repositories such as an Eye Bank.

05:26 Organ donation wishes may be part of the patient's living will.

05:31 So its important to discuss these issues with the patient's family.

05:37 So what are the types of loss? There is Actual Loss. When you loose a body part or job.

05:44 There is Perceived Loss where the person feels that they lost something.

05:48 But you can't see it e.g. loss of self-esteem.

05:52 There is Maturational Loss that occurs when your child goes off to kindergarten for the first day.

05:57 Or there is a Situational Loss which is a sudden and unplanned event.

06:02 For example, when your house is burnt down by a fire.

06:07 So how a person deals with loss might give you some insight that how they are going to grieve.

06:12 People deal with loss and grief in different ways.

06:16 The importance that the person places on the loss can also give you insight under how much their grieving would be affected.

06:26 So what are Palliative Care and Hospice Care? Palliative Care is made up of healthcare professionals such as physicians and nurses.

06:34 It provides comfort measures to patients and focuses on prevention, lessening and respite of physical, emotional, social and spiritual signs of the disease or therapy.

06:48 Hospice Care is actually a medicare benefit.

06:52 So if your patient has medicare, they are available for Hospice Care.

06:55 This provides care for patients who only have a short time to live.

07:00 Focuses on relieving symptoms and encumbrance of the illness.

07:06 And it helps the patients live as fully as possible.

07:12 So what are the nurses assessment during these phases of loss and grief? You want to observe the patient and family behaviors.

07:21 You want to observe the family member's response to loss and specially the non-verbal behaviors between the family members.

07:30 So some examples of nursing diagnosis could be compromised family coping related to impending death.

07:38 Or ineffective denial as evidence by a family member arriving at the hospital inebriation.

07:46 Or spiritual distress related to feelings of guilt and loneliness.