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.
The lecture Grief and Loss (Nursing) by Jill Beavers-Kirby is from the course Psychosocial Integrity (Nursing). It contains the following chapters:
5 Stars |
|
5 |
4 Stars |
|
0 |
3 Stars |
|
0 |
2 Stars |
|
0 |
1 Star |
|
0 |