Hi, today we are going to be
talking about Grief and Loss.
My name is Jill Beavers-Kirby.
There are different types of grief.
The first is normal grief.
This is expected, emotional and
behavioral reaction to a loss.
Next we have anticipatory
grief. This occurs
before the impending loss. This
is the process of letting go.
The third type of grief
is complicated grief
and this can be intense long lasting grief.
The person is unable to move forward.
And finally disenfranchised grief.
This is when the heart is grieving but
the person is unable to let got.
Elizabeth Kuler Ross was a psychiatrist who was
known for her theory of the 5 stages of the grief.
The 1st stage is Denial.
This is a defense mechanism where the person
denies that this grief
is actually happening.
This is usually a temporary reaction.
The next stage is Anger.
Where the person gets angry
toward the actual event,
the person, the healthcare
workers for the actual disease.
The 3rd stage is Bargaining.
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.
This is the sadness, regret, and worry
that goes along during this stage.
And finally, the last stage is Acceptance.
This is when you accept
the grief and the loss.
However, not everybody
gets to this stage.
This full grieving process
can take up to a year.
So what are the symptoms
associated with Normal Grief?
Some of the feelings that a
person may experience are: Anger,
Some cognitive changes you may notice.
The patient may have
It may be disoriented or confuse.
It may be very forgetful
or just feel hopeless.
Physical signs may include:
Fatigues and an Exhaustion.
Chest tightness and Achy muscles.
Headaches or just Restlessness.
And some behavioral symptoms
may include: improper sleeping,
crying, loss of appetite
and very commonly visions
or dreams of a diseased.
So what are legal implications
that are associated with loss?
Well, there are advance directives.
One is a living will.
A living will allows
the person to document their
wishes at the end of life.
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.
Another legal implication is
a Medical Power Attorney
also known as a healthcare proxy.
This allows the patient to appoint
someone to make their decisions
or the patient is unable
to make their decisions.
This goes into effect when
a physicians concludes
that the patient is unable
to make decisions on their own.
Do Not Resuscitate orders (DNR):
These forms vary by individual state.
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
This does not effect any other healthcare
modality, such as dialysis
or feeding tubes or IV hydration.
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.
Autopsies: Autopsies sometimes may be
mandated depending upon how the patient died.
Or they may be requested on the part of the
physician and the family to see how the patient died.
Autopsies can be done for
medical or forensic reasons.
However, there are spiritual,
religious or cultural reasons
why someone might not want an autopsies.
For example: Christian Scientist
do not advocate for autopsies
but if an autopsies is
needed they will consent.
It's important to address these
issues with the patient's family.
Organ donation: If your family is interested
in organ donation you want to provide
a private area for
family to discuss this.
You gonna have to remember that all family
members understand what brain death is.
There are people who are specially trained to
discuss organ donation with the families.
These may include transplant
coordinators or social workers.
For patient to donate major
organ such as the heart
liver, or lungs. These organs must be
kept in working order until donation.
There are state, logo and organs specific
repositories such as an Eye Bank.
Organ donation wishes may be
part of the patient's living will.
So its important to discuss these
issues with the patient's family.
So what are the types of loss?
There is Actual Loss. When
you loose a body part or job.
There is Perceived Loss where the
person feels that they lost something.
But you can't see it
e.g. loss of self-esteem.
There is Maturational Loss that occurs when your
child goes off to kindergarten for the first day.
Or there is a Situational Loss which
is a sudden and unplanned event.
For example, when your house
is burnt down by a fire.
So how a person deals with loss might give you
some insight that how they are going to grieve.
People deal with loss and
grief in different ways.
The importance that the
person places on the loss
can also give you insight under how
much their grieving would be affected.
So what are Palliative
Care and Hospice Care?
Palliative Care is made up of healthcare
professionals such as physicians and nurses.
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.
Hospice Care is actually
a medicare benefit.
So if your patient has medicare, they
are available for Hospice Care.
This provides care for patients
who only have a short time to live.
Focuses on relieving symptoms and
encumbrance of the illness.
And it helps the patients
live as fully as possible.
So what are the nurses assessment
during these phases of loss and grief?
You want to observe the
patient and family behaviors.
You want to observe the family
member's response to loss
and specially the non-verbal behaviors
between the family members.
So some examples of
nursing diagnosis could be
compromised family coping
related to impending death.
Or ineffective denial as evidence
by a family member arriving
at the hospital inebriation.
Or spiritual distress related to
feelings of guilt and loneliness.