Grief and Loss (Nursing)

by Jill Beavers-Kirby

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    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.

    About the Lecture

    The lecture Grief and Loss (Nursing) by Jill Beavers-Kirby is from the course Psychosocial Integrity (Nursing). It contains the following chapters:

    • Grief and Loss
    • 5 Stages of Grief
    • Legal Implications
    • Autopsies
    • Types of Loss

    Author of lecture Grief and Loss (Nursing)

     Jill Beavers-Kirby

    Jill Beavers-Kirby

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