THE EXPERIENCE

LOSS, DEATH &

GRIEF

The Role of the Nurses

Prevent

illness, injury and help

patients return to health

Help

patients and family cope with

things they can not change and
facilitate a peaceful death

LOSS
Definition
An actual or potential situation in
which something that is valued, is
changed, no longer available or
gone. People grieve the loss of
multiple things.

Types of Loss
Necessary

loss a part of life as

people move forward in life may be
permanent or for the better

Maturational

loss includes all

normally expected life changes
across the life span

Types of Loss
Situational

Loss can be caused

by sudden, unpredictable external
events e.g. income, physical
change as a result of injury

Types of Loss
Actual can be identified
by others
Perceived cannot be
verified by others.
Anticipatory is experienced
before it really occurs

Types of Loss
Death

The ultimate loss

Generates anxiety, fear and uncertainty
Permanently separates people
physically
Approach to death is influenced by
values, culture, previous experience
and social support

GRIEF
Grief

the emotional response to

the loss, manifested in ways
unique to an individual and based
on personal experience, cultural
expectation and spiritual beliefs

Mourning
Mourning the outward, social
expression of grief and the
behavior associate with loss
Influenced

by culture, religious
experience and customs.

Bereavement
Bereavement

encompasses both
grief and mourning and includes
the emotional response and
outward behaviors of a person
experiencing loss

Types of Grief
Normal
Anticipatory
Disenfranchised
Ambiguous

loss
Complicated
Exaggerated
Delayed
Masked

Mourning/Grief
Response
Grief

Mourning
Period

of
acceptance
after a loss

response

Depends

on
cause of death
Sudden death
Death from
socially
stigmatized
illness
Infant,
miscarriage
Violent

Grief Response
Accidental

death

Feelings of bad luck

Guilt response

Line

of Duty

Death while defending is viewed as

honorable
Soldiers
Police

Suicide

Religious implications

Stages
of Dying

Kubler-Ross (1969)
Five Stages

Denial
Anger
Bargaining
Depression
Acceptance

Kulber-Rosss Stages of Dying

1.

Denial and
isolation

2.

Anger Why me?

3.

Bargaining

4.

Depression

5.

Acceptance

Factors Influencing Loss

and Grief

Human
Development

Personal
Relationship

Nature of the loss

Coping Strategies

Factors Influencing Loss

and Grief

Socioeconomic
Status

Culture and
Ethnicity

Spiritual and
Religious Beliefs

Factors Influencing Grief:

Age
Sex

roles

Social

support

Nature
Dying

grief

of loss

persons

Factors Influencing Grief

Family
Socioeconomics
Culture/Religion
Nature

of
relationship

Nursing Process
Assessment

Nature of Relationship
Social Support System
Nature of the Loss
Cultural and Spiritual Beliefs
Life Goals
Family Grief Pattern
Self Care
Hope

Nursing Process
Nursing

Diagnosis

Grieving
Hopelessness
Ineffective denial
Fear
Impaired Comfort
Readiness for enhanced spiritual wellbeing

Nursing Process
Planning

Goals and Outcomes

Encourage patients and family

members to share their priorities for
care at the end of life

Nursing Process
Implementation

Health Promotion
Palliative Care in Acute and
Restorative settings
Hospice Care
Use Therapeutic Communication
Provide Psychosocial Care

Nursing Process
Implementation

contd

Manage Symptoms
Promote Dignity and Self-Esteem
Maintain a Comfortable and Peaceful
Environment
Promote Spiritual Comfort and Hope
Protect Against Abandonment and
Isolation

Nursing Process
Implementation

contd

Support the Grieving Family

Assist with End of Life Decision
Making
Facilitate Mourning
Care After Death

Nursing Process
Evaluation

The success of the evaluation process

depends partially on the bond that you
formed with the patient

A patients response and perceptions of

the effectiveness of nursing
interventions determines if the existing
plan of care is effective or needs to be
revised

Once Death Occurs.

Care

of the body - viewing

Tubes, dressings
Family, loved ones time
Identification of body
Pastoral, psychosocial support

Nursing Responsibilities:
Autopsy
Medical

Examiner
(county coroner)

No consent needed
if
Death

caused by
accident
Suicide
Homicide
Illegal therapeutic
practice
Sudden
unexplained death

Care of Self

Importance of Nurses Self

Care
Nurses

can not give fully engaged,

compassionate care to others
when you feel depleted or do not
feel cared for yourself

Nurses

who practice self-care are

more likely to experience
professional and personal growth
and find meaning in their work.

Advance Directives
Living

Will / D.N.R.

Durable
Health

Power of Attorney

Care Surrogate
designation

Advance Directives
Aging

with Dignity
www.AgingWithDignity.org
End of Life Issues
www.FloridaHealthStat.com