Loss, Grief, and Dying

by

Dr. Cyrill S. Consuelo, RN, MAN, LPT, LLB

Prof. Ma. Elena C. Diasen, RN, MSN
Manila Central University
College of Nursing
Types of Loss
• Actual loss — can be recognized by others
• Perceived loss — is felt by person but intangible to others
• Physical loss versus psychological loss
• Maturational loss — experienced as a result of natural
developmental process
• Situational loss — experienced as a result of an
unpredictable event
• Anticipatory loss — loss has not yet taken place
Definitions
• Grief — emotional reaction to loss
• Bereavement — state of grieving; person goes through
grief reaction
• Mourning — acceptance of loss; person learns to deal
with loss
Engel’s Six Stages of Grief
• Shock and disbelief
• Developing awareness
• Restitution
• Resolving the loss
• Idealization
• Outcome
Kubler-Ross’s Five Stages of Grief
• Denial and isolation
• Anger
• Bargaining
• Depression
• Acceptance
Clinical signs of Impending Death
• Inability to swallow
• Pitting edema
• Decreased gastrointestinal and urinary tract activity
• Bowel and bladder incontinence
• Loss of motion, sensation, reflexes
• Elevated temperature, cold or clammy skin, cyanosis
• Lowered blood pressure
• Noisy or irregular respiration
• Cheyne-Stokes respirations
Three Definitions of Death
• Traditional heart-lung — irreversible cessation of
spontaneous respiration and circulation
• Whole brain — irreversible cessation of all functions of
the entire brain
• Higher brain — irreversible loss of all “higher” brain
function
Components of a Good Death
• Pain and symptom management
• Clear decision-making
• Preparation for death
• Completion
• Contributing to others
• Affirmation of the whole person
Five Principles of Palliative Care
• Respects goals, likes, and choices of the dying person
and his loved ones
• Looks after the medical, emotional, social, and spiritual
needs of the dying person
• Supports the needs of family members
• Helps to gain access to needed healthcare providers and
care setting
• Builds ways to provide excellent care at end of life
Advance Directives
• Decide who will make decisions for the patient in case he
or she is unable.
• Decide the kind of medical treatment the patient wants
or doesn’t want.
• Decide how comfortable the patient wants to be.
• Decide how the patient will be treated by others.
• Decide what the patient wants loved ones to know.
Special Orders
• Do-not-resuscitate (DNR) or no-code
• Comfort measures only
• Do-not-hospitalize
Factors Affecting Grief and Dying
• Developmental considerations
• Family
• Socioeconomic factors
• Cultural influences
• Religious influences
• Causes of death
Developing a Trusting Nurse-Patient
Relationship
• Explain the patient’s condition and treatment.
• Teach self-care and promoting self-esteem.
• Teach family members to assist in care.
• Meet the needs of dying patient.
• Meet family needs.
Needs of Dying Patients
• Physiological needs — physical needs, such as hygiene,
pain control, nutritional needs
• Psychological needs — patient needs control over fear of
the unknown, pain, separation, leaving loved ones, loss
of dignity, loss of control, unfinished business, isolation
• Sexual needs — patient needs ways to be physically
intimate that meets needs of both partners
• Spiritual needs — patient needs to practice religious faith
Providing Postmortem Care
• Care of the body
• Care of the family
• Discharging legal responsibilities
• Death certificate issued and signed
• Labeling body
• Reviewing organ donation arrangements if any
• Care of other patients
Postmortem Care of the Body
• Prepare body for discharge.
• Place body in anatomical position, replace dressings, and
remove tubes (unless there is an autopsy scheduled).
• Place identification tags on the body.
• Follow local law if patient died of communicable disease.
Postmortem Care of the Family
• Listen to family’s expressions of grief, loss, and
helplessness
• Offer solace and support by being an attentive listener.
• Arrange for family members to view the body.
• In the case of sudden death, provide a private place for
family to begin grieving.
• It is appropriate for the nurse to attend the funeral and
make a follow-up visit to the family.
THANK YOU!