BATAAN PENINSULA STATE UNIVERSITY

Main Campus, Balanga City

COLLEGE OF NURSING AND MIDWIFERY

MEDICAL SURGICAL NURSING (NRCM 103)

DEATH – a universal and inevitable experience as a fact of human existence permanent causation of all vital
functions

DYING – is an integral art of life; a natural and predictable as being born

GRIEF – is the process of psychologic, social and somatic reaction to a perceived loss

MOURNING – includes a wide array of intrapsychic processes, conscious and unconscious that are the results of
loss

BEREAVEMENT – the state of having suffered a loss

SUFFERING – is submitting or being forced to submit and endure set of circumstances that is not under one’s
control

LOSS – any change in person’s situation that reduces the probability of achieving goals or when a person is
without something he / she formerly possessed.

CATEGORIES OF LOSS

1. Self-Losses
a. Loss of Psychologic Self – include loss of self-esteem and personal identity
b. Loss of Sociocultural self – include the loss of language, associations and type meaning of one; cultural
heritage
c. Loss of physical self – more obvious but their impact is not necessarily so clear
d. Loss of the spiritual self – loss of hope, values and beliefs

2. External Losses
a. Loss of objectives or possession
b. Loss of loved ones
c. Loss of environment
d. Loss of support

3. Real / Imagined Losses

4. Present / Anticipated

THE GRIEF PROCESS

- a process that an individual goes through in response to the loss of a significant or loved person

BASIC TASK OF GRIEF

According to Hindenmann

1. Emancipation from the bondage of the lost objects.

2. Readjustment to the environment in which the loss object is missing
3. Formation of new relationship

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 STAGES OF GRIEF / GRIEVING
According to Lindemann

1. Shock, disbelief and numbness

- displays inability to comprehend the meaning of loss
- attempts to protect self against painful feelings
- as awareness increases, the bereaved experiences severe anguish

2. Acute mourning
- the next stage where the work of restitution takes place
- rituals of the funeral help the bereaved accept reality

3. Resolution of grief
- occurs as the mourner begins to deal with the void
- idealization of the deceased occurs next where only the pleasant memories are remembered

Eventual outcome influenced by:

a. Importance of the deceased in the life of mourner
b. The degree of dependence in the relationship
c. The amount of ambivalence toward the deceased
d. The more hostile the feelings that exist, the more guilt that interferes with the grieving process
e. Age of both mourner and deceased
f. Death of a child is more difficult to resolve that that of an aged loved one
g. Number and nature of previous grief experiences
h. Degree of preparation for the loss

Task of Grief and Mourning

According to Worden

1. To accept the reality of loss

2. To experience the pain of the grief
3. To adjust to an environment in which the deceased is missing
4. To withdraw emotional energy and reinvest it in another relationship

Possible Types of Complicated Outcomes of Grief

1. Persevering
2. Syndromes of symptoms
3. Diagnosable mental or physical disorders
4. Suicide

DEATH AND DYING

Types of Death

1. Physiologic Death – occurs at the time of cardiac / respiratory arrest

2. Brain Death – the irreversible cessation of brain function
3. Cellular Death – irreversible body cells become anoxic

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 Criteria for Determining Brain Death

1. Unreceptivity and unresponsivity to extent stimuli

2. No movement or breathing for at least 1 hour
3. No reflexes
4. A flat encephalogram, run for at least 10 minutes and repeated after 24 hours with no changes

Signs and Symptoms of Impending Death

1. Muscle relaxation
2. Slowing of circulation / cardiovascular collapse
3. Changes in vital signs
4. Sensory impairments
5. Slowing of body’s metabolism
6. Renal failure
7. Decreased physical and mental capacity
8. Gradual loss of consciousness

Clinical Signs of Imminent Death

1. Pupils are dilated

2. Impaired mobility
3. No reflexes
4. Rapid pulse but weak

STAGES OF DEATH AND DYING

1. Stage of Denial and Isolation

- individual is stunned at the knowledge he or she is dying and denies it

2. Stage of Anger
- anger and resentment usually follow as the individual question, “Why me?”

3. Stage of Bargaining
- bargaining for time to complete some situation in his or her life

4. Stages of Depression
- full acknowledgment usually brings depression; individual begins to work through feelings and to
withdraw from life and relationships

5. Stage of Acceptance
- final stage is full acceptance and preparation for death

NURSING MANAGEMENT FOR DYING CLIENT

A. Nursing Management of the Adult

1. Minimize physical discomfort

- attend to all physical needs
- make client as comfortable as possible

2. Recognize crisis situation

- observe for changes in client’s condition
- support client

3. Be prepared to give the dying client the emotional support needed

4. Encourage communication
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 - allow client to express feelings, to talk, or to cry
- pick up cues that client wants to talk, especially about fears
- be available to form a relationship with client
- communicate honestly

5. Prepare and support the family for their impending loss

6. Understand the grieving process of client and family

B. Nursing Management for Dying Child

1. Always elicit the child’s understanding of death before discussing it

2. Before discussing death with a child, discuss it with parents
3. Parental reactions include the continuum of grief process and stages of dying
- reactions depend on previous experience with loss
- reactions also depend on relationship with the child and circumstances of illness of injury
- reactions depend on degree of guilt felt by parents

4. Assist parents in understanding siblings’ possible reactions to a terminally ill child

- Guilt : belief that they caused the problem or illness
- Jealousy : demand for equal attention from the parents
- Anger : feelings of being left behind

Prepared By
Maria Casoline S. Lamira-Santos, RN, MAN
INSTRUCTOR

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