TYPES OF LOSSES - NECESSARY LOSS

ACTUAL LOSS
PERCEIVED LOSS
MATURATIONAL LOSS
SITUATIONAL LOSS
ANTICIPATORY LOSS
DEVELOPMENTAL LOSS
LOSS OF EXTERNAL OBJECTS
LOSS OF KNOWN ENVIRONMENT
LOSS OF ASPECT OF LIFE
LOSS OF LIFE OR DEATH
GRIEF, MOURNING & BEREAVEMENT

Mourning is the outward sign of grief.

 GOALS OF HEALING PROCESS
•Healing the self
•Recovering from the loss
•Undoing psycho social bonds to loved one and
eventually creating new ties
•Adding new roles, skills, and behaviors
•Pursuing a healthy lifestyle
•Integrating the loss into life
CONCEPTS & THEORIES OF THE GRIEVING PROCESS
CLINICAL SYMPTOMS OF GRIEF
Emotional symptoms of grief
A person who is dealing with grief will most likely display some of
the emotional symptoms associated with grieving.
Increased irritability
Numbness
Bitterness
Detachment
Preoccupation with loss
Inability to show or experience joy
ii.Physical symptoms
It may come as a surprise that grief is not entirely
emotional. There are very real effects that grief can
have on the body.
Digestive problems
Fatigue
Headaches
Chest pain
Sore muscles
NURSING IMPLICATIONS
Nursing care involves providing comfort ,maintaining
safety ,addressing physical and emotional needs ,and teaching
coping strategies to terminally ill patients and their families .
More than ever ,the nurse must explain what is happening to
the patient and the family and be a confident who listens to
them talk about dying.
Hospice care , attention to family and individual psychosocial
issues ,and symptom and pain management are all part of the
nurse's responsibilities.
The nurse must also be concerned with ethical considerations
and quality-of-life issues that affect dying people.
• Of utmost importance to the patient is assistance
with the transition from living to dying, maintaining
and sustaining relationships, finishing well with the
family, and accomplishing what needs to be said
and done.
• In the hospital, in long-term care facilities, and in
home settings, the nurse explores choices and end-
of-life decisions with the patient and family.
• Referrals to home care and hospice services, as
well as specific referrals appropriate for the
management of the situation, are initiated.
• The nurse assesses current and past participation in
religious or spiritual practices
• Interventions that foster spiritual growth or reconciliation
include being fully present; listening actively; conveying a
sense of caring, respect, and acceptance; using
therapeutic communication techniques to encourage
expression; suggesting the use of prayer, meditation, or
imagery; and facilitating contact with spiritual leaders or
performance of spiritual rituals.
• Offer ‘memory making’ options, if that is a practice in
your hospital.
DEATH
Definition
“A permanent cessation of all vital functions : the end of life”
- Merriam Webster
"An individual who has sustained either (1) irreversible
cessation of circulatory and respiratory functions, or (2)
irreversible cessation of all functions of the entire brain,
including the brain stem is dead. A determination of death must
be made in accordance with accepted medical standards."
- The National Conference of Commissioners
on Uniform State Laws
MANIFESTATIONS OF IMPENDING DEATH
INTEGUMENTARY SYSTEM
RESPIRATORY SYSTEM
URINARY SYSTEM
GASTROINTESTINAL SYSTEM
MUSCULOSKELETAL SYSTEM
CARDIO VASCULAR SYSTEM
PSYCHOSOCIAL MANIFESTATIONS
• Altered decision making
• Fear of loneliness
• Fear of pain
• Helplessness
• Restlessness
• Anxiety
• Impending doom
• Grief
TRADITIONAL CLINICAL SIGNS OF DEATH
ASPECTS OF END - OF- LIFE CARE
i. Palliative care
ii. Care during final days
iii.Hospice care
iv.Advanced directives
v. Understanding CPR & DNR
NURSING IMPLICATIONS
• Use foam cushions to make beds and chairs more
comfortable and help the patient to change positions
frequently and change the bed linens as necessary.
• Elevate the patient’s head or turn the patient on his or
her side to help make breathing easier.
• Use blankets to help keep the person warm & gently
rub the person’s hand, feet or soak the hands and feet
in warm water.
• Controlling pain is an important part of dying
comfortably and peacefully.
LEGAL & ETHICAL ISSUES AFFECTING END-
OF-LIFE CARE
Organ/Tissue donation

Terminal Weaning & Euthanasia

 NURSING IMPLICATIONS
• reat people compassionately
• listen to people
• communicate clearly and sensitively
• identify and meet the communication needs of
each individual
• acknowledge pain and distress and take action
• recognise when someone may be entering the
last few days and hours of life
 involve people in decisions about their care and
respect their wishes
keep the person who is reaching the end of their
life and those important to them up to date with
any changes in condition
document a summary of conversations and
decisions
seek further advice if needed
look after yourself and your colleagues and seek
support if you need it
CONCLUSION
Grieving is painful, and it’s important that those who
have suffered a loss be allowed to express their grief.
It’s also important that they be supported
throughout the process.
Each person grieves differently.
The length and intensity of the emotions people
go through varies from person to person.