• FOUNDATION OF NURSING II

• By Masino T(BSC ,MSC)

Loss and grieving
 LOSS AND GRIEVING

CX’S OF NORMAL GRIEF AND LOSS

04/29/2023
LOSS
 is experience of parting (separating) from an object, person,
belief, or relationship that is valued.
 May be minor as loss of wallet or major as loss of loved
person
Grief
 is a series of intense physical and psychological responses
that occur following a loss.
3
 CX’S CONT’D

 The intensity and duration of grief depends on factors like:

04/29/2023
Significance of the loss
Person’s personality
Availability of support
 Each loss has both positive and negative aspects
TYPES OF LOSS
1. Objective versus Subjective
2. Actual versus Perceived
3. Material versus Psychological
4. Expected versus Unexpected
4
 CONT’D
 Objective loss: loss that is readily recognized by others

04/29/2023
 Subjective loss: loss that is not readily apparent to others but perceived
by the person only
 Material loss: loss of some tangible object or possession

 Psychological loss: loss of something that has no physical form but

has important symbolic meaning
 Perceived loss: Occurs when a sense of loss is felt by an individual but
is not tangible to others

5
 TYPES OF LOSS CONT’D
 Objective or material loss include loss of:

04/29/2023
 Money
 Loss of home
 Loss of job
 Loss of body part
 Loss of body function, etc

 Subjective or psychological losses include:

 Loss of relationship
 Loss of hope
 Loss of dream
 Loss of sense of immortality, etc

6
 CX’S CONT’D
GRIEF
 responses a person experience after loss of significant

04/29/2023
person object, belief, or relationship that is valued
 Includes physical, psychological, cognitive and behavioural
responses to loss

 Bereavement: a state of desolation (loneliness) that occur as

a result of loss, particularly loss of significant person, w/c
includes emotional, social, physical and cognitive responses
to loss.

7
 GRIEF CONT’D
 Mourning: socially prescribed behaviour after the death of

04/29/2023
significant other like wearing black cloths
 It varies from culture to culture

Types of Grief
1. Conventional grief: psychological and physiological
responses after actual loss of significant person, object,
belief or relationship
2. Anticipatory grief: psychological and physiological
responses a person shows to impending loss (real or
imagined)
 Anticipatory grief facilitates coping when the loss actually
occurred. 8
 NORMAL FUNCTIONAL GRIEF
PATTERN
 Grief help in making the following:

04/29/2023
To make the outer reality of loss in to an internally
accepted reality
To sever (cut) the emotional attachment to the lost person
or object
To make it possible for the grieved person to become
attached to other person or object
 Although grief is painful, it is both normal and
necessary. Inability to grief is abnormal.
9
 FACTORS AFFECTING NORMAL GRIEF
FUNCTION
 Characteristics of the loss

04/29/2023
 Personal resources
 Personal stressors
 Socio-cultural resources
 Socio-cultural stressors

10
 ALTERED GRIEVING FUNCTION
 Dysfunctional grief: is grief that falls outside the
normal response range and may be manifested as

04/29/2023
exaggerated, prolonged, or absence of grief
 Different terms used to label dysfunctional grief and
include pathologic grief, unresolved grief, and
prolonged grief
 Potentials for altered grief are the following:
Severalconcurrent losses
Few or absent support systems
Poor coping skills
Previous unresolved loss
11
 MANIFESTATIONS OF ALTERED
GRIEF FUNCTION
 Normal grief manifestations

04/29/2023
The following are normal at 1 year post bereavement:
Excessive or persistent expression of affect
Inability to express joy
Clinical symptoms of depression
Inability to form new relationships
Inability to speak of the deceased without intense emotion
Hearing or seeing the deceased
Feelings

12
 MANIFESTATIONS CONT’D
 Abnormal grief manifestations

The following are abnormal if present beyond 3 years

04/29/2023
Leaving the deceased’s room and belongings intact
Reporting physical symptoms similar to those the
deceased had before death
Talking about the loss as if it just happened now
Inability to remember or talk about the deceased
Being preoccupied by the thoughts of the deceased
Talking or acting as if the deceased were still alive

13
 ASSESSMENT

Subjective Data
Functional pattern identification

04/29/2023
Assess the nature of the relationship with deceased and
the circumstances of the loss
Risk identification
Assess and analyze the resources and stressors that the
patient experiencing
Dysfunction identification
Arrange several contacts with the patient over extended
period of time and if the patient remains in complete
denial or grief symptoms he/she is likely having
dysfunctional grief 14
 ASSESSMENT CONT’D
Objective Data
Objective manifestations are:

04/29/2023
Dejected physical appearance
Slowed motor function
Weeping/crying
Outburst of anger
Emotional blunting
Unkempt (non smart) appearance
Sleep disturbance
Appetite disturbance (excessive weight loss or gain)
Preoccupation with thoughts of that which was lost
15
NURSING DIAGNOSES
 Anticipatory grieving

04/29/2023
Individual or group experience of feelings in
response to an expected significant loss
 Dysfunctional grieving
Individualor group experience of prolonged, or
unresolved grief or engage in detrimental activities

16
 NURSING INTERVENTIONS

 Nursing interventions to health and grieving function

04/29/2023
 Patientteaching
 Working through grief stages with the patient
 Support groups
 Care for the deceased (post mortem care)
 Nursing interventions for altered grief function
 Individualtherapy according to their feelings
 Professionally led support group

17
CARE OF THE BODY AFTER DEATH

 Care given to the body after death also

called Post mortem care.

04/29/2023
 Death may come to all of us. We must
try to make the patient comfortable and
free from pain.

18
BODY CHANGES

1. Rigor mortis: is the stiffening of the body that occurs

about 2 to 4 hours after death.

04/29/2023
 It results from a lack of ATP which is not synthesized
because of a lack of glycogen in the body. ATP is
necessary for muscle fiber relaxation.
 Rigor mortis starts in the involuntary muscles (hearts,
bladder and soon) then progresses to the head, neck
and trunk and finally reach to the extremities. Place
dentures in the mouth and close eye and mouth before
rigor mortis set in.
19
2. Algor mortis:- is gradual decrease of body
temperature after death. When blood circulation
terminates and hypothalamuses cease to function body

04/29/2023
temperature falls about 1co per hour.
3. Livor mortis: - After blood circulation has ceased the
skin become discolored. The red blood cells break
down releasing hemoglobin which discolors the
surrounding tissue. This discoloration referred to as
Livor mortis. The hotter the temperature the more
rapid the change. Therefore bodies stored in cool
places to delay this process

20
 LEGAL ASPECT OF DEATH
1. Certification of death: - A death certificate
must be made out when a person dies.

04/29/2023
2. Labeling of the deceased: - you have to handle
the deceased with dignity and label the
corpse/cadaver/ appropriately. Mishandling can
cause emotional distress to the survivor.
3. Autopsy: - Post mortem examination is an
examination of the body after death.
 To know the exact cause of death.
21
4. Organ donation: - It is process of gift the body for
the following purposes. For medical or dental science,
therapy or transplantation. The donation can be made

04/29/2023
by a provision will or by signing a card like form in
the presence of two witnesses.
5. Inquest/examination/: - is a legal inquiry into the
cause or manner of a death.
6. Euthanasia: - is the act of painlessly putting to death
for persons suffering from incurable or distressing
disease. It is commonly referred to as “Mercy killing”.

22
 STAGE OF DYING
 As a person learns his own impending death, he or she
experiences grief in relation to his or her own loss.

04/29/2023
1. Denial: - The survivor either refuses to accept the loss
or shows intellectual acceptance of the loss but denies
the emotional impact. may search health care
professional who will give a more favorable opinion.
May seek unproven therapies.
2. Anger: - It may be directed to ward fate, God, family
member, health care provider or others.” Why me”
feeling

23
3. Bargaining: - The client and /or family plead/pray/ for
more time to reach an important goal
 promises are some times made with God.

04/29/2023
4. Depression: - When the client acknowledges the
reality and inevitability of his or her impending death.
Sadness , grief, mourning for impending losses.
5. Acceptance: - I have lived a good life and I have no
regrets patient and /or families are neither angry nor
depressed.

24
PURPOSE OF POST MORTEM CARE

To show respect for the death

To prepare the body for burial

04/29/2023
To prevent spread of infection
To show kindness to the family

25
Equipment:-
 Basin of water

 Wash cloth and towel

 Cotton

04/29/2023
 Forceps

 Gauze

 Name tag

 Dressing and tape if necessary

 Glove

 Clean sheet

 Soap and dish

 Stretcher (2)

 Roller bandage

 Chart
26
 PROCEDURE
1. Note the exact time of death and chart it.
2. If the Doctor is present call him to pronounce death.

04/29/2023
3. If the family members are not present send for them.
4. Close the eyes and mouth place the body flat on its
back with arms and legs straight. Remove the blanket
from the bed cover the body with a sheet.
5. Ask the family to wait outside while you prepare the
body.
6. Change any soiled dressing with clean ones.

27
7. Remove the gown and wash the body.
8. Pack all orifices with cotton wool to prevent soiling from
stool, urine, vaginal discharge.

04/29/2023
9. If the mouth will not remain closed tie a gauze or bandage
under the chin and over the head for a while.
10. Tie the thumbs and large toes together.
11. Place a sheet over the body.
12. Move the body to the Morgue on a stretcher.
13. Be sure the family receives all articles and clothes that
belong to the dead.

28

thank you!