Transcript Loss_and_Grief

TRANSITIONS THROUGH HEALTH
AND END OF LIFE
Jenny Huri 2011
(Foundation)
LEARNING OBJECTIVES
Students will be able to
 Define and understand loss
 Define and understand grief
 Support the patient and family in grief
 Assess and support the dying patient and
his family
 Identify actions that promote effective
end of life care
Learning outcomes 1 and 3 HEAL4002
One of the most difficult realities that nurses face is
that, despite our very best efforts, some patients will
die.
Although we cannot change this fact, we can have a
significant and lasting effect on the way in which
patients live until they die, the manner in which
death occurs and the enduring memories of the death
for families
(Smeltzer & Bare, 2005)
NURSES ……
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are uniquely prepared to offer compassionate care for
dying patients and their families.
have a fundamental responsibility to alleviate pain and
suffering.
are educated in pain management, palliative care and in
helping people cope with grief, death and dying.
are key members of interdisciplinary teams caring for
dying patients and their families
PALLIATIVE CARE
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WHO – an approach that improves the
quality of life of patients and their
families facing the problems associated
with life-threatening illness, through the
relief of suffering by means of early
identification and assessment and
treatment of pain and other problems.
WORLD CHAMPIONS!!
LOSS
LOSS is said to have occurred “when something or
someone can no longer be seen, felt, heard, known or
experienced.
 There is a sense of being deprived of something of value,
of having something taken away against one’s will or of
being robbed
(Crisp and Taylor,2005)
 Understanding the meaning of loss is a vital aspect of
caring for survivors and care givers
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LOSS
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Loss is a normal part of the life cycle
People experience loss in the form of change,
growth and transition
The experience can be painful, frightening
and lonely
Triggers an array of emotional responses
Can manifest itself in different ways.
LOSS
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Age
Gender
Personality
Cultural heritage
Race
religion
LOSS CAN BE REFERRED TO AS……….
Actual
 Perceived
 Maturational
 Situational
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ACTUAL LOSS
Reduces the chance of attaining personal goals
 loss of sight
 Speech
 Mobility
 Limb
 Spinal injury
PERCEIVED LOSS
Dignity
 Confidence
 Self esteem
 Alteration of hope
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MATURATIONAL LOSS
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From being a baby
Loss of childhood
From teenager to
adult
From roaring 40’s to
50’s
Life after 50
SITUATIONAL LOSS
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Sudden ,
unpredictable
Physiological
Social - Divorce
Psychological
Natural disaster
Illness – life
threatening or
Chronic
LOSS PRECIPITATES A PAINFULL
HUMAN EMOTION ……… GRIEF !!
CATEGORIES OF LOSS
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Loss is experienced in the form of :
- Losing a loved one (person or pet) – life
significant other
- change (moving house, country, job) – known
environment
- health (illness or accident) aspect of self
- losing things we own by accident or theft –
external objects
- our place in the world
Precipitates a painful human emotion - Grief
EMOTIONAL RESPONSES
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Denial
Shock – “I feel numb”
Disbelief – feeling of unreality
Anger - hostility
Unbearable loneliness
Sadness
Depression – hopelessness –
worthless
EMOTIONAL RESPONSES
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Social withdrawal – no one cares or really
understands
Apathy
Longing for who or what was lost
Blaming self or others – what you could have
done, but didn't - guilt
Questioning beliefs
Feelings of panic - self destruction, desire to
run away and “chuck it all in”
PHYSIOLOGICAL RESPONSES
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Increase in heart rate
Blood pressure changes
Chest discomfort
Shortness of breath – tightness in throat
Appetite changes – digestive symptoms
Sleep deprivation
Abdominal upsets – hollow feeling in stomach
Weight loss, hair loss, memory loss
CHANGES IN BEHAVIOUR
Purposeless activity
 Crying
 Lack of interest
 Easily distracted
 Forgetfulness
 Slow movements
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IT,S NOT SO SIMPLE ………….
WHAT IS GRIEF ?
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The emotional suffering you feel when someone or
something you love is taken away.
A natural response to loss which we all experience at
some time
Usually associated with the death of a loved one – most
intense
The more significant the loss, the more intense the grief
Very personal and highly individual experience – no right
or wrong way to grieve
STAGES OF GRIEF – ELIZABETH KUBLER- ROSS
GRIEF IS A ROLLERCOASTER !!!
Dr Patch Adams
“the worst part for people who are considered to be dying
is being treated as if they are already dead – people want
visitors who are jolly fun and cheerful”
“Dying is that process a few minutes before death, when
the brain is deprived of oxygen, everything else is
living”
NON THERAPEUTIC COMMUNICATION
False reassurance
 Sympathy
 Changing the subject
 Giving personal opinions
 Approval or disapproval
 Arguing
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BEREAVEMENT
Bereavement is the actual process a
person goes through following a significant
loss
 It has been likened to thoughts and
feelings following the experience of being
robbed or deprived of something of value
 Something suddenly been yanked away
(Crisp & Taylor, 2005)
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PROCESSES OF MOURNING
T – to accept reality of loss
E – experience the pain of loss
A – Adjust to an environment that no longer
includes the lost person , object or
aspect of self
R – reinvest emotional energy into new
relationships
Nurses and caregivers need to……..
accept diversity in the beliefs and
responses of others.
 view each situation as unique.
 respond to situations in an honest,
sensitive and caring manner.
 take time to intervene sensitively and
appropriately when caring for those who
have experienced a loss
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Nursing goals for dying patient
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Gaining and maintaining comfort
Maintaining independence in ADL’s
Reducing anxiety
Ensuring feelings of security – do not leave alone
Achieving spiritual comfort and forgiveness
Gaining relief from loneliness and isolation
Allow patient / family control & involvement
Tailor to beliefs, customs and practices held by patients
WHO GUIDELINES (2003)
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Provide relief from pain and other distressing symptoms
Affirm life and regard dying as a normal process
Neither hasten or postpone death
Integrate the psycological and spiritual aspects of
patient care
Support patients to live as actively as possible until
death
Use a team approach to address the needs of patients
and their families
Enhance quality of life, and positively influence the
course of illness
CHRISSIE’S STORY
http://www.youtube.com/watch?v=wVIVhYa2-ho&feature=related
AN ANCHOR HAS BEEN LIFTED AND THE WAKA OF LIFE ROCKS. WE WHO
ARE LEFT BEHIND WILL HOLD STEADILY TO THE COURSE YOU HAVE
STEERED.
HOEA CHRISSIE MO AKE TONU ATU