Lecture on Grief and Loss

Presented by Clinical Instructor Sharon Celestine

Purpose of the Lecture

• Understand loss and grief
• Examine factors influencing grief responses
• Apply the nursing process in cases of grief, loss, or death
• Develop individualized care plans for dying patients
• Discuss the nurse's role in postpartum care

Defining Loss

• Loss: Undesired change/removal of a valuable object, person, or situation
  • Examples: Loss of home, loved one, job, mobility
• Categories of Loss:
  • Actual vs. Perceived Loss:
    • Actual Loss: Visible to others (e.g., death, relationship ending)
    • Perceived Loss: Internal, felt by the person (e.g., loss of trust)
  • Physical vs. Psychological Loss:
    • Physical Loss: Injury, organ removal, amputation
    • Psychological Loss: Loss of trust or friendship
  • External vs. Internal Loss:
    • External Loss: Loss of objects with monetary/sentimental value (e.g., home, jewelry)
    • Internal Loss: Psychological or perceived loss
  • Loss of Aspect of Self:
    • Includes physical disfigurement, loss of faith, or hope
  • Environmental Loss:
    • Changes in familiar surroundings (e.g., moving, new job)
  • Loss of Significant Relationship:
    • Death, divorce, separation

Understanding Grief

• Grief: Physical, psychological, and spiritual response to loss
• Mourning: Actions associated with grief (e.g., crying, wearing black)
• Bereavement Period: Subjective time for adjusting to loss

Types of Grief

• Uncomplicated Grief: Normal response to loss
• Dysfunctional Grief: Complicated by unresolved issues
• Chronic Grief: Continuous grief due to successive losses
• Masked Grief: Hidden by other behaviors
• Delayed Grief: Postponed due to unexpectedness
• Disenfranchised Grief: Not recognized by society
• Anticipatory Grief: Expected loss due to illness

Factors Affecting Grief

• Type of relationship
• Significance of loss
• Support system
• Unresolved conflicts
• Circumstances of the loss
• Prior losses
• Spiritual and cultural beliefs
• Timeliness of death

Stages of Grief (Kubler-Ross Model)

1. Denial: Refusing reality
2. Anger: Directed at various targets
3. Bargaining: Attempting to negotiate
4. Depression: Deep sorrow
5. Acceptance: Coming to terms with loss
   • Not experienced linearly

Stages of Dying (Psychological)

• First Three Months: Withdrawal, increased sleep
• 1-2 Weeks Before Death: Physical changes like low BP, skin changes
• Days to Hours Before Death: Surge of energy, difficulty swallowing
• Moments Before Death: Unresponsiveness, cessation of breathing

Nursing Process in Grief and Loss

1. Assessment: Patient and family response, coping mechanisms
2. Diagnosis: Identifying grief-related issues
3. Planning: Focus on comfort, support, and communication
4. Implementation: Trust, empathy, communication, symptom management
5. Evaluation: Validating goals, addressing patient needs

Palliative vs. Hospice Care

• Palliative Care: Comfort care for progressive diseases, not limited to dying patients
• Hospice Care: Holistic care for patients expected to die within six months

Post-Mortem Care

• Document all actions
• Respect cultural/religious practices
• Prepare the body with dignity
• Allow family viewing with explanations
• Follow facility protocols for body handling and transfer

Instructor's Contact:

• Sharon Celestine
• Email: sceles.educ.edu

Additional Resources Provided:

• Videos on recognizing dying signs, post-mortem care, and more.