Loss,Grief & Stages of grief
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This document discusses terminal illness and the stages of grief. It begins by defining terminal illness as a disease that cannot be cured and is expected to result in death within a short period of time. It then discusses various types of loss, including actual versus perceived loss, physical versus psychological loss, and external versus internal loss. The document also covers the stages of grief as proposed by Kübler-Ross, including denial, anger, bargaining, depression, and acceptance. It provides descriptions of each stage and the nurse's responsibilities for supporting patients experiencing grief.
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Loss,Grief & Stages of grief
- 1. CHAPTER 14 - CARE OF TERMINALLY ILL PATIENT Ms.Lincy Thomas Tutor St.James’ College of Nursing, Chalakudy
- 2. “LOSS,GRIEF AND STAGES OF GRIEF” ()
- 3. TERMINAL ILLNESS • “Terminal illness is a medical term used to describe a disease that cannot be cured or adequately treated and ie, reasonably expected to result in the death of the patient within a short period of time” • It indicates that eventually ends the life of the sufferer.
- 4. Loss ‘Loss is the removal or absence of an important object or subject from an individual’s life’ ‘Loss is an actual or potential situation in which something ie, valued is changed, no longer available or gone’. ‘Loss is an absence of something valued from an individual’s life’. ‘It may be an absence of an object, person, body part, emotion, idea or function that was valued’. ‘Death is a fundamental loss, both for dying person and for those who survive’.
- 5. Forms of loss • Personal loss • Group loss • Multiple loss
- 6. Types of Loss • Actual loss is identified and verified by others • Perceived Loss cannot be verified by others • Maturational Loss occurs in normal development • Situational Loss occurs without expectations • Ultimate Loss (Death) both for dying person and for those who survive
- 7. Actual versus perceived loss/Anticipatory loss • Actual loss includes the death of a loved one (or relationship), theft, deterioration, destruction, and natural disaster. Actual loss can be identified by others, not just by the person experiencing it (e.g., hair loss during chemotherapy). • Anticipatory loss is experienced before the loss actually occurs(e.g: a woman whose husband is dying may experience actual loss in anticipation of his death) • Perceived loss is internal; it is identified only by the person experiencing it (e.g: a woman diagnosed with an STD may perceive herself as having lost her purity. e.g: a women who leaves her employment to care for her children at home may perceive a loss of independence and freedom)
- 8. Physical versus psychological loss • Physical loss includes (1) injuries (e.g., when a limb is amputated); (2) removal of an organ (e.g., hysterectomy); and (3) loss of function (e.g., loss of mobility). • Psychological losses challenge our belief system. They are commonly seen in the areas of sexuality, control, fairness, meaning, and trust. Some losses may be mixed. Ex: after removal of a prostate gland, a man may feel both the physical and psychological loss of sexuality.
- 9. External versus internal loss • External losses are actual losses of objects that are important to the person because of their cost or sentimental value (e.g., jewellery, pets, a home). These losses can be brought about by theft, destruction, or disasters such as floods and fire. • Internal loss is another term for perceived or psychological loss.
- 10. • Loss of aspects of self This includes physical losses such as body organs, limbs, body functions, and/or body disfigurement. Psychological and perceived losses in this category include aspects of one’s personality, developmental change (as in the aging process), loss of hopes and dreams, and loss of faith. • Environmental loss This involves a change in the familiar environment, even if the change is perceived as positive. Examples include moving to a new home, getting a new job, and going to college. These losses can be perceived or actual. • Loss of significant relationships This includes, but is not limited to, actual loss of spouses, siblings, family members, or significant others through death, divorce, or separation (e.g., military deployment)
- 11. GRIEF • Grief is the natural response to loss. It is the emotional suffering you feel when something or someone you love is taken away. • The intensity of the grief depends on the meaning the person attaches to the loss. Although each person may express grief differently, some aspects of grief are shared by almost everyone. DEFINITION OF GRIEF Grief is defined as “the multifaceted physical, emotional and behavioural responses of an individual to the death of a significant other or any loss”
- 12. • Mourning Outward social expression of grief and the behaviors that are influenced by cultural mores and customs (ex: crying, wearing black clothing.) • Bereavement The response pattern, psychologic and physiologic, displayed by an individual following the loss of a significant object/subject.
- 13. TYPES OF GRIEF • Normal Grief reaction- Abbreviated & Anticipatory • Unhealthy Grief reaction- Pathologic & Dysfunctional(Unresolved & Inhibited) Abbreviated Grief is brief but genuinely felt. The lost object may not have been sufficiently important to the grieving person or may have been replaced immediately by another, equally esteemed object. Anticipatory Grief is experienced in advance or before of the event
- 14. • Pathologic (Unresolved ) is extended in length and severity. The same signs are expressed as with normal grief, but bereaved may also have difficulty expressing the grief, may deny the loss or may grieve beyond the expected time. • Dysfunctional (Inhibited) many of the normal symptoms of grief are suppressed and other effects, including somatic are experienced instead.
- 15. • Dysenfranchised Grief occurs when a person is unable to acknowledge the loss to other persons. eg: socially unacceptable loss such as suicide, abortion or giving a child up for adoption, a man whose wife has had a miscarriage, a mistress whose lover dies, or a bereaved partner in a homosexual relationship not recognized by the families • Exaggerated Grief An intense reaction to the loss that can include thoughts of suicide, phobias or nightmares.
- 16. Factors Affecting Grief • Significance of the loss The meaning the person has attached to the person or object lost will be different for each person. The more attachment to the relationship or object, the more difficult is the grieving. • Support System The amount of support for the bereaved: People with more emotional and psychosocial support typically have less complicated grief. • Circumstances of the loss If the circumstances of the loss leave the bereaved feeling guilty or responsible, his or her healing process may be impeded. (this may occur in losses other than death such as loss of a job)
- 17. • Previous Loss If the person has sustained more than one loss in a short period of time, the grieving process can become more complicated. • Spiritual/Cultural Beliefs and Practices Can help or hinder the grieving process. One person might believe the deceased is in a place of contentment and happiness, where all suffering is over. Another may believe that the deceased person will be reborn into another form. Yet another may believe that death is final and there is no afterlife. • Age of a person grieving
- 18. • Gender Men are frequently expected to be strong and show very little emotion during grief. • Expectations of death / cause of loss or death Injuries or deaths occuring during respected activities in the line of duty are considered honourable Those occurring during illicit activities are considered socially unacceptable loss.
- 19. PHYSICAL SYMPTOMS OF GRIEF We often think of grief as a strictly emotional process, but grief often involves physical problems, including: • Fatigue • Nausea • Lowered immunity • Weight loss or weight gain • Aches and pains • Insomnia
- 20. EMOTIONAL SYMPTOMS OF GRIEF • Shock and disbelief. Right after a loss, it can be hard to accept what happened. You may feel numb, have trouble believing that the loss really happened, or even deny the truth. If someone you love has died, you may keep expecting them to show up, even though you know they’re gone. • Sadness. Profound sadness is probably the most universally experienced symptom of grief. You may have feelings of emptiness, despair, or deep loneliness. You may also cry a lot or feel emotionally unstable. • Guilt. You may regret or feel guilty about things you did or didn’t say or do. You may also feel guilty about certain feelings (e.g. feeling relieved when the person died after a long, difficult illness). After a death, you may even feel guilty for not doing something to prevent the death, even if there was nothing more you could have done.
- 21. • Anger. Even if the loss was nobody’s fault, you may feel angry and resentful. If you lost a loved one, you may be angry with yourself, God, the doctors, or even the person who died for abandoning you. You may feel the need to blame someone for the injustice that was done to you. • Fear. A significant loss can trigger a host of worries and fears. You may feel anxious, helpless, or insecure. You may even have panic attacks. The death of a loved one can trigger fears about your own mortality, of facing life without that person, or the responsibilities you now face alone.
- 22. STAGES OF GRIEF
- 23. “Stages of grief is the series of emotional stages or responses that someone experiences when faced with an impending death or other extremes of loss”( Griever is expected to move through these stages) It was introduced by DR.ELIZABETH KUBLER- ROSS in 1969 and these stages also known as Kubler Ross Model
- 24. • Elisabeth Kübler-Ross was a Swiss-American psychiatrist, a pioneer in near-death studies, and author of the internationally best-selling book, On Death and Dying, where she first discussed her theory of the five stages of grief.
- 25. • Dr. Elizabeth Kübler-Ross has researched the dying process and has identified 5 stages of grieving that dying patients and their families may experience in preparation for death. • Stages may not appear in order and some patients may be in several stages at the same time. Some patients die before progressing through all the stages.
- 26. STAGES OF GRIEF 1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance (These stages popularly known by the acronym DABDA)
- 27. Stage 1: Denial Denial is an immediate response to news of loss or impending loss lt is a conscious or unconscious refusal to accept facts, information, reality, etc., relating to the situation concerned. That means ,the individual may refuses to believe that a loss has occurred. It's a defense mechanism and perfectly natural.
- 28. Statements such as “No, that can’t be so” and “it can’t be happening to me” are common In this stage , person may often experiences a state of shock & disbelief and you may feel numb ,disoriented or reports a sense of unreality. This is a temperory response that carries us through the first wave of pain. Physiologic response may include muscular weakness, tremors, deep sighs, flushed /cold/clammy skin, diaphoresis, anorexia and discomfort
- 29. Nurses responsibility • Support emotional needs without reinforcing denial (the patient might become argumentative at this stage but this is only a normal response) • The nurse must constantly be by the patient’s side to attend his needs. • Offer basic care ,such as food, drink, oxygenation, comfort and safety
- 30. Stage 2: Anger Individual resist the loss and may act out to everyone and everything in the environment. It is an intense emotion that is expressed as anger. They may become irritable and frustrated.
- 31. Anger can manifest in different ways. People dealing with emotional upset can be angry with themselves, and/or with others, especially those close to them, family, staff, physicians, to god or inanimate objects etc.. In this stage , the individual may be reluctant to share their feelings and thoughts. Common statements , “why me”, “why is this happening to me” “I hate my life, I don’t want to talk to anyone, Don’t come near me” etc…
- 32. Nurses responsibility • Nurse should also maintain a normal tone of voice and show that you are actively listening to them even though when they are angry. • Nurse should remain calm in dealing with an angry patient. • Provide anticipatory guidance about their feelings. • Nurse must never feel that the anger is directed towards them • Do not allow them to take anger personally • Encourage client and family to express their feelings
- 33. Stage 3: Bargaining This stage of grief may be marked by persistent thoughts about what “could have been done” to prevent the death or loss. Bargaining is often accompanied by guilt. This is basically our way of negotiating with the hurt and pain of loss. Common statements are, “if only we had sought medical attention sooner…….” “if only we got a 2nd opinion from another doctor…..” “I would give everything I own if I become healthy and free of this sickness”
- 34. Nurses responsibility • Listen attentively and encourage client to talk to relieve his guilt, discomfort and irrational fear. • If appropriate ,offer spiritual support.
- 35. Stage 4: Depression At this stage the individual has come to recognize that a loss has occurred or will occur. The individual may isolate themselves and spend time in crying and grieving. Depression and sadness are the most recognizable and perfectly normal emotional response.
- 36. During this stage, you will likely to withdraw from normal activities and feel as you are in a fog of sadness. You may find it difficult to go on without that person in your life or you believe that you cannot be cured of the sickness. Common statements “I would rather stay in my room rather than go out “ “I do not feel like anything all day” etc..
- 37. Nurses responsibility • Allow the client to express sadness • Communicate non-verbally by sitting quietly without expecting conversation • Convey caring by touch • Nurse must be aware of the symptoms of major depression-watch out for signs of impending suicide because most depressed clients finally resort to suicide. • Provide the client with activities that would bring out positive thoughts.
- 38. Stage 5: Acceptance This is the point or stage where the individual will come to accept the loss or new reality. They understand the situation logically and they have come to terms emotionally with the situation. Acceptance doesn’t mean that you are okay with your situation; it simply meant, you recognize that person is indeed gone, that your situation has changed and people may wish to begin making new plans (eg:will,prosthesis,altered living arrangements etc.)
- 39. Nurses responsibility • Help family and friends understand client’s decreased need to socialize. • Encourage client to participate as much as possible in the treatment program • Make interventions to promote his comfort
- 40. Video on stages of grief http://www.metacafe.com/watch/5788546/5_stages_of_grief_giraffe/