GRIEF, LOSS, DEATH

AND COPING
“Every suffering has meaning”
 OBJECTIVES

At the end of GNO Death and Coping discussion, the participants will be able
to:
1. Describe death and dying.
2. Define loss, grief, mourning and bereavement.
3. Identify the stages of grieving.
4. Discuss the nursing responsibilities/management during each stages of
dying.
5. Enumerate the nursing care for a diseased patient
 INTRODUCTION

 Birthand death are two aspects of life, which will happen to

everyone.

 Dying and death are painful and personal experiences

 Loss, grief, and bereavement can affect the patient, family, and nurse.

 Death affects each person in multiple ways

DEFINITION OF DEATH

 The end of life

 Cessationof heart- lung function, or of whole brain function, or of
higher brain function.
 Either irreversible cessation of circulatory and respiratory functions or
irreversible cessation of all functions of the entire brain, including the brain
stem" - (The President's Commission for the study of Ethical problems in
Medicine and Biomedical and Behavioral Research, US, 1983).

 Permanent state in the field of biology

All living things will eventually die……
DEATH AND DYING IN ISLAM

 Death is seen as something predestined by God.

 In Islam, grieving is allowed for only three days (except that a widow
may grieve for 4 months and 10 days).

 The body should not be washed, as this will be done as part of a

special religious ritual before burial.

 Muslim burials are performed as soon as possible after death,

sometimes on the same day.
BELIEFS RELATED TO DEATH

The Qur’an says, “They (true believers) say:

To God we belong and to Him is our Return”

 A part of a journey and a contract & part of their faith in Allah

 Muslims believe that dying is a part of living and an entrance to the

next life.

 A transformation from one life to another.

LOSS, GRIEF
AND
BEREAVEMENT
 LOSS LOSS

Any situation wherein a valued object or person is

changed or is no longer accessible to the individual.
 Universal experience that occurs throughout the lifespan.

 Something of value is gone

1. Actual

2. Perceived

3. Physical

4. Psychological
 GRIEF

 The grief process involves a sequence of affective, cognitive

and psychological states as a person responds to and finally
accepts a loss

 Responses to loss are strongly influenced by one’s cultural

background.
 MOURNING AND BEREAVEMENT
MOURNING
 Behavioral response
 The period of time during which grief is expressed and
resolution and integration of loss occur.

BEREAVEMENT
A period of grief following the death of a loved one.
 Subjective response to by loved ones
STAGES OF GRIEVING

STAGES BEHAVIORS
DENIAL Refuses to believe that loss
is happening
ANGER Retaliation
BARGAINING Feelings of Guilt,
punishment for sins
DEPRESSION Laments over what has
happened
ACCEPTANCE Begins to plan
 DENIAL
 “No, not me…”

 On being told that one is dying, there is an

initial reaction of shock.

 After the initial shock has worn off, the next

stage is usually one of classic denial, where
they pretend that the news has not been given.

 The patient may appear dazed at first and may

then refuse to believe the diagnosis or deny
that anything is wrong.

 They effectively close their eyes to any

evidence and pretend that nothing has
happened.
Interventions

1. Do not interfere unless it becomes destructive

2. Do not support denial; conversations should include reality.

3. Continue to teach and encourage self care activities.

 ANGER
Anger
“ Why me?”

 This stage often occurs in an explosion

of emotion, where the bottled –up
feelings of the previous stages are
expulsed in a huge outpouring of grief.

 Whoever is in the way is likely to be

blamed.

 Patients become frustrated, irritable

and angry that they are sick.
Interventions

 Give space allowing them to rail and below. The more the storm
blows the sooner it will blow itself out.

 When anger is destructive , it must be addressed directly. Remind the

person of appropriate and inappropriate behavior.

 Allow patient to talk and express feelings

 Engage patient in exercise or activities

 It won’t last forever

 BARGAINING
Anger
 “Yes me, but…”
 The patient attempts to negotiate a
postponement with God and is
generally kept a secret.
 Provides temporary escape and
hope
 Allows time to adjust to reality
 Eg.: Giving to charity or
reaffirming an earlier faith in God.
Interventions

 Spend time with patients

 Discuss importance of valued objects and people.

 DEPRESSION
Anger
 The inevitability of the news
eventually (and not before time)
sinks in and the person reluctantly
accepts that it is going to happen.
 The patient shows clinical signs of
depression
 The depression may be a reaction to
the effects of the illness on his or her
life or it may be in anticipation of the
approaching death.
Interventions

 Be available

 Don’t attempt to cheer person up

 Find out any religious support

 ACCEPTANCE
Anger
 Restful time, but not necessarily happy.
 Often begin putting their life in order,
sorting out wills and helping others to
accept the inevitability.
 The patient realizes that death is inevitable
and accepts the universality of the
experience.
 Under ideal circumstances, the patient is
courageous and is able to talk about his or
her death as he or she faces the unknown.
 People with strong religious beliefs and
those who are convinced of a life after death
can find comfort in these beliefs (Zisook &
Downs, 1989).
 Interventions

 Plan care to allow the person with whom patient is comfortable to care
for him or her

 It is important that you don’t withdraw

 Fear of Loneliness
COMMON
Fear of Sorrow
FEARS
Fear of the Unknown
OF
Loss of Self-Concept and
A Body Integrity
DYING Fear of Regression
PATIENT
Fear of Loss of Self Control
Signs and Symptoms of Approaching Death

 Motion and sensation is gradually lost

 May have increased hallucinations

 Decreased appetite

 May have temperature spikes

 Incontinent for stool and urine 24 to 72 hours prior to death

 Pain may be more intense

 Restlessness is common 12 to 24 hours prior to death

Signs and Symptoms of Approaching Death

 Changes in respiratory status

 Decrease Blood Pressure; Pulse-irregular, and rapid

 Increase in chest fluids

 Grunting and moaning on expiration

 Skin changes
Taking Care of the Dying Person

 The role of the nursing staff is fundamentally supportive

 Accept the physical and mental state he is in

 Show him that they will not abandon him

 Responds to the persons needs in a physical, psychological, social

and intellectual level
Nursing Responsibilities

 Nurses need to take time to analyze their own feelings about death before they
can effectively help others with terminal illness
 Understand that you may experience grief
 Nurses have to be strong to control their feelings to be able to tolerate pain,
illness, and death, and to keep their distance
 Provide relief from illness, fear and depression
 Help clients maintain sense of security
 Help accept losses
 Provide physical comfort
Nursing Responsibilities
 Physical Level: Biological needs; reduction and control of pain
 Intellectual Level: Nursing staff should stand by him without being judgmental,
let him decide where he wants to spend his last days, and interact with him as
a person who LIVES
 Emotional and Social Level: Need of emotional withdrawal co-exists with the
need of belonging to an accepting and supportive social environment
 When family/medical nursing staff keep their distance in order to protect themselves,
the person experiences a “social death”, which is sometimes more painful than the actual
death
 Nursing staff must treat the dying person without fear, encourage relatives to be close
to him, act as a liaison with the outside world
Care of Deceased Patient(SFH)

Definition:

The immediate care after confirmation of death by a physician

involving transfer of the body to the mortuary and release of the
body to the claimant.
Care of Deceased Patient(SFH)

1. The attending or on‐call physician notifies the next of kin if death

occurs. The staff nurse will inform the Nursing Supervisor.
2. Standard precautions shall be implemented in post mortem care.
3. Ensure that the relatives of the deceased patient should have an
opportunity to view the body either in the unit or in the mortuary.
4. The Senior Registered Nurse on duty will take responsibility for
ensuring that care of the deceased will be carried out in a dignified
manner
Care of Deceased Patient(SFH)

DO’s:-
1. Inform the physician and the Nursing Supervisor (On‐call).
2. Document the death of the patient in the Nurses Progress Notes.
3. Obtain twelve (12) leads ECG.
4. Once death is confirmed and certified by the Physician, the next of
kin must be informed immediately.
5. Post Mortem Care is implemented as soon as death occurs to the
patient.
Care of Deceased Patient(SFH)

DO’s:-
1. One nurse must accompany the body to the mortuary along with the
porters.
2. Keep all clothing and non‐valuables on the unit until the next of kin is
present.
3. Ensure that the relatives are informed, that there are no body washing
facilities at the SFHM.
4. The Notification of Death Form and Permission for Burial Form is
filled-out by the attending or on call Physician. Place both forms on the
deceased patient file before sending to mortuary.
5. Fill in the information in mortality log book at the unit.
Care of Deceased Patient(SFH)

1. Remove valuables, such as jewelry, from the deceased.

2. List the valuables in the Nurses Progress Notes and ensure two nurses
have witnessed the procedure.
3. Place the valuables in an envelope and list the contents on the front of
the envelope. Both nurses sign to confirm the contents are correct. Seal
the envelope and forward it to the Security Officer and then give it to
the family member (if present) at the time of death of the patient after
confirming his/her relation with the deceased patient.
4. Inform the relatives to collect the valuables from the Security office
during office hours.
Care of Deceased Patient(SFH)

1. Do not bath the body as per protocol.

2. Re‐dress wounds and change soiled dressings.
3. Close the patient’s eyelids, support the jaw, and straighten the limbs.
4. Label one wrist or one ankle with an identification bracelet.
5. Offer comfort and emotional support to the family and allow family as much
privacy as possible.
6. Place an identification label on the outside of the shroud at chest level.
7. Turn the body towards Kaabah.
8. Ask the porter to collect a morgue tray from the mortuary.
9. Place the deceased body of the patient on the tray and then place the tray on a
stretcher for transfer.
REFERENCES

BOOKS
Craven R F, Hirnle C J. Fundamentals of nursing. 5th ed. Philadelphia: Lippincott
Williams & Wilkins Publishers, 2006.
Kozier, B., et al.: Fundamentals of nursing: Concept process and practice, Pearson
Prentic Hall, 2008.

INTERNET:
http://www.napavalley.edu/people/rmillay/Documents/PTEC%20150%20PowerPoint%
20Handouts/Loss,%20Grief,%20and%20%20Dying.pdf

http://nursingassignments.blogspot.com/2012/05/nursing-care-of-death-dying.html