Grief Process, Death and

Dying
Plaut
&
Roark

LOSS

Actual

Perceived

External Objects

Known Environment

Significant Other

Aspect of Self

Life
Roark, 2004

Kubler-Ross Stages of Grief

Denial

Anger

Bargaining

Depression

Acceptance

Roark, 2004

Death and Dying

Assisting the
patient to Live
well and Die
well

What does this mean

to you?
Roark, 2004

Common fears of the dying

patient

Fear of Loneliness

Distancing by support people and

caregivers can occur
Debilitation, pain, and incapacitation
Hospital, a place that can be very lonely
Fear of dying alone

Roark, 2004

Fears of the dying client

Fear of Sorrow

Sadness
Letting go of hopes, dreams, the future
Awareness of own mortality
Grief about future losses
Anticipatory grief that involves mourning, coping
skills
Grief related to diagnosis that has a long term
effect on the body such as cancer
Patient may feel well at time of diagnosis
Roark, 2004

Fears of the dying client

Fear of the unknown:

Death is an unknown state

What will happen after death?
What will happen to loved ones, those
left behind

Roark, 2004

Fears of the dying client

Loss of self concept and body

integrity

Mutilation via therapy

Body image changes
Loss of role or status
Loss of standard of living

Roark, 2004

Fears of the dying client

Fear of Regression

Ego is threatened
Physical deterioration may occur
Mental deterioration may occur
Unable to care for self
Become dependent on others for care

Roark, 2004

Fears of the dying client

Fear of Loss of Self Control

Loose ability to control life decisions

Loose ability to control ADLs
Loss of control of body functions
Loss of control of emotions
Loss of independence

Roark, 2004

Fears of the dying client

Fear of Suffering and Pain

May be many different types of pain or

suffering such as physical, emotional,
social, or spiritual in nature
Altered relationships with others
Anxiety related to the disease and
consequences of the disease

Roark, 2004

Childs Response to Illness and

Death

Infant
Toddler
Preschool
School Aged
Adolescent

Roark, 2004

Cultural Backgrounds Affect

Beliefs Concerning Death

Beliefs, attitudes, and values that stem from

the patients cultural background will strongly
influence their reaction to loss, grief, and death
Expressions of grief are governed by what is
acceptable by the family and within the cultural
context
Comfort may be found through spiritual beliefs,
and finding comfort in specific rites, rituals, and
practices

Roark, 2004

Cultural Backgrounds Affect

Beliefs Concerning Death

Organized religious practices

Nurses need to be in tune with
patients spiritual needs
Becoming familiar with cultural views
will help
Can you name some cultural practices
associated with loss, grief, and death?
Roark, 2004

Support the client

Nurses can help to identify coping mechanisms,

and encourage effective coping mechanisms
Allow client/family to visit the chapel if desired
Allow family members around
Client may have problems with conflicting
feelings that do not align with culture or
religious practices-nurse can evaluate coping
and guide the client to appropriate interventions

Roark, 2004

Role of the Chaplain

Can be a member of the health care

team
Assist with religious practices
Perform rites
Provide prayer, support, and comfort
Assist with mobilizing other support
systems that are important to the client
Support family members
Roark, 2004

Nurses response to the dying

patient

Nurses grieve also

Nurses need to come to terms with personal
meanings of life and death
Best prepared to work with terminal clients
when the nurse has been given the time to
come to terms with own mortality
Common feelings
Develop personal/professional support
systems
Roark, 2004

Rationale for Communicating

Truthfully about Terminal
Illness

Right to know
Time frame
Nurse needs to assess whether or
not the patient/family have been told
and what was told to them
THE PHYSICIAN WILL TELL THE
CLIENT FIRST, NOT THE NURSE
Roark, 2004

Communicating Terminal
Illness, continued

The nurse:

Clarifies what was said

Listens to concerns
Fosters communication between MD, client,
and family
Allows patient to express loss
Facilitate grief through nursing process
Be available for patient
Assist patient to identify needs/hopes for
remainder of life
Connect patient with proper resources
Roark, 2004

List nursing strategies

appropriate for grieving
persons

Open ended statements

Patient sets the pace
Accept any grief reaction
Be awarenurse may be target of anger
Remove barriers
Avoid giving advice
Allow patient to talk
Allow patient to express signs of hope
Support hope by helping focus
Roark, 2004

Assist Family to Grieve

Explain procedures and equipment

Prepare them about the dying process
Involve family and arrange for visitors
Encourage communication
Provide daily updates
Resources
Do not deliver bad news when only one
family member is present
Roark, 2004

Choices of Care Setting

Families have choices of where to

care for the dying loved one
Ask the patient and family
preferences
Support whatever the choice
Hospital, Home/Hospice

Roark, 2004

Elements of Hospice Care

Home care coordinated with hospital

Control of symptoms holistically
Physician directed care
Utilization of variety of health care
professionals
Bereavement follow up care
Acceptance based on need, not $
Roark, 2004

Nursing strategies to meet

physical and psychosocial
needs of the dying patient

Thorough pain
control
Maintain
independence
Prevent isolation
Spiritual comfort
Support the family

Roark, 2004

Signs/Symptoms of
Approaching Death

Motion and sensation is gradually lost

Increase in temperature
Skin changes-cold, clammy
Pulse-irregular, and rapid
Respirations-strenuous, irregular, Cheyne stokes
Death rattle
Decrease Blood Pressure
Jaw and Facial muscles relax
MOST POSITIVE SIGN OF DEATH=Absence of brain
waves (Need two MDs to sign off)
Roark, 2004

Nursing care after death

Autopsy: examination performed after

a persons death to confirm or
determine cause of death
For tissue and organ removal:

Keep CV system going

Call donor bank representative
Must be agreed on by all family members
Or, patient decision before death
Roark, 2004

Nursing care after death

Legally, a person is considered dead when
there is a lack of brain waves even though
other body organs continue to function
This definition allows for harvesting of
organs and tissue for donation
Vital organs are: heart, liver, kidney, lung,
pancreas
Non-vital organs are: eye corneas, long
bones, middle ear bones, and skin
Roark, 2004

Deceased patient, before

viewing the body

Check orders for special requests

Remove equipment
Remove supplies
Change soiled linens and cleanse patient
Use room deodorizer
Place patient in supine position, with small
pillow under head
Insert dentures
Roark, 2004

Deceased patient, before

viewing the body continued

Remove valuables and give to family

Stay with family, if requested

After the family leaves:

Tag patient according to hospital/agency
policy
Wrap body in shroud
Put ID tag on shroud
Transfer to morgue
Document
Roark, 2004

Describe response of family to

dying process

Related to cultural background

Unresolved grief issues
Emotions
Requests
Physical symptoms may occur
Reorganization
Individualized grief patterns
Roark, 2004

Behavioral responses that

obstruct the expression of grief

Sudden, unexpected death

Lengthy illness resulting in death
Loss of a child
Perception that the death was preventable
Unsteady relationship with deceased
Mental illness of survivor
Lack of social support
Roark, 2004

Thanatology

Thanatology= study of death

The description of study of the
phenomena of death, and of
psychological mechanisms for coping
with death

Roark, 2004

Thank you

Roark, 2004