MAR BASELIOS COLLEGE OF NURSING NURSING BHOPAL
SUBJECT: ADV ADVA ANCED NURSING PRACTICE TOPIC PRESENTATION ON
“COPING WITH LOSS, DEATH AND GRIEVING”
SUBMITTED TO,
SUBMITTED BY,
Mrs. Ree! A"#
Ms. R$%s& A%r!'!(
Ass). Pr$*ess$r
M.S+. Nrs"-, I Ye!r D!)e: /010123
COPING WITH LOSS, DEATH AND GRIEVING
INTRODUCTION Death is inevitable, yet the loss of a close friend or family member always showers us with a range of emotions. One day we might desperately try to avoid the pain, anxiety and feelings of helplessness we feel when a loved one dies. Other days, we feel like life has returned to normal—at least until we realize that our life has changed irrevocably. Despite the gamut of emotions we feel, grieving for a loved one helps us cope and heal. The intense, heartbreaking anguish indicates that a deep connection has been severed. !ithout a doubt, grieving is painful. "ut it is also necessary. #oing forward doesn$t mean forgetting about the loved one who died. %n&oying life again doesn$t imply that the person is no longer missed. 't simply means that your grief has run its course.
DEFINITIONS L$ss: ( person experiences loss in the absence of an ob&ect, person$s body part or function, or emotion that was formerly present. De!)': Death occurs when an individual has sustained either irreversible cessation of circulatory and respiratory functions or irreversible cessation of all functions of the entire brain, including the brain stem. Gr"e*: #rief is a reaction of an individual to a significant loss. C$4"-: The term )coping$ is used to refer to the process by which a person attempts to manage stressful demands.
CLASSIFICATION OF LOSS A+)!# #$ss: 't is easily identified and can be recognized by others as well as person sustaining the loss, loss of a limb, of a spouse, of an ob&ect and of a &ob. Per+e"5e6 #$ss: it is felt by the person but is intangible or less intangible to others. *or e.g. •
+aturational loss loss resulting from normal life transitions -loss of youth, of financial
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independence. /ituational loss loss occurring suddenly in reference to a specific external event -sudden death of loved one.
A)"+"4!)$r& #$ss: in this a person displays loss and grief behavior for a loss that has yet to take place, e.g. sickness or death.
COMMON SYMPTOMS OF GRIEF !hile loss affects people in different ways, many experience the following symptoms when they$re grieving. 't must be remembered that almost anything that you experience in the early stages of grief is normal—including feeling like we$re going crazy, feeling like we$re in a bad dream, or 0uestioning our religious beliefs. S'$+7 !6 6"s%e#"e* 8 1ight after a loss, it can be hard to accept what happened. !e may feel numb, have trouble believing that the loss really happened, or even deny the truth. 'f someone we love has died, we may keep expecting him or her to show up, even though we know he or she is gone. S!6ess 8 2rofound sadness is probably the most universally experienced symptom of grief. !e may have feelings of emptiness, despair, yearning, or deep loneliness. !e may also cry a lot or feel emotionally unstable. G"#) 8 we may regret or feel guilty about things we did or didn$t say or do. we may also feel guilty about certain feelings -e.g. feeling relieved when the person died after a long, difficult illness. (fter a death, we may even feel guilty for not doing something to prevent the death, even if there was nothing more we could have done. A-er 8 %ven if the loss was nobody$s fault, we may feel angry and resentful. 'f we lost a loved one, we may be angry with ourselves, #od, the doctors, or even the person who died for abandoning us. we may feel the need to blame someone for the in&ustice that was done to us. Fe!r 8 ( significant loss can trigger a host of worries and fears. !e may feel anxious, helpless, or insecure. !e may even have panic attacks. The death of a loved one can trigger fears about our own mortality, of facing life without that person, or the responsibilities we now face alone. P'&s"+!# s&(4)$(s 8 !e often think of grief as a strictly emotional process, but grief often involves physical problems, including fatigue, nausea, lowered immunity, weight loss or weight gain, aches and pains, and insomnia.
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PHYSIOLOGICAL AND PSYCHOLOGICAL RESPONSE TO GRIEF P'&s"$#$-"+!# Ps&+'$#$-"+!# 3rying 'ntense loneliness and sadness • /ighing respirations (nxiety or panic episodes • /hortness of breath, palpitations Difficulty focusing and concentrating • *atigue, weakness, exhaustion Disorientation • 'nsomnia (nger • 4oss of appetite 4ow selfesteem • 3hoking sensation Tightness in chest
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#astrointestinal disturbances
STAGES OF GRIEF 'n 5676, psychiatrist %lisabeth 8ubler1oss introduced what became known as the 9five stages of grief,: which represent feelings of those who have faced death and tragedy.: These stages of grief were based on her studies of the feelings of patients facing terminal illness, but many people have generalized them to other types of negative life changes and losses, such as the death of a loved one or a breakup. 5. De"!#: This is a stage of shock and disbelief . The response may be 9This can$t be happening to me.: Denial is a protective mechanism that allows the individual to cope within an immediate timeframe while organizing more effective defense strategies. ;. A-er: 9!hy is this happening< !ho is to blame<: are comments often expressed during the anger stage. (nger may be directed at self or displaced on loved ones, caregivers and even #od. There may be a preoccupation with an idealized image of the lost entity. =. B!r-!""-: 9+ake this not happen, and in return ' will >>>>.:During this stage, which is generally not visible or evident to others, a bargain is made with god in an attempt to reverse or postpone the loss. ?. De4ress"$: 9'$m too sad to do anything.: During this stage, the full impact of the loss is experienced. This is a time of 0uiet desperation and disengagement from all associations with the lost entity. @. A++e4)!+e: 9'$m at peace with what has happened.: The final stage brings a feeling of peace regarding the loss that has occurred. *ocus is on the reality of the loss and its meaning for the individuals affected by it.
GRIEF PROCESS The grieving process describes a series of occurrences in the resolution of loss. This process provides support as an individual works through the feelings of anger, hopelessness and futility that accompany loss. 't provides time to put things into perspective, to place into memory that which is gone, and to embrace life. #rowth occurs as the bereaved person comes to the point of letting off the past. This does not reduce the importance of the loss but allows the person to continue living with a new perspective. This acceptance indicates that the grief process is coming to a close.
COPING WITH LOSS, DEATH AND GRIEF 3oping with death is vital to your mental health. 't is only natural to experience grief when a loved one dies. The best thing you can do is allow yourself to grieve. There are many ways to cope effectively with your pain. See7 $) +!r"- 4e$4#e. *ind relatives and friends who can understand your feelings of loss. Aoin support groups with others who are experiencing similar losses. E94ress &$r *ee#"-s. Tell others how you are feelingB it will help you to work through the grieving process.
T!7e +!re $* &$r 'e!#)'. +aintain regular contact with your family physician and be sure to eat well and get plenty of rest. "e aware of the danger of developing a dependence on medication or alcohol to deal with your grief. A++e4) )'!) #"*e "s *$r )'e #"5"-. 't takes effort to begin to live again in the present and not dwell on the past. P$s)4$e (!$r #"*e +'!-es. Try to hold off on making any ma&or changes, such as moving, remarrying, changing &obs or having another child. Cou should give yourself time to ad&ust to your loss. Be 4!)"e). 't can take months or even years to absorb a ma&or loss and accept your changed life. Dr!; +$(*$r) *r$( &$r *!")': 'f you follow a religious tradition, embrace the comfort its mourning rituals can provide. /piritual activities that are meaningful to you—such as praying, meditating, or going to church—can offer solace. 'f you$re 0uestioning your faith in the wake of the loss, talk to a clergy member or others in your religious community. See7 $)s"6e 'e#4 ;'e e+ess!r&. 'f your grief seems like it is too much to bear, seek professional assistance to help work through your grief. 'ts a sign of strength, not weakness, to seek help.
HELPING OTHERS GRIEVE 'f someone we care about has lost a loved one, we can help them through the grieving process. S'!re )'e s$rr$;. (llow them — even encourage them — to talk about their feelings of loss and share memories of the deceased. D$<) $**er *!#se +$(*$r). 't doesnt help the grieving person when you say Eit was for the bestE or Eyoull get over it in time.E 'nstead, offer a simple expression of sorrow and take ti me to listen. O**er 4r!+)"+!# 'e#4. "abysitting, cooking and running errands are all ways to help someone who is in the midst of grieving. Be 4!)"e). 1emember that it can take a long time to recover from a ma&or loss. +ake yourself available to talk. E+$r!-e 4r$*ess"$!# 'e#4 ;'e e+ess!r&. Dont hesitate to recommend professional help when you feel someone is experiencing too much pain to cope alone.
COMMON ADAPTIVE COPING TECHNI=UES 2roblemsolving • (ssertiveness • 2ositive self talk and self acceptance • /tress and anger management • 4earning skills needed for communication and relationships • 3onflict resolution • Time management • 3ommunity living skills •
CONCLUSION 4ife is a series of losses and gains. %veryone experiences losses at various points in the life continuum. "irth, loss and death are universal and individually uni0ue events of the human experience. (t any stage of one$s life, there is the potential for loss, grief and death. (ll losses have the possibility of triggering the grief process. Fnderstanding loss, the grief process and the task of dying can assist the nurse in delivering 0uality care to those patients and families experiencing death. Gurses need to understand loss and grief because death is a fre0uent reality in many nursing care settings. +ost nurses interact daily with clients and families experiencing loss and grief.
BIBLIOGRAPHY
BOO>S •
3arol Taylor et.al, 9fundamentals of nursing the art and science of nursing care:, = rd
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%dition, 4ippincott1aven 2ublishers -566HB HI5IJJ. +ary 8owalski, 9Textbook of "asic Gursing:, Ith %dition, 4ippincott !illiam K !ilkins
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-;JJ=B H6;H66. +ary /ulakshini 'mmanuel, 9Gursing *oundations 2rinciples K 2ractices:, Fniversities
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press -'ndia 2rivate 4imited -;J5?B =@J=@?. 2otter K 2erry, 9"asic Gursing %ssentials for 2ractice:, 7 th edition, +osby %lsevier 2ublishers -;JJHB 75J7;6.
JOURNALS •
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3hristopher Lall, 9"ereavement theory recent developments in our understanding of grief and bereavement:, ==-5, *ebruary, ;J5? ;@;H. 8. 8ellie #oldsworthy, 9#rief and loss theory in social work practice (ll changes involve loss, &ust as all losses re0uire change:, @I-;, Govember, ;JJ@=7?J. 1obert (. Giemeyer, et al., 9( /ocial 3onstructionist (ccount of #rief 4oss and the Garration of +eaning: =I-I, /eptember, ;J5? ???I. Theresa (. #ordon , 9#ood #rief %xploring the Dimensionality of #rief %xperiences and /ocial !ork /upport:, 6-5, Aanuary,;J5= @;@7.
INTERNET •
www.helpguide.org/articles/grief-loss/coping-with-grief-and-loss.htm
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www.webmd.com/mental-health/mental-health-coping-with-grief
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cmhc.utexas.edu/griefloss.html
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www.mentalhealthamerica.net/.../coping-loss-bereavement-and-grief
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www.cancer.org/coping-with-the-loss-of-a-loved-one-pdf
