ADVANCED NURSING PRACTICE PRESENTATION ON DEATH COPING.pptx
- 1. WELCOME
- 2. COPING, LOSS, DEATH & GRIEF REACTION
- 3. LOSS Loss occurs when a valued person, object or situation is changed or made inaccessible so that its value is diminished or removed.
- 4. TYPES OF LOSS • Actual loss It can be recognized by others as well as by the person sustaining the loss, loss of a limb, a spouse, or a valued object such as money & a job are the examples.
- 5. • Perceived loss It is felt by the person but intangible to others, loss of youth, financial independence &loss of a valued environment are examples. • Maturational loss It is experienced as a result of natural developmental process. The first child may experience a loss of status when her sibling is born.
- 6. • Situational loss It is experienced as a result of an unpredictable event including traumatic injury, disease or natural disaster. • Anticipatory loss In which a person displace loss & grief behaviour for a loss that has yet to take place.
- 7. GRIEVING Grief is the emotional reaction to loss. It occurs with loss caused by separation as well as the loss caused by death.
- 8. GRIEF REACTION • Engels six stages are: • shock and disbelief • Developing awareness • Restitution • Resolving the loss • Idealism • Outcome
- 9. GRIEF THEORY • The Kubler-Ross model, commonly known as The Five Stages of Grief, is a theory first introduced by Elisabeth Kubler-Ross in1969 , on death and dying.
- 10. First stage -Denial • This is the first stage of shock • Denial is a protective mechanism that allows the individual to cope within an immediate time frame • The response may be “No, It can’t be true”
- 11. Second Stage- anger • Anger may be directed to self or loved one or caregiver. • Usually the comment is “Why me?’’
- 12. Third stage-bargaining • During this stage a bargain is made with god, is an attempt to reverse the loss
- 13. Fourth stage- Depression • Full impact of the loss is experienced. • This is the time of quiet desperation and disengagement from all association .
- 14. Stage five -Acceptance • The final stage . • Brings a feeling of peace regarding the loss that has occurred. • Individual is accepting the reality.
- 15. TYPES OF GRIEF:- UNCOMPLICATED GRIEF:- Uncomplicated grief is that many individuals would refer to as normal grief reaction is similar to other physical condition .
- 16. • SOME OF THE COMMON REACTIONS EXPERIENCED BY THE GRIEVING INCDIVIDUAL Psychosocial reactions Profound sadness Helplessness Hopelessness Denial Angry
- 17. PHYSICAL REACTIONS • Loss of appetite • Insomnia • Fatigue • Decreased libido • Decreased immune functions • Multiple somatic compliance
- 18. • COGNITIVE REACTIONS • Inability to concentrate • Forgetfulness • Decreased problem solving activity • Impaired judgement
- 19. Behavioural reactions • Impulsivity • Social withdrawal • Distancing
- 20. DYSFUCTIONAL GRIEF:- • It is a demonstration of a persistent pattern of grief that does not result in reconciliation of feelings. • The person experiencing pathological grief continues to have strong emotional reactions, does not return to a normal sleep pattern or work routine usually remains isolated and displays altered eating habits.
- 21. SOME OF THE DYSFUNTIONAL GRIEF:- • ABSENT GRIEF:- It is the inability of the person to incorporate the reality of his life. This blocking of reality leads to incapacity to feel. • CONVERTED GRIEF:- When the anxiety is expressed as distressing symptom without the bereavement being aware of the relationship between symptoms and the loss.
- 22. ANTICIPATORY GRIEF:- Anticipatory grief is the occurrence of grief work before an expected loss actually occurs. Anticipatory grief may be experienced by the terminally ill person as well as the person’s family.
- 23. DISENFRANCHISED GRIEF:- • Christensen (1994) describe disenfranchised grief as grief that is not openly acknowledged , socially sanctioned or publically shared. • Grief can become disenfranchised when an individual either is reluctant to recognize the sense of loss and develops guilt feeling or feels pressured by society to get on with life.
- 24. FACTORS AFFECTING LOSS AND GRIEF:- • developmental stage • religious and cultural beliefs • relationship with lost object • Cause of death.
- 25. DEVELOPMENTAL STAGE • CHILDHOOD:- • It is important to understand the way a child ‘s concept of death . • The concept varies with development and may affect mastery of developmental task.
- 26. • ADOLESCENT:- • Most of the adolescents value physical attractiveness & athletic abilities. • Grief may over when the adolescent suffers the loss of a body part or functions.
- 27. EARLY ADULTHOOD • In the young adult, grief is usually precipitated by loss of role status. • The concept of death in age group is primarily a reflection of cultural values & spiritual belief.
- 28. MIDDLE ADULTHOOD • During adulthood the potential for experiencing losses increases. • As individual ages it can be especially threatening when peer die ,because these deaths forces, acknowledgement of one’s own mortality.
- 29. LATE ADULTHOOD • During the adulthood most the individuals recognize the inevitability of death • It is a challenging for elders to experience the death of old friends or to find themselves that last one of their peer group left living.
- 30. RELIGIOUS AND CULTURAL BELIEFS:- Religious and cultural beliefs can have a significant effect on individuals grief experience . Beliefs an afterlife ,a supreme being redemption of the soul and reincarnation are important aspects that can assist one in grief work.
- 31. RELATIONSHIP WITH LOST PERSON / OBJECT:- • The death of a child poses a particular risk for dysfunctional grieving. • The death of a child is generally thought to be exceptionally painful because it upsets the natural order of things • Parents do not except their children to die before them.
- 32. CAUSES OF DEATH • Unexpected death:- • The loss occurring as a result of an unexpected death posses particular difficult for the bereaved in achieving closure. • Unexpected death, such as death from a heart attack, aneurism or stroke, leaves survivor shocked and bereaved.
- 33. Traumatic death:- Complicated grief is associated with traumatic death such as death by homicide; violence or accident . survivors suffer emotions of greater intensity than those associated with normal grief.
- 34. • Suicide:- The loss of loved one to suicide is frequently compounded by feeling to guilt among the survivors They feel guilty for failing to recognize clues that may have enabled the victim to receive help. These feelings of guilt and self blame can transform into anger at the victim for inflicting such pain at them and at care giver.
- 35. • Cultural and social beliefs:- Values ,cultural norms, attitude. • Loss of personal life goals:- Actual or perceived individual losses affecting future decisions and option.
- 36. Nursing process and grief ASSESSMENT:- 1)Type and stages of grief:- • The nurse asks clients to describe their loss and how it has affected them. • The nurse can anticipate characteristic or response during the phase of grieving .
- 37. Factors affecting grief assessment • Nature of relationship- Functions of the family ,community and society . • Social support system:- Availability of family friends ,health care workers. • Nature of loss:- Actual versus perceived death issue impact or roles
- 38. • Cultural and social beliefs:- Values ,cultural norms, attitude. • Loss of personal ,life goals:- Actual or perceived individual losses affecting future decisions and options Families risk factors :- Relationship.
- 39. Nursing diagnosis:- • Compromised family coping • Ineffective family coping • Ineffective denial • Anticipatory grieving • Dysfunctional grieving • Hopelessness • Spiritual distress
- 40. PLANNING • Grieving is a natural response to loss & thus has a therapeutic value. • The focus is planning care is to support the client physically, emotionally, developmentally & spiritually in the expression of grief. • Application of critical thinking ensures a well designed plan where the nurse supports the client’s self esteem .
- 41. implementation • Cognitive dimension • Behavioral dimension • Affective dimension • Therapeutic communication • Promoting hope
- 42. EVALUATION • Evaluation requires the nurse to remain aware of signs and symptoms of grief ,even when clients are not specifically seeking care related to loss. • By comparing actual client behaviour with expected outcome the nurse evaluate the clients health status and whether there is a need to revise the plan
- 43. DYING AND DEATH
- 44. DEFINITION • Death can be defined as when an individual has sustained either irreversible cessation of circulatory and respiratory functions or irreversible cessation of functions of the entire brain including the brain stem – (Presidents Commission for the study of Ethical problems in Medicine and Biomedical and Behavioural Research )
- 45. Signs of impending death • Inability to swallow. • Pitting oedema. • Decreased urinary tract and gastro intestinal activity. • Bowel and bladder incontinence. • Loss of motion, sensation, reflexes
- 46. • Elevated temperature but cold or clammy skin, cyanosis. • Lowered blood pressure . • Noisy or irregular respiration. • Chyne-stroke respiration
- 47. Responses to dying and death According to Kubler Ross ,the five stages of dying are: • Denial and isolation • Anger • Bargaining • Depression • Acceptance
- 48. NURSING CARE FOR THE DYING:- Palliative care:- Palliative care is the care seeks to address not only physical pain but also social, emotional and spiritual pain to achieve the best possible quality of life for patients and the families. (WHO )
- 49. Hospice care:- Hospice care is the supportive care for in any weeks and months of life as long as curative therapies are no longer a goal, for the patient and doctor.
- 50. NURSING GOALS IN THE END OF THE LIFE CARE:- • avoid seeing a dichotomy between the living and dying. • Strive for increased physical and psychological comfort. • Relationships are of prime important.
- 51. BIBLIOGRAPHY 1) Black M Joice Medical surgical nursing 8th edition, Faunder’s publication 2009. 2) Lewis and Dirksen medical and surgical nursing 8th editin,Elsevier publication 2007. 3) Smeltzen C Brenda, brunner. Text book of medical surgical nursing 7th edition , Philadelphia, publication 2004. 4) Sr Nancy principles and practice of nursing . 4th edition 2005. N R brother’s publication.
- 52. THANK YOU