Grief and Loss

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Chance Reaves
MSN-Ed,RN
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Outline

Overview

  1. Grief & Loss
    1. Perception
    2. Theories
    3. Grief continuum
    4. Human response
    5. Nurse’s role

Nursing Points

General

  1. Perception
    1. Grief
      1. Emotional response to loss
    2. Loss
      1. Deprivation of an object or person
    3. Grief and loss are perceived to be about people or death
      1. Situational loss
      2. Perceived loss
      3. Loss of limb
  2. Theories
    1. Multiple theories on grief and death exist
      1. Kubler-Ross
      2. Bowlby
      3. Worden
    2. Falls on grief continuum
      1. Changes over time
      2. Can go back and forth
    3. Grief may change between theories
    4. Duration of stages may vary
  3. Human response
    1. Age
      1. Acceptance of grief and loss becomes more accepting with age
    2. Coping
      1. People use different coping tools to deal with grief
    3. Socioeconomic status
      1. Lack of resources may increase grief
    4. Culture & ethnicity
      1. Different cultures express grief differently
    5. Spirituality
      1. Belief systems impact how patients deal with grief
        1. Some beliefs allow for easier acceptance of loss
  4. Nurse’s role
    1. Offer support
    2. Use therapeutic communication
    3. Promote resources
      1. Ex: Palliative care for anticipatory grief
    4. Manage symptoms
    5. Maintain comfort
    6. Give a damn

Nursing Concepts

  1. Communication
  2. Coping
  3. Grief
  4. Interpersonal relationships

Patient Education

  1. Educate patient or family on resources available for grief counseling.
  2. Provide information and educate patients or families on misinformation regarding death, grief and loss.

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Transcript

In this lesson, we’re going to hit the high points of grief and loss.

Ok guys, for this lesson, we’re really just going to hit on the high points about grief. There’s another lesson on grief and loss in the Mental Health course and I encourage you to go check it out. Today, we’re really just hitting some overall concepts.

Remember that grief is an emotional response to loss, with loss being deprived of something or someone. There’s this idea that grief and loss only exist with death, which is just not true. Loss can be removing someone from their life, so like a breakup, or if someone moves, or if someone is incarcerated, which is situational. Also, grief and loss can be perceived or anticipated. For your patients that you withdraw care on, the family may anticipate that loss, so they already start processing grief. Another situation is an amputee, when they lose their limb.

The important takeaway is that grief doesn’t solely focus on death.

I’m sure you’re looking at this going what the heck, right? Well, hang tight and I’ll explain.

Grief follows a continuum, and there are lots of theories like Kubler-Ross and Bowlby and Worden and they all are about how people process grief. For nurses, what you need to realize is that in spite of all of these theories, there is one main idea, and it’s that people most commonly follow a continuum. They’ll go from one stage to another, and sometimes will fluctuate between theories as well.

For instance, several years ago, I lost a childhood friend, who was relatively young. It was this impossible thing to think about. And looking back on it, I realize that I didn’t follow Kubler-Ross or Bowlby; I circumnavigated this whole thing, jumping from theory to theory. And I never stayed in one stage long, with the exception of maybe Worden’s emotionally relocating. It was difficult for me to figure out how to take his legacy and move forward. Eventually I did, and I learned to appreciate what he did for me.

What you need to understand as the nurse is that regardless of the theory, people can go through stages at various speeds and jump between this principles.

As the nurse, you need to understand that there are several influences on how patients respond to, adapt and overcome grief.

Age is a big one. Most people, as they age, handle grief differently. Older patients tend to understand and accept death better than younger patients, so they may process it faster.

Some people have better coping mechanisms than others.

Socioeconomics play a huge factor in grief processing. If they lose someone or something, and they have all of these other financial or socioeconomic burdens, they may take longer to grieve their loss or losses.

Also, culture and ethnicity play a difference in how people process loss and grief. Some cultures celebrate life instead of grieving or they have their own way of processing loss that doesn’t fit the theories surrounding grief.

Spirituality is a huge player of grief and acceptance. Religious or spiritual beliefs influence grief heavily, with concepts of faith and hope being key players in providing comfort for those patients and families.

So how can we help our patients when they grieve?

First off, give support and find out what the family or the patient needs in that particular time. Sometimes, it’s a soda or maybe a snack or tissues. Just ask them how you can help. Be sure to use your therapeutic communication that you learned about in your other lesson. Also, promote and provide resources to your patient. Do they need chaplain or a grief counselor or some other healthcare provider? Ask them.

If it’s your patient who’s experiencing grief, be sure to also manage their symptoms. Don’t forget to still be their nurse and manage their illness, injury or disease. And be sure to maintain comfort for them. So blankets, pain medications if necessary. Stuff like that.

Most importantly – and I want to drive this home. Give a damn about your patient and family. There’s absolutely nothing worse than a nurse who is apathetic to a patient or family member when they grieve. Ask them how you can help. Sometimes they just want to hold your hand, or they want a hug or they want to be left alone. But ask them, and find out how you can help them.

Today, we’ve really focused on coping and grief for your patients and their family and also how you communicate with them.

Let’s recap:

Remember that grief varies and looks different for lots of people. It’s also influenced by lots of factors like age, culture and spirituality.

Grief is the emotional response to loss, and it doesn’t have to be about death.

People can change between stages and theories. People don’t always follow the same path or stages that others do, and they can bounce back between them.

Don’t be apathetic. Give a damn, and focus on supporting your patient in whatever stage of grief they are in.

And lastly, sometimes grief can be unhealthy, and some patients will need some additional help and resources. Be sure to check out the mental health lesson on grief for more information on unhealthy grieving.

That’s it for this lesson. Make sure you check out all the resources attached to this lesson. Now, go out and be your best selves today. And, as always, happy nursing!!

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Mental Health Prep

Concepts Covered:

  • Studying
  • Substance Abuse Disorders
  • Anxiety Disorders
  • Central Nervous System Disorders – Brain
  • Cognitive Disorders
  • Eating Disorders
  • Medication Administration
  • Depressive Disorders
  • Personality Disorders
  • Psychotic Disorders
  • Trauma-Stress Disorders
  • Bipolar Disorders
  • Developmental Considerations
  • Concepts of Mental Health
  • Health & Stress
  • Psychological Emergencies
  • Somatoform Disorders
  • Communication

Study Plan Lessons

08.01 Psychological Review for CCRN Review
Addiction – Behavioral Problems Nursing Mnemonic (The 5 D’s)
Albumin Lab Values
Alcohol Withdrawal (Addiction)
Alcohol Withdrawal Case Study (45 min)
Alcoholism – Outcomes Nursing Mnemonic (BAD)
Alprazolam (Xanax) Nursing Considerations
Altered Mental Status- Delirium and Dementia for Progressive Care Certified Nurse (PCCN)
Alzheimer – Diagnosis Nursing Mnemonic (The 5 A’s)
Ammonia (NH3) Lab Values
Anorexia – Signs and Symptoms Nursing Mnemonic (ANOREXIA)
Antianxiety Meds
Antianxiety Meds
Antidepressants
Antidepressants
Antipsychotics
Antipsychotics
Anxiety
Anxiety Disorders (PTSD, Anxiety, Panic Attack) for Certified Emergency Nursing (CEN)
Atypical Antipsychotics
Benzodiazepines
Benzodiazepines Nursing Mnemonic (Donuts and TLC)
Blood Urea Nitrogen (BUN) Lab Values
Bulimia – Signs and Symptoms 1 Nursing Mnemonic (BULIMIA)
Bulimia – Signs and Symptoms 2 Nursing Mnemonic (WASHED)
Buspirone (Buspar) Nursing Considerations
Calcium-Ca (Hypercalcemia, Hypocalcemia)
Carbamazepine (Tegretol) Nursing Considerations
Chloride-Cl (Hyperchloremia, Hypochloremia)
Chlorpromazine (Thorazine) Nursing Considerations
Cholesterol (Chol) Lab Values
Cognitive Impairment Disorders
Creatinine (Cr) Lab Values
Day in the Life of a Hospice, Palliative Care Nurse
Day in the Life of a Mental Health Nurse
Defense Mechanisms
Defense Mechanisms
Dementia Nursing Mnemonic (DEMENTIA)
Depression
Depression Assessment Nursing Mnemonic (SIGNS)
Depression Concept Map
Diazepam (Valium) Nursing Considerations
Disruptive Behaviors, Aggression, Violence for Progressive Care Certified Nurse (PCCN)
Dissociative Disorders
Divalproex (Depakote) Nursing Considerations
Eating Disorders (Anorexia Nervosa, Bulimia Nervosa)
Encephalopathy Case Study (45 min)
End of Life for Progressive Care Certified Nurse (PCCN)
End-of-Life and Palliative Care (Organ and Tissue Donation, Advance Directives, Care Withholding, Family Presence) for Certified Emergency Nursing (CEN)
Escitalopram (Lexapro) Nursing Considerations
Fluoxetine (Prozac) Nursing Considerations
Generalized Anxiety Disorder
Glomerular Filtration Rate (GFR)
Grief and Loss
Grief and Loss
Haloperidol (Haldol) Nursing Considerations
Handling Death and Dying
Head to Toe Nursing Assessment (Physical Exam)
Homicidal and Suicidal Ideation for Certified Emergency Nursing (CEN)
Hypochondriasis (Hypochondriac)
Lamotrigine (Lamictal) Nursing Considerations
Lithium (Lithonate) Nursing Considerations
Lithium Lab Values
Liver Function Tests
Lorazepam (Ativan) Nursing Considerations
Magnesium-Mg (Hypomagnesemia, Hypermagnesemia)
Manic Attack – Signs and Symptoms Nursing Mnemonic (DIG FAST)
MAO Inhibitors Nursing Mnemonic (TIPS)
MAOIs
Meds for Alzheimers
Mental Health Course Introduction
Metabolic Alkalosis
Methadone (Methadose) Nursing Considerations
Midazolam (Versed) Nursing Considerations
Mood Disorders (Bipolar, Depression) for Certified Emergency Nursing (CEN)
Mood Disorders (Bipolar)
Mood Stabilizers
Mood Stabilizers
Nurse-Patient Relationship
Nursing Care Plan (NCP) for Alcohol Withdrawal Syndrome / Delirium Tremens
Nursing Care Plan (NCP) for Alzheimer’s Disease
Nursing Care Plan (NCP) for Anxiety
Nursing Care Plan (NCP) for Depression
Nursing Care Plan (NCP) for Dissociative Disorders
Nursing Care Plan (NCP) for Eating Disorders (Anorexia Nervosa, Bulimia Nervosa, Binge-Eating Disorder)
Nursing Care Plan (NCP) for Mood Disorders (Major Depressive Disorder, Bipolar Disorder)
Nursing Care Plan (NCP) for Paranoid Disorders
Nursing Care Plan (NCP) for Personality Disorders
Nursing Care Plan (NCP) for Post-Traumatic Stress Disorder (PTSD)
Nursing Care Plan (NCP) for Schizophrenia
Nursing Care Plan (NCP) for Somatic Symptom Disorder (SSD)
Nursing Care Plan (NCP) for Suicidal Behavior Disorder
Nursing Case Study for (PTSD) Post Traumatic Stress Disorder
Nursing Case Study for Bipolar Disorder
Nursing Case Study for Mania (Manic Syndrome)
Olanzapine (Zyprexa) Nursing Considerations
Oxycodone (OxyContin) Nursing Considerations
Palliative Care for Progressive Care Certified Nurse (PCCN)
Paranoid Disorders
Paroxetine (Paxil) Nursing Considerations
Personality Disorders
Phases of Nurse-Client Relationship
Phosphorus-Phos
Post-Traumatic Stress Disorder (PTSD)
Postmortem Care
Potassium-K (Hyperkalemia, Hypokalemia)
Psychological Disorders (Anxiety, Depression) for Progressive Care Certified Nurse (PCCN)
Quetiapine (Seroquel) Nursing Considerations
Schizophrenia
Schizophrenia Case Study (45 min)
Self Concept
Senile Dementia – Assess for Changes Nursing Mnemonic (JAMCO)
Sertraline (Zoloft) Nursing Considerations
Sodium-Na (Hypernatremia, Hyponatremia)
Somatoform
Somatoform Disorder Case Study (30 min)
SSRI’s Nursing Mnemonic (Effective For Sadness, Panic, and Compulsions)
SSRIs
Substance Abuse (Alcohol, Drug Withdrawal) for Progressive Care Certified Nurse (PCCN)
Substance Abuse (Chronic Alcohol Abuse, Chronic Drug Abuse) for Progressive Care Certified Nurse (PCCN)
Substance Abuse (Drug-Seeking Behavior) for Progressive Care Certified Nurse (PCCN)
Suicidal Behavior
TCAs
Therapeutic Communication
Therapeutic Drug Levels (Digoxin, Lithium, Theophylline, Phenytoin)
Thought Disorders (Psychosis, Schizophrenia) for Certified Emergency Nursing (CEN)
Total Bilirubin (T. Billi) Lab Values
Types of Schizophrenia
Urinalysis (UA)
Vitamin B12 Lab Values