Loss, Grieving, Death

• Loss can be defined as an actual or potential situation in which something that is valued is changed or no longer available
• Types of loss include actual loss (recognized by others), perceived loss (experienced by one person but cannot be verified by others), and anticipatory loss (experienced before the loss actually occurs)
• Loss can be viewed as situational (e.g., losing a job, death of a child) or developmental (e.g., grown-up children leaving home)
• Sources of loss include loss of an aspect of oneself, loss of an object outside oneself, separation from accustomed environment, and loss of a loved or valued person
• Grief is the total response to the emotional experience related to loss
• Grieving permits the individual to cope with the loss gradually and accept it as part of reality
• Bereavement is the subjective response experienced by the surviving loved ones
• Mourning is the behavioral process through which grief is eventually resolved or altered
• Types of grief responses include anticipatory grief (experienced in advance of the event), disenfranchised grief (unable to acknowledge the loss to other people), and unhealthy grief (pathologic or complicated grief)
• Stages of grieving include denial, anger, bargaining, depression, and acceptance
• Nursing management involves assessment, diagnosing, planning, implementation, and evaluation
• Assessment includes awareness of both the patient and family members regarding the situation
• Diagnosing involves identifying nursing diagnoses appropriate for dying clients such as fear, hopelessness, powerlessness, and complicated grieving
• Planning major goals for dying clients include maintaining physiological and psychological comfort and achieving a dignified and peaceful death
• Implementation focuses on assisting the client to a peaceful death with respect and appropriate interventions
• Evaluation involves achieving client goals through open communication, physical help, and emotional and spiritual support
• Postmortem care includes caring for the body after death according to hospital policy and may be influenced by religious law
• Algor mortis refers to the coldness of death, rigor mortis to the stiffness of death, and livor mortis to the discoloration of death
• Stage of grieving that refuses to believe what is happening

  Denial
• anger


  Stage of grief that Client or family may direct anger at nurse or staff about matters that normally would not bother them
• stage of grief that seeks bargain to avoid lodd

  bargaining
• stage of grief that Grieves over what has happened and what cannot be

  depression
• stage of grief that comes to terms with loss

  acceptance
• Type of awareness that the client is not made aware of impending death.  

  Closed awareness
• type of awareness wherein the client, family, and health care personnel know   that the prognosis is terminal (but fail to acknowledge it?)

  Mutual pretense
• Type of awareness where the client and   others know about the impending death and feel   comfortable discussing it, even   though it is difficult

  open awareness