Coping with loss, grief and death

• Loss


  A situation where a valued object, person, or the like is no longer perceived as valuable
• Bereavement


  The subjective response to a loss through the death of a person with whom there has been a significant relationship
• Grief


  The response to the emotional experience of the loss and is manifested in thoughts, feelings, and behavior
• Mourning


  The behavioral process through which grief is resolved, often influenced by culture and custom
• Religious beliefs and practices

  • Mourning for 9 days
  • Vigils
  • Last rites: Sarcraments (Annointing of the sick)
  • Baptism before death
  • Rosary throughout the day
  • Wakes
• Symbolism


  • The cross
  • Images of Saints
  • The Rosary
  • Wearing black or white

  
• Infants and toddlers (0-2 years)

  • Probably don't understand that someone is dying or has died
  • Acutely sensitive to any changes or disruptions in their environment and routine
  • Feel comforted and secure when normal routines are continued as much as possible and they are cared for with sensitivity
  • Although they probably have few or no memories of the person who has died, a bond can be nurtured as infants and toddlers age and grow by telling stories about the person, sharing photos or videos, and describing the relationship the child was too young to remember
• Developmental concept of death

  • 3 to 4 years: Does not understand the concept of death, believes death is reversible, a temporary departure or sleep, understands death is final, believes own death can be avoided, associates death with aggression or violence
  • 5-9 years: Understands death as the inevitable (unavoidable) end of life, begins to understand own mortality (temporality)
  • 9-12 years: Fears of lingering (slow to end) death, may fantasize that death can be defied (escaped), acting out defiance through reckless behavior, views death in religious and philosophic terms (afterlife, reincarnation, etc.)
  • 12-18 years: Has increased attitude or awareness towards death that is influenced by religious and cultural beliefs
  • 18-45 years: Accepts own mortality, encounters death of parents and some peers, experiences peak of death anxiety
  • 45-65 years: Fears prolonged illness, encounters death of family members and peers, sees death as having multiple meanings (e.g. freedom from pain, reunion with already deceased family members)
  • 65 years above
• Kubler-Ross stages of grieving

  • Denial
  • Anger
  • Bargaining
  • Depression
  • Acceptance
• Martocchio's five cluster of grief


  • Shock and disbelief
  • Yearning and protest
  • Anguish, disorientation and despair
  • Identification in bereavement
  • Reorganization and restitution
• Symptoms of grief


  • Repeated somatic distress
  • Tightness in the chest
  • Choking or shortness of breath
  • Sighing
  • Empty feeling in the abdomen
  • Loss of muscular power
  • Intense subjective distress
• Assisting clients with their grief


  1. Provide an opportunity for the persons to "tell their story"

  2. Recognize and accept the varied emotions that people express about a significant loss

  3. Provide support for the expression of difficult feelings, such as anger and sadness

  4. Include children in their grieving process

  5. Encourage the bereaved to maintain established relationships

  6. Acknowledge the usefulness of mutual-help groups

  7. Encourage self-care by family members particularly, the primary caregivers

  8. Acknowledge the usefulness of counseling for especially difficult problems
• Signs of impending clinical death

  • Loss of muscle tone
  • Slowing circulation (diminished sensation, mottling and cyanosis of the extremities, cold skin)
  • Changes in vital signs (decelerated and weaker pulse, decreased blood pressure, rapid, shallow irregular, or abnormally slow respirations)
  • Sensory impairment (blurred vision, impaired sense of taste and smell)
• Indications of death


  • Total lack of response to external stimuli
  • No muscular movement
  • No reflexes
  • Flat encephalogram (EEG- electrical activity of the brain)
  • No electrical activity of the heart (ECG)
• Nursing diagnoses for dying clients

  • Fear related to knowledge deficit, lack of social support in threatening situations
  • Hopelessness related to prolonged restriction of activity resulting in isolation, deteriorating physiologic condition
  • Powerlessness related to terminal illness, chronic disease
• Nursing interventions for the dying client

  1. Assist the client achieve a dignified and peaceful death

  2. Maintain physiologic and psychologic comfort (personal hygiene, pain control, relief of respiratory difficulties, assistance with movement, nutrition, hydration, and elimination, measures related to sensory changes)

  3. Provide spiritual support (search for meaning, sense of forgiveness, need for love, need for hope)
• The dying person's bill of rights

  • I have the right to be treated as a living human being until I die
  • I have the right to maintain a sense of hopefulness however changing its focus may be
  • I have the right to be cared for by those who can maintain a sense of hopefulness, however changing this might be
  • I have the right to express my feelings and emotions about my approaching death in my way
  • I have the right to participate in decisions concerning my care
  • I have the right to expect continuing medical and nursing attention even though "cure" goals must be changed to "comfort" goals
  • I have the right not to die alone
  • I have the right to be free from pain
  • I have the right to have my questions answered honestly
  • I have the right not to be deceived
  • I have the right to have help from and for my family in accepting my death
  • I have the right to die in peace and dignity
  • I have the right to retain my individuality and not be judged for my decisions which may be contrary to the beliefs of others
  • I have the right to discuss and engage my religious and/or spiritual experiences, whatever these may mean to others
  • I have the right to expect that the sanctity of the human body will be respected after death
  • I have the right to be cared for by caring, sensitive, knowledgeable people who will attempt to understand my needs and will be able to gain some satisfaction in helping me face my death
• 5 signs of irreversible death

  • Decapitation
  • Decomposition
  • Postmortem lividity
  • Post-mortem rigidity
  • Burned beyond recognition
• Stages of death


  • Pallor mortis
  • Algor mortis
  • Livor mortis
  • Rigor mortis