The document provides information on coping with loss, death, and grieving. It defines key terms like loss, grief, death, and coping. It discusses the various types of loss and grief, as well as the stages of grief. It also covers death and dying, including definitions of terms like advance directives and palliative care. Palliative care aims to relieve suffering and improve quality of life, while hospice care supports those in the last six months of life. The document provides nursing implications for supporting those coping with loss, death, and grieving.

1. COPING WITH LOSS,
DEATH & GRIEVING
JUHIN J
1ST YEAR MSC-NURSING

3. OBJECTIVES
At the end of this session, you will be able to get clear understanding about;
• Loss– Introduction.
• List down the types of loss
• Grief – Introduction
• Enumerate the symptoms of grief
• Classify the types of grief
• List down the factors influencing loss and grief
• Explain the stages of grief
• Death and dying – Introduction
• Explain in detail about trajectory model
• Explain end of life care in detail
• Enumerate amyotrophic lateral sclerosis
• Describe the process of coping with loss, death and grief
• Enumerate care of care giver

4. INTRODUCTION
▪ Death is inevitable, loss of a close
friend or family member always
shower us with a range of emotions.
▪ Grieving for loved one helps us cope
and heal.
▪ Without a doubt, grieving is painful,
but it is also necessary.
▪ Going forward doesn’t meant
forgetting about the loved one who
died.
▪ It simply means that your grief has
run its course.

5. DEFINITIONS
A situation in which a valued
object or person is no longer
perceived as valuable
Loss
Normal, appropriate emotional
response to an external and
consciously recognized loss.
Grief
Cessation of all vital functions
of the body including heart,
brain activity and breathing.
Death
Adaptive or successful method of dealing
with individual or environmental
situations that involve psychological or
physiological stree or threat.
Coping

6. LOSS
● Loss is a part of life cycle.
● Everyone experience loss in
the form of change, growth
and transition.
● The experience of loss is
painful, frightening and lonely.
● It triggers a set of emotional
responses.

7. TYPES OF LOSSES
Necessary Loss
• Natural & Integral part
of each person’s life.
• Eg: Growing up process
Actual Loss
• Any loss of a person or
object
• Eg: Loss of child
Perceived Loss
• Any loss that is uniquely
defined, may be less obvious
to others, easily
misunderstood.
• Eg: Loss of confidence
Maturational Loss
• Any change in developmental
process that is normally
expected during a life time.
• Eg : Normal life transition.

8. TYPES OF LOSSES
Situational Loss
• Any sudden, un predictable external event.
• This loss includes multiple loss rather than a single loss.
• Eg: Automobile accident that leaves a driver paralyzed, unable to
return to work and grieving over the loss of passenger in accident.
Loss of external
objects
• Grieving depends on
object’s value,
sentiment attached to
it and its usefullness.
Loss of known
environment
• Loss occurs through maturational
or situational event.
• Loneliness or new unfamiliar
setting threatens self esteem and
makes grieving difficult.
• Eg: Moving from a neighbourhood
Cont.

9. TYPES OF LOSSES
Loss of an aspect of Life
• Illness, injury or developmental changes result in
loss of aspect of self.
• Eg: Loss of body part
Loss of Life
• Creates grief for those left behind.
• Person facing death often fears pain, loss of
control & dependency on others.
• Eg: Death of friend
Own death
Cont.

10. GRIEF
● Grief is an emotional response
to a loss.
● People grieve in different ways
and there is no time limit for
completing the grieving
process.
● Mourning – Psychological
process, an individual passes
on to successful adaptation to
the loss of a valued object.
● Bereavement – the inner
feeling and outward reactions
of survivor.

11. GOALS OF GRIEVING PROCESS
Healing the self Recovering from the loss

12. SYMPTOMS OF GRIEF
Anger
Even if the loss was
nobody’s fault, we may
feel irritated
Fear
May feel anxious, helpless
or insecure
Physical Symptoms
Fatigue, nausea, lowered
immunity, weight loss/
gain, pain, insomnia
Shock & disbelief
Have trouble in believing that
the loss really happened or
even deny the truth
Sadness
Have feelings of
emptiness, yearning or
deep loneliness
Guilt
may feel guilt about things
we did or didn’t say or do.

13. TYPES OF GRIEF
Normal grief
Consists of normal
feelings, behaviours and
reaction to a loss.
Anticipatory grief
Process of disengaging or
“letting go” before an actual
death.
Complicated grief
Bereavement appears to go
wrong and loss never
resolves
Disenfranchised grief
Experiences grief for a loss which
cannot be shared publicly.

14. FACTORS INFLUENCING LOSS & GRIEF
● Human development
● Psychological perspectives of loss and grief
● Socio- economic status
● Personal relationships
● Nature of loss
● Culture and ethnicity
● Spiritual beliefs

15. STAGES OF GRIEF
● Shock
● Denial
● Anger
● Bargaining
● Depression
● Testing
● Acceptance

16. Shock
● May provide an emotional buffer and can protect an individual from
being overwhelmed all at once.
Denial
● May feel like the world around is meaningless and the life may make
no sense.
● It is a natural way of dealing with only what can be handled.
Anger
● May be directed at things or person that was lost, doctors, friends,
family, God, etc.
● It is a necessary stage of healing process.

17. Bargaining
● This is the step where one may think, “If this ____, then this ____”.
● It may come in a form of “what if” statements.
Depression
● Empty feelings come forward and one’s grief moves in a deep level
than before.
● This type of depression is not a sign of mental illness, although
reaching out for help maybe the right step.

18. Testing
● This is the process of rebuilding the life in the new setting.
● Individual may require further resources during this stage as they
are trying out what works for their new way of life.
Acceptance
● Accepting that, this is their new reality and it is permanent.
● Without acceptance life cannot go on.

19. NURSING IMPLICATIONS
Nurses should help the patient in
● Acceptance of the loss
● Acknowledgement of the
intensity of pain
● Adaptation of life after loss
● Cultivation of new relationships
and activities.

20. CARE OF BEREAVED
● Have contact physically and emotionally with the person.
● Assess when the person is in grieving process.
● Allow the person to grieve and normalize the grieving process.
● Encourage the person to talk about the relationship he/she had with the
deceased person.
● Tell the person to expect mood swings, pain and various life changes.
● Allow the person to take a break and focus on self care.
● Encourage sources of comfort such as religion or nature.
● Encourage medical or psychiatric care as needed.

21. DEATH & DYING
● Death means end of life.
● It means cessation of all vital
functions of the body
including heart, brain activity
and breathing.

22. DEFINITIONS
Legal order that tells a
health care team that patient
does not want to be intubated in
life threatening situations
DNI - Do Not Intubate
Removal of tubings to provide a
peaceful death. Eg: Ventilator
De- Escalation
DNR – Do Not Resuscitate
Legal order that tells a
health care team that patient
does not want CPR in life
threatening situations

23. DEFINITIONS
When the patient discharges himself from the
hospital, but the discharge has not been authorized by the
treating doctor
DAMA – Discharge Against Medical Advice
When the patient leaves the hospital
against the advice of Doctor, without informing or
may walk out of the ward
LAMA – Left Against Medical Advice

24. TRAJECTORY MODEL
● Nursing model, applicable in
situations on people with chronic
diseases.
● Developed by Anselm L Straus and
Juliet Corbin.
● This model is used to find the
actions taken by patient, families
and health care workers to manage
the course of disease.

25. STAGES OF COURSE OF DISEASE
● Initial or Pre trajectory phase
● Trajectory onset phase
● Crisis phase
● Actual phase
● Stable phase
● Unstable phase
● Downward phase
● Dying phase ●McCorcle & Pasacreta
●2001

26. NURSING PROCESS IN
TRAJECTORY MODEL
● Identify the trajectory phase
● Identify problems and establish goals
● Identify factors that facilitate attainment of goals
● Implement interventions
● Evaluate the effectiveness of interventions
(Corbin and Straus)

27. END OF LIFE CARE
Nursing care given to patient
and their family members during the
final weeks of life when death is
imminent.

28. GOALS OF END OF LIFE CARE
● Prevent or relieve suffering
● Provide comfort and support
● Maintain human dignity
● Respect patient wishes and desires
● Improve quality of life
● Provide emotional support

29. ASPECTS OF END OF LIFE CARE
Advance Directives Palliative Care
Hospice Care Preparation at the
end of life care

30. 1. ADVANCE DIRECTIVES
● Living Will
● Durable health care power of attorney
Patient Self Determination Act (PSDA) in 1990

31. 2. PALLIATIVE CARE
• Palliative care is active total care of the clients whose disease is
not responsive to curative treatment.
• The goal is not to give cure to the disease condition, but to
reduce pain and side effects and to improve the quality of life.

32. 2.1 PRINCIPLES OF PALLIATIVE CARE
• Respect likes & dislikes, goals and choices of dying person.
• Offer a support system to help patients live as actively as possible
until death.
• Concerned with healing rather than curing.
• Provide relief from pain and other distressing symptoms
• Accepting death but also life enhancing.
• Offer support system to help the family to cope during the patient’s
illness and in their own bereavement.

33. 2.2 PALLIATIVE CARE TEAM
• Doctor
• Nurses
• Dietician
• Spiritual advisor
• Physiotherapist
• Social worker
• Grief and bereavement coordinator

34. 2.3 PALLIATIVE CARE SETTINGS
• Hospital setting
• Home care setting

35. 3. HOSPICE CARE
● Criteria for hospice care
Hospice care refers to a
program that supports the client and
family through the dying process and
family members through the process of
bereavement, traditionally limited to
last six months of life.

36. 4. PREPARATION AT THE END OF
LIFE CARE
• Grieving loss
• Getting affairs in order
• Religion & Spirituality

37. AMYOTROPHIC LATERAL
SCLEROSIS (ALS)
● Signs and symptoms
● Causes
● Risk factors
● Diagnostic methods
● Management of ALS
● Complications
● Recent researches
Rare neurological
disease, affects nerve cells in
brain & spinal cord, responsible
for controlling voluntary muscle
movement, causing loss of
muscle control in chewing,
waling, talking, breathing, etc.

38. CLINICAL MANIFESTATION AT THE END
OF LIFE
• Sensory system
• Integumentary system
• Respiratory system
• Urinary system
• Gastrointestinal system
• Musculoskeletal system
• Cardiovascular system
• Psychosocial manifestations

39. NURSING IMPLICATIONS
Nurses should help the patient in
● Providing comfort
● Maintaining safety
● Addressing physical and
emotional needs
● Reducing pain
● Preventing dehydration
● Preventing skin breakdown
● Care of anorexia, nausea &
vomiting

40. COPING WITH LOSS, DEATH & GRIEF
• Seek out caring people
• Express your feelings
• Take care of your health
• Accept that life is for living
• Postpone major life changes
• Be patient
• Draw comfort from your faith
• Seek outside help when
necessary

41. CARE OF CARE GIVER
● Allow them to share the sorrow
● Don’t offer false comfort
● Offer practical help
● Be patient
● Encourage professional help when necessary

42. ANY DOUBTS??

43. SUMMARY

44. ASSIGNMENT
DIFFERENCE BETWEEN PALLIATIVE CARE AND HOSPICE CARE

45. REFERENCES
Book:
Shebeer. P. Basheer , S. Yaseen Khan.(2013).A Concise Text Book of Advanced Nursing Practice . P.638-643
Journals:
The Journals of Gerontology, Series B, Vol 57, Issue 1, 2002, P. S33- S42
Internet:
https://www.ncbi.nlm.nih.gov/books/NBK518989/
https://www.medicinenet.com/script/main/art.asp?articlekey=83860
https://www.apa.org/topics/grief
https://www.nursingpath.in/2013/04/trajectory-model.html
https://medical-dictionary.thefreedictionary.com/de-escalate
https://slideplayer.com/slide/10731022/
https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Amyotrophic-Lateral-
Sclerosis-ALS-Fact-Sheet

46. THANK YOU
EVERYONE

47. THANK YOU
EVERYONE