AUTUMN OF LIFE-A LAST GASP-LOSS, GRIEF AND END- OF- LIFE MASLOW'S HIERARCHY, ANTICIPATORY GRIEF, DIMENSION OF GRIEVING, GRIEF AWARENESS, Five Wishes, NEEDS OF DYING PERSONS AND SURVIVORS

19. ANTICIPATORY GRIEF

21. Some Individuals Experience A Process
Of Grief Known As Bereavement
 Feelings Of Sadness, Insomnia, Poor
Appetite, Deprivation.
 The Accumulation Of Loss Over Time
Can Lead To Bereavement Overload

22. GRIEF THEORY
 Dr. Kubler Ross Model Of Death And
Grieving
 Swiss Psychiatrists
 Analyzing Patterned Exhibited In The
Attitudes Of Terminally Ill Patients
 The Five Stage Are Response To Loss That
Many People Have But There Is No Typical
Response To Loss

24. DENIAL
A. During This Stage, The Person
Displays A Disbelief In The
Prognosis Of Inevitable Death.
B. Typical Responses Include: “No,
It Can’t Be True,” “It Isn’t
Possible,” And “No, Not Me.”

25. ANGER
 When Reality Sets In.
 Feelings Associated With This Stage Include
Sadness, Guilt, Shame, Helplessness, And
Hopelessness.
 Self-blame Or Blaming Of Others May Lead
To Feelings Of Anger Toward The Self And
Others.

26. BARGAINING
 Statements Such As “If I Promise To Take
My Medication, “If I Get Better, I’ii Never
Miss Church Again”
 The Dying Client Acknowledges His Or Her
Fate
 The Client Is Ready To Take Care Of
Unfinished Business,

27. DEPRESSION
The Individual Mourns For That Which Has Been
Or Will Be Lost. This Is A Very Painful Stage,
 Reactive Depression -Mourning A Change In
Body Image.
 Preparatory Depression- Feelings Associated
With An Impending Loss
 Regression, Withdrawal, And Social
Isolation May Be Observed

28. ACCEPTANCE
 At This Time, The Individual Has Worked Through
The Behaviours Associated With The Other Stages
And Accepts To The Loss.
 Anxiety Decreases
 The Client Is Less Preoccupied With What Has
Been Lost And Increasingly Interested In Other
Aspects Of The Environment.

29. DIMENSION OF
GRIEVING

30. COGNITIVE RESPONSES
1) Pre Occupation With The Deceased
• Having Conversation With The Deceased
• Picking Up The Telephone To Tell The Something
2) Difficulty Concentrating
• Complete Lapses Of Focus Or Orientation To
Time/Person/Place

31. 3) Difficulty Remembering (Short Term Memory)
4) Seeking Or Longing For The Lost Persons/
Objectives
5) Hallucination
–Mementary Glimpness Of The Deceased
–Auditory Messages Perceived To Be Spoken
By The Deceased.

32. EMOTIONAL RESPONSE
1.Anger, Sadness, And Anxiety Are The
Predominant Emotional Responses To Loss.
2.Common Reactions The Nurse Might Hear
Are As Follows:
 "He Should Have Stopped Smoking Years
Ago.“

33.  "If 1 Had Taken Her To The Doctor Earlier,
This Might Not Have Happened."
 "It Took You Too Long To Diagnose His
Illness.“
3. Guilt Over Things Not Done Or Said In The
Lost Relationship Is Another Painful Emotion.

35. BEHAVIOURAL RESPONSE
1) Inability To Perform Basic Activities Of Daily Living
 Washing And Dressing
 Communication
 Eating And Drinking
2) Disorganized Behaviour
 Inability To Cope With Children
 Neglecting Household Chores
 Not Paying Bills
 Not Doing Homework/Studying For Tests
3) Intense Sense Of Isolation.

36.  Weakness, Loss Of Appetite/Comfort Eating,
Feeling Of Choking, Shortness Of Breath,
Tightness In The Chest Dry Mouth,
Gastrointestinal Disturbances
 Increased Alcohol Intake, Smoking
Excessively

37.  Fatigue, Exhaustion And Insomnia
 Excessive Tearfulness/ Not Crying At All
 Increased Vulnerability To Physical And
Mental Illness

38. DELAYED OR INHIBITED
GRIEF
• Many times, cultural influences, such as the expectation
to keep a “stiff upper lip,” cause the delayed response.
• Delayed or inhibited grief is potentially pathological
because the person is simply not dealing with the reality
of the loss. He or she remains fixed in the denial stage of
the grief process, sometimes for many years.
• Overreaction to another person’s loss may be one
manifestation of delayed grief.

40. PRACTICAL TIPS FOR
CLILNET
 They Include Allowing Oneself To Experience Feelings
Of Pain,
 Anger,
 Sharing Personal Feelings With Others;
 Talking Out Loud To One’s Loved One To Release
Feelings;
 Maintaining Or Resuming A Daily Schedule Or
Routine To Avoid Feeling Overwhelmed;

41.  Avoiding The Use Of Alcoholic Beverages To Avoid
Feeling
 More Depressed; Sleeping, Eating, And Exercising
Regularly;
 Delaying The Making Of Any Major Decisions
Immediately
 After The Loss; And Asking For Help To Deal With A
Loss To Avoid Unresolved Or
 Dysfunctional Grief

42. PEOPLE CAN NOT STOP
GRIEVING

43. GRIEF AWARENESS

46.  Pain And Symptom Management
 Nutritional Counselling
 Physical, Occupational, And Speech Therapies
 Home Health Services For Personal Care
 Psychosocial Emotional Support
 Grief Counselling
 Crisis Care During Medical Emergencies

48. • Advance care planning is a thoughtful, facilitated discussion
that encompasses a lifetime of values, beliefs, and goals for
the client and family.
• Advance care planning often involves completion of an AD.
The two most common forms of ADs are the living will or the
health care directive
• document called Five Wishes enables all caretakers to know
and understand the desires of a dying client

49. Wish 1: STATE THE NAME OF THE PERSON YOU WANT TO
MAKE HEALTH CARE DECISIONS. WHEN YOU CAN’T MAKE
THE DECISIONS YOURSELF.ABOUT
 MEDICAL TESTS,
 TREATMENTS,
 SURGERY,
 ADMISSION TO A HOSPITAL,
 HOSPICE & NURSING HOME

50. Wish 2: Describe the kind of medical
treatment you want or don’t want.
 Choices Are Listed For Clinical Situations Such
As A Coma, Near-death Situation, Permanent
And Severe Brain Damage Without Recovery,
Or Any Other Condition Under Which The
Client Does Not Wish To Be Kept Alive

51. Wish 3 : State How Comfortable You
Want To Be. Several Choices Are
Given Regarding Activities Of Daily
Living, Pain Management, And
Relaxation Techniques Or
Interventions.

52. Wish 4: Describe How You Want People To
Treat You. This Wish Addresses The Spiritual
Needs Of The Client During The Dying
Process, Such As
 Having Someone Present At Bedside,
 Having Prayers Said At A Vigil Or In Church,
 Having Visits From A One’s Spiritual
Advisor,
 Expressing The Desire Whether To Die At
Home Or In The Hospital.

53. Wish 5: Explain What You Would Like
Your Loved Ones To Know. This Wish
Addresses How The Client Wants To Be
Remembered And Gives Him Or Her
The Opportunity To Relay Funeral And
Memorial Wishes

54.  Refers To A Program That Supports The Client And Family
Through The Dying Process And The Surviving Family
Members Through The Process Of Bereavement.
 It Is Based On A Biopsychosocial Model Rather Than A
Disease Model Of Care
 The Essential Philosophy Of Hospice Care Is The Focus On
Comfort, Dignity, And Personal Growth At Life’s End.

55.  Is Available To Family Members Who Provide
Care To Hospice Clients At Home.
 It Allows For A Client To Be Admitted To An
Inpatient Hospice Facility For A Brief Period
Of Time So That Family Members Are Able To
Rest And Attend To Other Pressing Concerns.

56. 1.BEHAVIORAL:
o AVOIDANCE,
o CONTROLLING,
o DISTANCING
2.EMOTIONAL:
ANGER, ANXIETY, DEPRESSION, EMOTIONAL OUTBURSTS,
FRUSTRATION, GUILT, SARCASM, EMOTIONAL
WITHDRAWAL FROM FAMILY OR FRIENDS

57. 3.PHYSICAL
 Fatigue, fluctuation In Vital Signs,
 Impaired Sleep,
 Impaired Mental Processes Such As Confusion Or
Delirium,
 Persistent Physical Symptoms Such As Pain, Weight
Gain, Or Weight Loss Spiritual:
 Verbalization Of A Sense Of Hopelessness,
Emptiness, Or Meaninglessness

58. NEEDS OF DYING PERSONS AND
SURVIVORS
DYING PERSONS NEEDS SURVIVORS NEEDS
Vent Anger And Frustration Provide A Quality Of Life For
The Dying Person While
Preparing For A Life Without
That Loved One
Share The Knowledge That
The End Is Near
Be Available To Offer Comfort
And Care Even Though The
Survivor Feels Like Running
Away To Escape The Pain Of
Death

59. Ensure The Well-being Of
Loved Ones Who Will Be
Left Behind, Because The
Person Resents The Fact
That Life Will Go On
Without Him Or Her
Hope That The Loved One Will
Somehow Live In Spite Of
Obvious Deterioration And
Inability To Function. At This
Time, The Survivor May Pray
For The Peace Of Death
Vent Feelings Or Irritation At
Omissions Or Neglect,
Although The Person Feels
Guilty Over The Pain This
Causes
Vent Feelings Or Irritation And
Guilt Over The Dying Person’s
Demands And Increased
Dependency Needs

60. Remain as independent as
possible, fearing he or she
will become unlovable
Live and appreciate each day
as one plans for a future
without the loved one
Be normal and natural at a time
when nothing appears to be
normal or natural. The dying
client generally experiences the
fears of pain, loss of control,
and dying alone. The client has
a need to maintain security,
self-confi dence, and dignity
Reassure the dying person that
the survivor will “continue in
his or her footsteps” by holding
the family together, raising the
children, or managing the
business, while knowing that
such talk about the future is
painful to the dying client

61. END OF LIFE CARE

65.  Understanding That Grieving Has No
Time Limits, There Is No Right Way To
Grieve
 Track To These Around You Who/One
You
 Journal
 Take Time Alone If Needed.

66. Take A Day At A Time
Try Not To Hide From Your Emotions
If Your Sad Be Sad,
If Your Happy Be Happy
Ask For Help
•Family, Teachers, Friends And
Counselling Are All Here To Assist
You

67. ASPECTS OF CARE FOR

68. PHASE-1 SYTOMPS
Emotion or attitude Nurse intervention
SHOCK- HELP REFOCUS ON PRESENT
FEAR PROVIDE PRESENCE
DISBELIEF SUSPEND JUDGMENT
CURIOSITY BE WATCHFULLY AWARE
HOPE OFFER WEBSITE INFORMATION

69. PHASE-2 WAITING
Emotion or attitude Nurse intervention
ANXIETY- TREAT ANXIETY AS NEEDED
WORRY- FOCUS ON WHAT PATIENT CAN
CONTROL
HOPE- HELP DEAL WITH UNCERTAINTY
FEAR PROVIDE DISTRACTION
RELIEF EDUCATE CELEBRATE

70. PHASE-3 RESOLUTION OF THREAT
Emotion or attitude Nurse intervention
DETERMINATION TO
FIGHT
GIVE INFORMATION ABOUT
THE DISEASE AND TREATMENT
FEAR PROVIDE PRESENCE
DENIAL ASK ABOUT ADVANCE
PLANNING

71. HOPEFULNESS HELP BALANCE HOPE WITH
PRAGMATISM
HOPELESSNESS DISCUSS OPTIONS AND
CHOICES
ANGER EXPLORE EXPRESSIONS OF
ANGER WITH PATIENT AND
FAMILY

72. EMOTION OR ATTITUDE NURSE
INTERVENTION
DEPRESSION ASSESS FOR DEPRESSION
NOT BEING IN CONTROL HELP PATIENT MAINTAIN SOME
CONTROL OVER SITUATION.
GUILT OFFER SPIRITUAL ADVISOR

73. EMOTION OR
ATTITUDE
NURSE INTERVENTION
FEELING MORE IN CONTROL ANSWER QUESTIONS HONESTLY
COURAGE GIVE POSITIVE FEEDBACK FOR
COPING SKILLS
HOPE FOR CURE TEACH ABOUT LAB VALUES AND
THEIR SIGNIFICANCE
FAITH ASK ABOUT SPIRITUAL BELIEF
DISCOURAGEMENT REMAIN CAUTIOUSLY OPTIMISTIC,
OFFER TO HELP PATIENT DECORATE
ROOM
DEPRESSION TREAT DEPRESSION, KEEP WINDOW
BLINDS OPEN

74. PHASE-5 DYING PROCESS
EMOTION OR
ATTITUDE
NURSE INTERVENTION
DENIAL INTRODUCE ‘WHAT IF’ IDEAS
ANTICIPATORY GRIEF BEGIN LIFE REVIEW
ANGER ADDRESS ANGER, INQUIRE ABOUT
FAMILY AND SOCIAL SUPPORT,
REFRAME HOPE
ACCEPTANCE GENTLY TEACH ABOUT DNR
ORDER AND NO ICU OPTION,
DISCUSS HOSPICE AND DYING AT
HOME OPTION/CHOICS

75. Appreciation of comfort offer palliative measures
and relieve bothersome
symptoms
Hope for a good death explain to patient and
family what to expect in
the final days and
moments

79. Go with loved one dying
GO WITH LOVED ONE DYING