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Grief and Loss Psych Chap12


- Tie everything together Grief and Loss Psych Chap12 Linda L. Franco RN, MSN NE-BC * * * * * * * * * * * * * Be supportive. * * * * * * Holding the baby may help ... – PowerPoint PPT presentation

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Title: Grief and Loss Psych Chap12

Grief and LossPsych Chap12
- Tie everything together
  • Linda L. Franco RN, MSN NE-BC

Definitions of Grief, pg 216
  • Grief - subjective emotions and affect that are a
    normal response to loss
  • Grieving/bereavement- process of experiencing
  • Anticipatory grief - facing imminent loss
  • Mourning - outward sign of grief

  • Perinatal loss is death of a fetus or infant from
    the time of conception through the end
  • of the newborn period 28 days after birth.
    Intrauterine fetal death (IUFD) after 20 weeks
  • gestation is often referred to as stillbirth or
    fetal demise.
  • Common causes of perinatal loss the incidence
    of fetal death after 20 weeks in the
  • United States is 6.8 per 1000 total births,
    accounting for 50 of all perinatal deaths
  • (Magann, Chauhan, Bofill, 2002). Over 80 of
    stillbirths occur before term, with more
  • than 50 occurring before 28 weeks gestation
    (Cunningham, 2001). Factors associated
  • with perinatal loss can be fetal factors,
    maternal factors or placental /other (cord
  • twins from assisted fertility technology,
    amniocentesis, genetic testing, etc) factors. May
  • be unknown or related to preeclampsia,
    eclampsia, abruptio placentae, placenta previa,
  • diabetes, congenital anomalies, renal disease,
    cord accidents, fetal growth restriction,
  • and alloimmunization.

  • Grief and loss are essential in life
    relinquishing and moving on happen as we grow and
  • Grief and loss are uncomfortable

Types of Losses, pg 216
  • Can be planned, expected, or sudden
  • Physiologic (loss of limb)
  • Safety (domestic violence, posttraumatic stress
    disorder, breach of confidentiality)
  • Security/sense of belonging (relationship loss
    death, divorce)
  • Self-esteem (ability to work, children leaving
  • Self-actualization (loss of personal goals, such
    as not going to college, never becoming an artist
    or a dancer)

Theories of the Grieving Processall pretty
  • Kuber Rosss 5 stages of grieving
  • Bowlbys 4 phases of grieving
  • John Harveys 3 phases of grieving
  • Rodebaughs 4 stages of grieving
  • Similarities among theorists
  • Not all clients follow predictable steps or make
    steady progress

Kubler-Rosss 5 stages of grieving
  • Denial (shock and disbelief)- may ask for 2nd
  • Anger (toward God, relatives, healthcare
  • Bargaining (trying to get more time, prolonging
    the inevitable loss)- bargain w/ God
  • Depression (awareness of the loss becomes acute)-
    weeping and withdraw, changing H levels may
    compound the stage.
  • Acceptance (person comes to terms with impending
    death or loss)- can take months to yrs

  • Denial Even when the initial healthcare
    provider suspects fetal demise,
  • the couple is hoping a second opinion may be
  • Anger results from feelings of loss,
    loneliness, and perhaps guilt. The
  • mother may attempt to identify a specific event
    that caused the death
  • and may blame herself.
  • Bargaining More common when the death is
    anticipated. It is marked
  • by the couple making mental trade-offs in
    exchange for the fetus being
  • healthy.
  • Depression Evidenced by preoccupation, weeping,
    and withdrawal.
  • Changing hormonal levels in the first 24 to 48
    hours after birth may
  • compound the depression and associated grief.
  • Acceptance Occurs when resolution occurs. This
    stage is highly
  • individualized and may take months to years to

Bowlbys 4 phases of grieving
  • Numbness and denial of the loss
  • Emotional yearning for lost loved one and
    protesting permanence of loss
  • Cognitive disorganization and emotional despair
  • Reorganizing and reintegrating sense of self

John Harveys 3 phases of grieving
  • Shock, outcry, and denial
  • Intrusion of thoughts, distractions, and
    obsessive reviewing of loss
  • Confiding in others to emote and cognitively

Rodebaughs 4 stages of grieving
  • Reeling
  • Feelings
  • Dealing
  • Healing

Tasks of the Grieving Process
  • Undoing psychosocial bonds to loved one and
    eventually creating new ties
  • Adding new roles, skills, and behaviors
  • Pursuing a healthy lifestyle
  • Integrating the loss into life

Cultural Considerations
  • All cultures grieve
  • Rituals and habits surrounding death vary among
  • Expression of sadness expressed
  • Time mourning should last
  • Many rituals have roots in religion
  • Nurses should be sensitive to cultural

African Americans
  • Typically view the body in church
  • Hymns, poetry, eulogies
  • Public prayer
  • Wearing black clothing
  • Decreasing social activities

Muslim Americans
  • Muslims do not permit cremation
  • Follow 5 steps of burial procedure
  • Haitian Americans
  • Practice vodun or calling on spirits
  • to make peace

Chinese Americans
  • Strict norms for announcing death,
  • preparing the body, arranging the funeral
  • and burial
  • Burning incense and reading scripture
  • assist the spirit of the deceased on his or
  • her journey

Japanese Americans
  • Buddhists view death as a life passage
  • Bathing and purification rites are
  • performed
  • Friends and family visit, bringing gifts or
  • money
  • Prayers are said
  • Incense is burned

Filipino Americans
  • Often Catholic
  • Wear armbands or black clothing
  • Place wreaths on casket
  • Black banner on the deceaseds home
  • Prayers and blessings for the soul of the
  • deceased

Vietnamese Americans
  • Predominately Buddhist
  • Deceased bathed and dressed in black
  • Rice and money sent with the deceased
  • View the body before burial at home

Hispanic Americans
  • Predominately Catholic
  • Pray for the soul during a rosary
  • Mourning may involve wearing black
  • and decreasing social activities
  • A wake in the home may be held

Native Americans
  • Variety of practices depending on religious
  • beliefs and practices of different tribes
  • Death seen as a state of unconditional love
  • Believe deceased is going on a journey
  • Celebrations may include a ghost meal
  • Mourners encouraged to be happy for the
  • person

Orthodox Jewish Americans
  • Leaving a dying person alone is a sign
  • of disrespect
  • Burial must occur within 24 hours unless
  • delayed by the Sabbath
  • Body should be untouched until rites
  • can be performed by family, rabbi, or
  • Jewish undertaker

Disenfranchised Grief
  • Grief over a loss that is not or cannot be openly
    acknowledged, mourned publicly, or supported
  • A relationship has no legitimacy lovers,
    same-sex relationships
  • The loss itself is not recognized - prenatal
    death, abortion, pet, job
  • The griever is not recognized - older adults,
    children, nurses

Complicated Grieving
  • Response that lies outside the norm of grieving
    in terms of extended periods of grieving
    responses that seem out of proportion or
    responses that are void of emotion

Vulnerable to complicated grieving
  • Low self-esteem
  • Low trust in others
  • A previous psychiatric disorder
  • Previous suicide threats or attempts
  • Absent or unhelpful family members
  • An ambivalent, dependent, or insecure attachment
    to the deceased person

Increased risk for complicated grieving, b/c
they are such a lrg part of their life
  • Death of a spouse or child
  • Death of a parent (particularly in early
    childhood or adolescence)
  • Sudden, unexpected, and untimely death
  • Multiple deaths
  • Death by suicide or murder

Complicated Grieving
  • Physical reactions can include
  • Impaired immune system (due to the stress)
  • Increased adrenocortical activity
  • Increased levels of serum prolactin and growth
  • Psychosomatic disorders
  • Increased mortality from heart disease (can
    become at risk themselves)
  • Emotional responses can include
  • Depression
  • Anxiety or panic disorders
  • Delayed or inhibited grief
  • Chronic grief

Potential Nursing Diagnoses
  • Grieving
  • Anticipatory grieving
  • Dysfunctional grieving

Nurses Role
  • Recognition of signs of grief
  • Support client
  • Therapeutic communication
  • Promote the expression and release of emotional
    and physical pain
  • Encourage effective use of grieving behaviors
    Praying, staying with body, rituals, memorial

Communication and interpersonal skills to assist
  • Use simple, nonjudgmental statements
  • Refer to a loved one by name
  • Appropriate use of touch
  • Respect clients process of grieving and
    personal beliefs
  • Be honest, dependable, consistent, and worthy of
    clients trust
  • Offer a welcoming smile and eye contact

Perinatal Loss
  • A child that loses a parent is an orphan,
  • A man who loses his wife is a widower, a woman
    who loses her husband is a widow,
  • However, there is no name for a parent that loses
    a child, for there is no word to describe such

  • Perinatal loss Death of a fetus or infant from
    the time of conception through the end of the
    newborn period of 28 days after delivery.
  • IUFD intrauterine fetal death after 20 weeks
    often referred to as stillborn or fetal demise.

Common Causes of Perinatal Loss
  • Fetal Factors
  • Maternal factors
  • Placental factors
  • Unknown

The Bereaved Familys Bill of Rights
  • You have the right to expect your grief to be
    acknowledged in a professional and compassionate
  • You have the right to be an educated consumer, to
    have all the requirements and options explained
    to you.
  • You have the right to ask all the questions and
    receive honest answers.
  • You have the right to express your needs,
    emotional, religious, and spiritual, and have the
    funeral director listen and facilitate your
    requests accordingly.
  • You have the right to plan a meaningful funeral
    ritual, tailored to your beliefs, customs, and

Rights of the Infant
  • To be recognized as a person who was born and has
  • To be named.
  • To be seen, touched, and held by the family.
  • To have the end of life acknowledged.
  • To be put to rest with dignity.

Nurses are a Powerful Influence!!!
  • We encounter families experiencing loss in many
  • Inpatient - antepartum, L D, postpartum,
  • nursery, NICU, emergency rooms,
  • med/surg recovery care
  • Outpatient clinics, offices, infertility,
    OB/GYN, family practice, pediatrician

Death of Dreams
  • It does not matter how long the pregnancy lasted,
    it is still a loss of the personhood of that
  • 6 weeks, 6 months, 6 days it was a child, it
    was a hope, it was a dream not fulfilled

Confirmation of Death
  • Many times mom notices a decrease or stoppage of
    fetal movement.
  • No heart tones
  • No cardiac activity on US
  • Will have drop of estriol levels in the blood

Responding to Grieving Families
  • Remember the 3 Hs
  • Hug
  • Hush
  • Hang around

What you can say
  • Im sad for you
  • How are you doing with all of this?
  • This is hard for you
  • What can I do for you?
  • Im sorry

What Not to say
  • Youre young, you can have more children
  • You have an angel in heaven
  • This happened for the best
  • Better for you now, before you knew the
  • There was something wrong with the baby anyway
  • Calling the baby a fetus or it

How you Can Help
  • Listen
  • Touch
  • Cry with the family
  • Attend the funeral/memorial service
  • Remember them on their babys due date, birthday,
    and death day etc
  • Never forget

Remembrances You Can Give the Family
  • Baby ring
  • Planter/flowers in a baby vase
  • Original poem
  • Tree or rose bush as a living memorial
  • Donation to a memorial fund
  • Photographs keepsakes

Preparing the Family for the Birth
  • Hospital room away from other laboring moms
  • Label patients door
  • Keep couple together
  • Same nurse
  • Encourage to express their feelings
  • Encourage the parents to see, touch, and name
    their baby
  • Spiritual support
  • Cultural support

Preparing for the Birth
  • Timing of the induction/delivery
  • Method of delivery
  • Medications for induction
  • Comfort measures
  • Immediate care of newborn and mom following

Nursing Care of the Baby
  • The baby is washed and dressed
  • It is wrapped and made to look like a sleeping
  • Defects are minimized if possible
  • Parents will usually ask for the baby several

Discharge Care of the Family
  • Remembrance box or package
  • Pictures
  • Early discharge
  • Lactation suppression
  • Community referrals/resources
  • Funeral arrangements or body disposal

Difficult Times for Parents
  • Anniversaries/holidays
  • Due date
  • Death date
  • Growth and development milestones

Suggestions for Bereaved Parents
  • Name the baby
  • Find out the sex of the baby if possible
  • See the products of conception to make baby more
  • Dont get rushed out of the hospital
  • See and hold your baby as many times as you want
  • Have your baby baptized or blessed according to
    your religious beliefs
  • Have a memorial service

Suggestions for Remembrance
  • Do a baby book
  • Have pictures taken
  • Save some mementoes such as footprints, hair, ID
    bracelets, clothing
  • Wear a remembrance of your baby
  • Plant a tree or plant
  • Buy a Christmas ornament with your babys name

Suggestions for Memorial Service
  • Draw a picture of your childs face and write
    poetry for the service
  • Write a letter to your baby or God.
  • Have your baby shown in a cradle at the funeral
    home or in your home
  • If you have cremation, have it done after
    visitation and funeral