Description
Part 1: Please answering the following question:
The APN’s role centers on caring for clients and families suffering multiple losses. How can the APN help families who are struggling with the paradox of caring for their dying parent and maintaining a “normal life” for their children?
Par 2: Please Respond to these 2 responses in regard to part 1:
Joanna: APN’s are crucial in assisting families in dealing with grief, loss, and sadness. With the daunting task of caring for an ailing parent who is dying while at the same time trying to maintain normalcy in their children’s lives, this becomes even more concerning. In such situations, APN’s may be instrumental in addressing the intricate issues related to families’ emotional and practical needs. The main benefit of nurse practitioners APN’s is the fact that they are highly skilled in performing comprehensive assessments addressing the medical, psychological, and emotional needs of families with terminally ill parents; this exhaustive evaluation makes both a thorough understanding of the issue and the promotion of tailored solutions possible. To facilitate open and honest discussions, essential for families to make informed decisions regarding the treatment and support their loved one may require, APN’s can help (Pearce et al., 2021).
APN’s can educate parents on how to give children age-appropriate explanations of what illness and death mean, teach families the process of grieving and lamenting and give them the tools that are needed to cope with such situations. They can also refer families for counselling programs or support groups to address their emotional needs. Social workers, psychologists, and chaplains are all essential members of the healthcare team that should collaborate. APN’s can also encourage self-care and organization of appropriate respite care (Pearce et al., 2021). These methods help loved ones take some time off mentally and physically, allowing them to recuperate their strength, which they would use effectively in helping.
Pearce, C., Wong, G., Kuhn, I., & Barclay, S. (2021). Supporting bereavement and complicated grief in primary care: a realist review. BJGP open, 5(3).
Jben: The APN serves an important role during end of life care especially when dealing with the patients family members. The APN can help families struggling with the paradox of their dying parent and maintaining a “normal life” for their children by being present. According to Sherman (2019), when caring for a patient with a terminal illness, the nurse’s role may be less action oriented and more presence oriented (pg. 544). A nurse’s presence can symbolize respect with the patient and caregivers, showing honesty, openness, and compassion. The process of loss, grief, and bereavement are unique to each individual which means the interventions are also unique. However, it is important to involve children in the care process and to provide them with clear and realistic information (Sherman, 2019).. The APN can educate the children on simple tasks to involve them in the patient’s care. The APN can help educate the parent on the grief and bereavement process in children and help provide the appropriate advice depending on the child’s age.
Reference:
Matzo, M., & Sherman, D. W. (Eds.). (2019). Palliative care nursing : quality care to the end of life (5th ed.). Springer Publishing Company.
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POWERPOINTS TO ACCOMPANY
Chapter 11
Loss, Grief, and Bereavement
Copyright Springer Publishing Company. All Rights Reserved.
From: Palliative Care Nursing
ISBN: 9780826135575
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© Springer Publishing Company, LLC.
Living With and Dying From a Life-Threatening
Illness
• Loss and suffering are inescapable dimensions of life
• Transitions through loss and suffering are variable
(see Table 11.1)
• Nurses’ role:
• In the unique position to assist others with suffering and loss
• Commit to provide quality of care at the end of life
• Convey understanding
• Help patients regain some control
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Loss and Suffering Across the Life Span
• Newborn: expelled from the uterus during birth
• 6 months old: separation anxiety
• 2 to 5 years old: death seen as temporary
• 6 to 10 years old: grasp the reality of death
• Adolescents: belief that they will eventually die
• Young adults: death anxiety more evident
• Middle-age and older adults: aware and accepting of death
• Responses to death are unique (see Table 11.2)
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Theories on Death and Dying
• Stage theory of grief:
• Stages:
• Disbelief
• Yearning
• Anger
• Depression
• Acceptance
• Additional theorists:
• Freud
• Lindemann
• Engel
• Glasser and Strauss
• Kubler-Ross
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Theories on Death and Dying (cont.)
• Additional theorists: (cont.)
• Pattison
• Bowlby
• Worden
• Rando
• Contemporary theorists:
• Buckman
• Copp
• Theories about reconstructing meaning after a loss:
• Florczak
• Bonanno
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Loss, Suffering, Grief, and Bereavement
• Loss:
• Deprived of something or someone
• Can be actual, potential, physical, or symbolic
• Related to health, function, roles, relationships, and life itself
• Primary losses: the initial loss
• Secondary losses: losses other than the death of a loved one
• Types of losses:
• Materialistic
• Relational
• Intrapsychic
• Functional
• Role
• Systemic
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Loss, Suffering, Grief, and Bereavement (cont.)
• Suffering:
• Bearing of pain or distress
• Impacts a patient’s body, mind, and spirit
• Pain compounds suffering and could lead to spiritual distress
• Can be present with or without the presence of pain
• Cannot be treated or managed like pain
• Is a personal experience
• Acute suffering: patient in crisis and facing an immediate loss
• Chronic suffering: long-term realization and impact of a loss that carries
great meaning to the person
• Chronic sorrow:
• Occurs in response to ongoing, significant losses
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Loss, Suffering, Grief, and Bereavement (cont.)
• Grief:
• Deep or intense sorrow or distress
• Normal reaction to the perception of loss
• Generally transitory
• Causes:
• Distraction
• Disorientation
• Distress
• Associated feelings: anger, shame, helplessness, sadness, guilt, despair,
relief, peacefulness, calm, and release
• Common grief responses (see Table 11.3)
• Anticipatory grief:
• Feelings of grief experienced prior to an expected loss
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Loss, Suffering, Grief, and Bereavement (cont.)
• Purposes:
• Helps individuals in working through depression related to the upcoming
death
• Rehearses the death
• Adjusts to the consequences of the death
• Increases concern for the terminally ill
• Gradual absorption of the reality of the loss
• Helps resolve unfinished business
• Changes assumptions about life and identity
• Helps make future plans
• Bereavement:
• State or act of being deprived of a loved one
• Long-term process of life without the loved one
• Major life event that can cause impaired health
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Relationship Significance to Loss and Suffering
• Intensity of loss for the dying patient and significant others relates
to the perception of the closeness of the relationship and how great
the loss will be
• Interpretation of loss and suffering is unique to each individual and
to each individual’s circumstances
• Categories of relationships:
• Social
• Intimate
• Therapeutic
• Influences:
•
•
•
•
•
Stage of growth and development
Unpredictability
Uncertainty
Pain
Reaction to change
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Assessments
• Three assessments need to occur:
• The nurse:
• Current beliefs about death
• Personal experience with death
• The patient:
• Where the patient is on the lifecycle continuum
• Current needs
• The family/significant others:
• Current place on the journey
• Roles and relationships
• Normal grief response
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Loss From a Child’s Perspective
• Loss of parent:
• Circumstance of the parent’s death influences the child’s reaction
• Degree of attachment (see Table 11.4)
• Development of separation anxiety
• Stress of observing the remaining parent deal with the loss
• Additional issues occur after the loss of a sibling
• Parental loss of a child:
• Infant:
• Look for someone or something to blame
• Experience guilt
• Mourn the loss of a normal healthy child and the death of the child
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Loss From a Child’s Perspective (cont.)
• Older adult children:
• Survivor guilt
• Powerlessness
• Loss of religious faith
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Gerontologic Grief
• Characteristics of successful aging:
• Actively engage in life
• Maximize cognitive and physical functioning
• Prevent disease and disability
• Experience developmentally appropriate spirituality
• Hardiness affects response:
• Control
• Commitment
• Challenge
• Need to discern grief from depression in the older adult
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Complicated Grief
• Three types:
• Delayed
• Inhibited
• Chronic
• Additional categories:
• Absent grief
• Conflicted grief
• Unanticipated grief
• Abbreviated grief
• Risk factors:
• Excessive dependency
• Insecure attachment styles
• History of childhood abuse
• Insomnia
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Complicated Grief (cont.)
• Three types:
• Delayed
• Inhibited
• Chronic
• Additional categories:
• Absent grief
• Conflicted grief
• Unanticipated grief
• Abbreviated grief
• Risk factors:
• Excessive dependency
• Insecure attachment styles
• History of childhood abuse
• Insomnia
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Complicated Grief (cont.)
• Risk factors: (cont.)
• Female gender
• Marital closeness
• Parents
• Those experiencing the loss of loved ones through unspeakable deaths
• Those with a psychiatric history
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Caregiving and Related Interventions
• The nurse:
• Needs:
• Compassion, skill, energy, sensitivity, and patience
• Self-care actions
• Process the loss
• Realize care is more about being present and less about action
• The patient:
• Prevent false reassurances
• Determine when to say “good-bye”
• The family:
• Help maintain normalcy and balance
• Intervene if response to death is maladaptive
• Bereavement counseling
• Recognize when bereavement is moving forward
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