Ministry of higher education Second Semester/First Class

and scientific research Academic year 2023- 2024

Duhok Polytechnic University
Technical college for Health and
Medical Techniques /Shekhan
Nursing Department

Lecture 15
Loss, Grieving, and Death

‫زانكويا ثوليتةكنيكى يا دهؤك‬

‫جامعـة دهــوك التقــنية‬
Duhok Polytechnic University
 :Learning Outcomes
:After completing this chapter, The student will be able to

.Describe types and sources of losses .1

.Discuss selected frameworks for identifying stages of grieving .2
.Identify clinical symptoms of grief .3
.Discuss factors affecting a grief response .4
Identify measures that facilitate the grieving process .5
.List clinical signs of impending and actual death .6
.Describe the process of helping clients die with dignity .7
Describe the role of the nurse in working with families or .8
.caregivers of dying clients
.Describe nursing measures for care of the body after death .9

‫زانكويا ثوليتةكنيكى يا دهؤك‬

‫جامعـة دهــوك التقــنية‬
Duhok Polytechnic University
 Everyone experiences loss, grieving, and death during his or her
life. People may suffer the loss of valued relationships through
life changes, such as moving from one city to another; separation
or divorce; or the death of a parent, spouse, or friend. People may
grieve changing life roles as they watch grown children leave
home or they retire from their lifelong work. Losing valued
material objects through theft or natural disaster can evoke
.feelings of grief and loss
in the clinical setting, the nurse encounters clients who may
experience grief related to declining health, loss of a body part,
terminal illness, or the impending death of self or a significant
other. The nurse may also work with clients in community
settings who are grieving losses related to a personal crisis (e.g.,
divorce, separation, financial loss) or disaster (war, earthquakes,
.or terrorism)

‫زانكويا ثوليتةكنيكى يا دهؤك‬

‫جامعـة دهــوك التقــنية‬
Duhok Polytechnic University
 Nurses may interact with dying clients and their families or
caregivers in a variety of settings, from a fetal demise (death of an
unborn child), to the adolescent victim of an accident, to the older
client who finally succumbs to a chronic illness. Nurses must
recognize the influences on the dying process—legal, ethical,
spiritual, biologic, psychological—and be prepared to provide
.sensitive, skilled, and supportive care to all those affected

Loss and Grief

Loss is an actual or potential situation in which something that is
valued is changed or no longer available. People can experience
the loss of body image, a significant other, a sense of well-being,
a job, personal possessions, or beliefs. Illness and hospitalization
.often produce losses

‫زانكويا ثوليتةكنيكى يا دهؤك‬

‫جامعـة دهــوك التقــنية‬
Duhok Polytechnic University
 Grief, Bereavement, and Mourning

Grief is the total response to the emotional experience related to

loss. Grief is manifested in thoughts, feelings, and behaviors
associated with overwhelming distress or sorrow. Bereavement is
the subjective response experienced by the surviving loved ones.
Mourning is the behavioral process through which grief is
eventually resolved or altered; it is often influenced by culture,
spiritual beliefs, and custom. Grief and mourning are experienced
not only by the person who faces the death of a loved one but also
by the person who suffers other kinds of losses. Grieving permits
the individual to cope with the loss gradually and to accept it as
part of reality. Grief is a social process; it is best shared and
.carried out with the assistance of others

‫زانكويا ثوليتةكنيكى يا دهؤك‬

‫جامعـة دهــوك التقــنية‬
Duhok Polytechnic University
 Caring for the Terminally ill (Death and Dying)

Life expectancy continues to lengthen year by year , yet death is a

certainty . The only unknowns Are when , where , and how it will
occur . Nurses and other health personnel are probably involved
more than any other group with people who experience
.impending death

Definitions and Signs of Death

The traditional clinical signs of death were cessation of the apical
pulse, respirations, and blood pressure, also referred to as heart-
lung death. However, since the advent of artificial means to
maintain respirations and blood circulation, identifying death is
.more difficult

‫زانكويا ثوليتةكنيكى يا دهؤك‬

‫جامعـة دهــوك التقــنية‬
Duhok Polytechnic University
 In 1968, the World Medical Assembly (Gilder, 1968) adopted the
:following guidelines for physicians as indications of death

Total lack of response to external stimuli •

No muscular movement, especially breathing •
No reflexes •
.Flat encephalogram (brain waves) •
In instances of artificial support, the absence of brain waves for at
least 24 hours indicates death. Only then can a physician
pronounce death, and only after this pronouncement can life-
support systems be shut of

‫زانكويا ثوليتةكنيكى يا دهؤك‬

‫جامعـة دهــوك التقــنية‬
Duhok Polytechnic University
 Another definition of death is cerebral death or higher brain
death, which occurs when the higher brain center, the cerebral
cortex, is irreversibly destroyed. In this case, there is “a clinical
syndrome characterized by the permanent loss of cerebral and
brainstem function, manifested by absence of responsiveness to
external stimuli, absence of cephalic reflexes, and apnea. An
isoelectric electroencephalogram for at least 30 minutes in the
absence of hypothermia and poisoning by central nervous system
depressants supports the
diagnosis

‫زانكويا ثوليتةكنيكى يا دهؤك‬

‫جامعـة دهــوك التقــنية‬
Duhok Polytechnic University
 :Terminal illness
Is one from which recovery is beyond reasonable expectation .On
learning that death is soon to be Inevitable , patients tend to go
.through several stages as they process the information

:Stages of Dying
:Denial – 1
Is a psychological defense mechanism in which a person
. refuse to believe that certain information is true
Terminally ill patients may first reject that their diagnosis
is
accurate . They may speculate that the test results are in
error or that the test results are in error or that the reports
.have been confused with those of another

‫زانكويا ثوليتةكنيكى يا دهؤك‬

‫جامعـة دهــوك التقــنية‬
Duhok Polytechnic University
 :Anger – 2
Is an emotional response to feeling victimized. Because
there is no way to retaliate against fate, patients often
,displace their anger onto others like nurses, the physician
.family and even god

:Bargaining – 3
Is a psychological mechanisms for delaying the inevitable, it
involves a process of negotiation usually with god or some
higher power. Usually the dying patient is willing to accept
death but wants to extend his or her life temporarily until
. some event take place in the future

:Depression – 4
Is a sad mood . It indicates that the dying patient’s
realization that his or her death will come sooner rather than
later than anticipated
‫زانكويا ثوليتةكنيكى يا دهؤك‬
‫جامعـة دهــوك التقــنية‬
Duhok Polytechnic University
 :Acceptance – 5
Is an attitude of complacency. Most patients arrive at
the stage of acceptance after having deal with their
.losses and completed their unfinished business

‫زانكويا ثوليتةكنيكى يا دهؤك‬

‫جامعـة دهــوك التقــنية‬
Duhok Polytechnic University
 Stage of Dying
Stage Typical emotional Response Typical comment

First stage Denial No not me – 1

Second stage Anger Why me – 2
Third stage Bargaining Yes me but – 3
Fourth stage Depression Yes me – 4
Fifth stage Acceptance I am ready – 5

‫زانكويا ثوليتةكنيكى يا دهؤك‬

‫جامعـة دهــوك التقــنية‬
Duhok Polytechnic University