Chapter 10 Nurse-Patient Relationships During Grief, Mourning, and Loss

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Chapter 10Nurse-Patient Relationships During
Grief, Mourning, and Loss
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Grieve big and small losses throughout life

• Weddings, graduations off to kindergarten,
  college
• Divorce
• Loss of a job (financial security)
• Loss of loved ones
• Losses associated with illness (self-esteem,
  belief systems, faith, hope, dreams)
• Often producing feelings of guilt

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Patient-Safe Strategies for Crying

• Use empathy I can see youre upset
• Allow emotional release through tears and words
• Raging and cryingallow patient to regain control
  (blow off steam) keep silent and accept response
• Quiet cryingsit on same level, hold hand, offer
  tissues

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Encouraging Emotional Release Using Tears A
Good Cry

• Tears reduce emotional pain levels
• Release of stress-related tensions and hormones
  in tears
• Relieve feelings of loss, sadness, grief,
  frustration and anger
• Initial release of catecholamines increases heart
  rate and blood pressure, followed by
  parasympathetic response generating systemic
  relaxation

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What not to say..

• Theres no need to cry. Youre doing fine.
  (stop)
• Please stop crying now.
• Get hold of yourself. (stop)
• Think positive. (advice)
• Think of your family. (guilt)
• You must be strong.
• You must be a man about this.
• Its time to get on with your life.
• I know how you feel.

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Gender Differences

• Women vent tensions, anger, and frustrations by
  crying across cultures, women cry more than men
• Men more often yell or shout
• Pressure for men not to cry for fear of being
  labeled sissy or crybaby Youre a big boy.
  Big boys dont cry.
• Men generally tend not to express emotions as
  much as women

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Why Do Women Cry and Express Themselves More
Freely?

• Socialization? Girls encouraged to express
  themselves and cry
• Physiological? Women secrete a hormone prolactin
  (30 times more than men) involved in tear
  production

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Shock, disbelief, denialAngerLack of
controlGuilt and fearAm I being
punished?Depression and sadnessNothing will
ever be the same againCome to terms with loss
and make plans
Grief Associated With Death and Significant Loss
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Before helping others grieve/mourn losses

• You must recognize your own vulnerability to loss
  and pain
• Acknowledge you can never be in total control
  of your life
• Acknowledge your own mortality
• Anticipatory grievingemotional responses to
  potential loss

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Grief work After death of loved one, intense and
painful

• Loss of pet20 hrs crying
• Spouse, parent, friend, child200 to 300 hrs
  crying
• Talk through tears review good and bad memories
• Restructure and rebuild lives without the loved
  one

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Grief work takes 1-3 years

• People, events, objects evoke memories of the
  deceased, bringing on feelings of sadness,
  depression, tears
• Holidays, special events
• Dysfunctional grieving Unsuccessful responses at
  working through the process of loss
• Sadness turns into depression
• Emotional depression unable to function in
  personal lives or jobs
• Physiological depression of immune system

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Successful Resolution of Grief

• Never forget but go on without the other
• Become actively involved in meaningful activities
  once more still see purpose in life
• Greater understanding of life, greater compassion
  for suffering and the needs of others

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Emotions are contagiousWe feel the same
emotions as those around usWe must acknowledge
and accept the emotions in ourselves and our
patients
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Health-Care Providers Cry, Too!

• When caring for patients and families, you will
  become close to some and experience grief along
  with them.
• Crying with a family member or patient is fine,
  as long as the other cries first.
• Avoid crying unless the patient cries first. If
  you are upset, you may need to excuse yourself
  and go to a private place.
• Discuss your feelings with a trusted nursing
  student/ faculty.
• Journaling to express feelings.

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Non-emotional health-care provider doing tasks,
procedures, paperwork comes across as uncaring,
task-oriented, too busy to be bothered