Care for the Dying and
for Those Who Grieve
CHAPTER 32
Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc.
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Hospice and Palliative Care
• Dr. Elisabeth Kübler-Ross
• Goal is quality, compassionate care for
people facing a life-limiting illness or
injury
• Team-oriented approach to expert
medical care, pain management, and
emotional and spiritual support
• Tailored to patient’s needs and wishes
• Support to patient's loved ones included
Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc.
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Hospice Care
• Available to everyone regardless of
age, diagnosis, or the ability to pay
• Requires a physician’s best clinical
judgment that the patient is terminally
ill with a life expectancy of 6 months or
less
• Patient chooses hospice care rather
than curative treatment
Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc.
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Nursing Goals in End-of-Life
Care
• Practice the art of presence
• Assess for spiritual issues
• Provide palliative symptom
management
• Become an effective communicator
• Counsel about anticipatory grieving
• Practice good self-care
Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc.
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Nursing Goals in End-of-Life
Care
Continued
• The Four Gifts of Resolving
Relationships
– Forgiveness
– Love
– Gratitude
– Farewell
Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc.
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Styles of Confronting the
Prospect of Dying: Seven Motifs
1. Struggle – living and dying are a struggle
2. Dissonance – dying is not living
3. Endurance – triumph of inner strength
4. Incorporation – belief system
accommodates death
5. Coping – working to find a new balance
6. Quest – seeking meaning in dying
7. Volatile – unresolved and unresigned
Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc.
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Grief Reactions, Bereavement,
and Mourning
• Grief – the reaction to loss
– Includes depressed mood, insomnia,
anxiety, poor appetite, loss of interest,
guilt, dreams about the deceased, poor
concentration
• Bereavement – period of grieving
following a death
• Mourning – things people do to cope
with grief
Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc.
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Dual-Process Model of Coping
with Bereavement
• Loss-oriented stressors – concentrating
on the loss experience, feeling the pain of
grief, remembering, and longing
• Restoration-oriented stressors –
overcoming loneliness, mastering skills and
roles once performed by the deceased,
finding a new identity, and facing practical
details of life
– Stroebe and Schut
Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc.
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Four Tasks of Mourning
• Accept the reality of the loss
• Experience the pain of grief
• Adjust to an environment without the
loved one
– Externally, internally, and spiritually
• Relocate and memorialize the loved one
Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc.
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Maladaptive Grieving
• Chronic grief
• Delayed grief
• Exaggerated grief
• Masked grief reactions
Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc.
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Helping People Cope with Loss
• Four constructs that support personal
growth
– Seeing some good resulting from the
death
– Continuing the connection with the
deceased
– Invoking intrinsic spirituality to understand
the death and aftermath
– Going forward with life
Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc.
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