GRIEF- Grief is the natural emotional response to the loss of someone close, such as a family member or friend. grief can also occur after a serious illness, a divorce or other significant losses. grief often involves intense sadness, and sometimes feelings of shock or even denial and anger. BEREAVEMENT - Bereavement is the experience of losing someone important to us. It's characterized by grief, which is the process and the range of emotions we go through when we experience a loss. ( It is the starting stage of grief) MOURNING – A reaction activated by a person to assist in overcoming a great personal loss. Mourning is an expression of grief or a time of grieving that follows a loved one's death or other serious loss. To begin to feel or show sadness for someone who has died : EX. - To begin the ritual observances accompanying a death (such as the wearing of WHITE - she went into mourning for her dead husband) HOSPICE CARE -Hospice care focuses on the care, comfort, and quality of life of a person with a serious illness who is approaching the end of life. At some point, it may not be possible to cure a serious illness, or a patient may choose not to undergo certain treatments. LAST OFFICE -The last offices, or laying out, is the procedures performed, usually by a nurse, to the body of a dead person shortly after death has been confirmed. The fact or process of losing something or someone. Loss is an inevitable (which can not be avoid) part of life, loss is an actual and symbolic (sure to happen) situation in which something that is valued is changed or no longer available or gone. SUDDEN LOSS - sudden loss or shocking losses due to event like crime, accident, suicide . PREDICTABLE LOSS / ANTICIPATORY LOSS - Predictable loss occurs due to terminal illness sometime allow more time to prepare for loss. PHYSICAL LOSS – Loss of part or aspect of the body, such as loss of an extremely in an accident, burn. PHYSIOLOGICAL LOSS - Emotional loss such as women feeling inadequately after menopause. MATURATIONAL LOSS – A maturational loss is a form of necessary loss which is normally expected occur during the life cycle. Ex. Death of spouse due to old age. ACTUAL LOSS – Actual loss is when something valuable is lost or damaged unexpectedly. .Ex. – If you buy a toy and it breaks. PERCEIVED LOSS – A perceived loss is a loss that is not necessarily seen or felt by others. loss occurs when a Divorce, property, Job termination . Grief is a subjective state of emotional, physical & social response to the loss. Grief is a series of intense physical, psychological response that occurs following loss. Grief is the subjective feeling participated by the death of loved one. NORMAL / COMMON GRIEF - Normal or common grief begins soon after a loss and symptoms go away over the time. Normal grief usually includes some common emotional reaction shock, denial occurring immediately after death if death is unexpected. Normal or common grief occur in 50 Percentag

1. CARE OF TERMINALLY ILL ,DEATH AND
DYING PATIENTS
MS.POOJA SEN
NURSING LECTURER

2. TERMINOLOGY
CARE - feeling or showing concern for
or kindness to others.
TERMINALLY ILL- having a disease or
illness that cannot be cured, and that is
expected to result in death in a short time

3. TERMINOLOGY
DEATH -the end of the life of a person
or organism.
DYING- on the point of death.

4. TERMINOLOGY
AUTOPSY - an examination of a body after
death to determine the cause of death or the
character and extent of changes produced by
disease. called also necropsy.
BIOPSY- A biopsy is a procedure to
remove a piece of tissue or a sample of cells
from your body so that it can be tested in a
laboratory.

5. TERMINOLOGY
LOSS - The fact or process of losing something or someone.

6. TERMINOLOGY
GRIEF- Grief is the natural emotional response to the loss of someone close, such as a
family member or friend. grief can also occur after a serious illness, a divorce or other
significant losses. grief often involves intense sadness, and sometimes feelings of shock or
even denial and anger.

7. TERMINOLOGY
BEREAVEMENT - Bereavement is the experience of losing someone important to us. It's
characterized by grief, which is the process and the range of emotions we go through when
we experience a loss. ( It is the starting stage of grief)

8. TERMINOLOGY
MOURNING – A reaction activated by a person to assist in
overcoming a great personal loss.
Mourning is an expression of grief or a time of grieving that
follows a loved one's death or other serious loss. To begin to
feel or show sadness for someone who has died :
EX. - To begin the ritual observances accompanying a death
(such as the wearing of WHITE - she went into mourning for
her dead husband)

9. TERMINOLOGY
PALLATIVE CARE - Palliative care is specialized medical care for people living with a
serious illness, such as cancer . Patients in palliative care may receive medical care for their
symptoms, or palliative care, along with treatment intended to cure their serious illness.

10. TERMINOLOGY
HOSPICE CARE -Hospice care focuses on the care, comfort, and quality of life of a
person with a serious illness who is approaching the end of life. At some point, it may not be
possible to cure a serious illness, or a patient may choose not to undergo certain treatments.

11. TERMINOLOGY
LAST OFFICE -The last offices, or laying out, is the procedures performed, usually by a
nurse, to the body of a dead person shortly after death has been confirmed.

12. TERMINOLOGY
RIGOR MORTIS – (Latin: rigor "stiffness", and
mortis "of death")
Rigor mortis is a postmortem change resulting in
the stiffening of the body muscles due to
chemical changes.
Rigor mortis appears approximately 2 hours after
death in the muscles of the face, progresses to the
limbs over the next few hours, completing
between 6 to 8 hours after death. Rigor mortis
then stays for another 12 hours (till 24 hours after
death) and then disappears.

13. TERMINOLOGY
EMBALMING - Embalming is a process that uses chemicals to preserve a body after death.
It helps delay the decomposition that begins in the hours and days after death.

14. TERMINOLOGY
EUTHANASIA – An easy or painless death, or the
intentional ending of the life of a person suffering from
an incurable or painful disease at his or her request ,
Also called MERCY KILLING.
Aruna Ramchandra Shanbaug (1 June 1948 – 18 May
2015), was an Indian nurse who was at the center of
attention in a court case on euthanasia after
spending over 41 years in a vegetative state because
of sexual assault.
ACCORDING TO ARTICLE 21-
Active euthanasia is illegal in India.
Passive euthanasia is legal under strict guidelines. For
this, patients must give consent through a living will. ( 7
March 2018 Supreme court of India)

15. TERMINOLOGY
ACTIVE EUTHANASIA: Killing a patient by active means, for example, injecting a patient with a lethal
dose of a drug, sometimes called “aggressive” euthanasia.
PASSIVE EUTHANASIA: Intentionally letting a patient die by withholding artificial life support such as
a ventilator or feeding tube.

16. LOSS & TYPES

17. DEFINITION
♠ The fact or process of losing something or someone.
♠ Loss is an inevitable (which can not be avoid) part of life, loss is an actual and symbolic
(sure to happen) situation in which something that is valued is changed or no longer
available or gone.

18. TYPES
♠ Maturational Loss
♠ Actual Loss
♠ Perceived Loss
♠ Sudden Loss
♠ Predictable Loss
♠ Physical Loss
♠ Physiological Loss
♠ Anticipatory Loss

19. ♠ MATURATIONAL LOSS – A maturational loss is a form of necessary loss which is normally
expected occur during the life cycle.
Ex. Death of spouse due to old age.
♠ ACTUAL LOSS – Actual loss is when something valuable is lost or damaged unexpectedly.
.Ex. – If you buy a toy and it breaks.
♠ PERCEIVED LOSS – A perceived loss is a loss that is not necessarily seen or felt by others.
loss occurs when a Divorce, property, Job termination .

20. ♠SUDDEN LOSS - sudden loss or shocking losses due to event like crime, accident, suicide .
♠PREDICTABLE LOSS / ANTICIPATORY LOSS - Predictable loss occurs due to terminal illness
sometime allow more time to prepare for loss.
♠PHYSICAL LOSS – Loss of part or aspect of the body, such as loss of an extremely in an
accident, burn.
♠PHYSIOLOGICAL LOSS - Emotional loss such as women feeling inadequately after
menopause.

21. GRIEF ,TYPES & STAGES

22. ♠Grief is a subjective state of emotional, physical & social
response to the loss.
♠Grief is a series of intense physical, psychological response that
occurs following loss.
♠Grief is the subjective feeling participated by the death of loved
one.
DEFINITION

23. TYPES
1. Normal / Common Grief
2. Anticipatory Grief
3. Complicated Grief
4. Absent Grief
5. Delayed Grief
6. Exaggerated grief

24. TYPES
1. NORMAL / COMMON GRIEF -
• Normal or common grief begins soon after a loss and symptoms go away over
the time.
• Normal grief usually includes some common emotional reaction shock, denial
occurring immediately after death if death is unexpected.
• Normal or common grief occur in 50 Percentage – 80 Percentage of person
begin soon after a loss.

25. TYPES
2. ANTICIPATORY GRIEF -
• Anticipatory grief has been defined as feeling of grief or loss that are felt
before the loss actually happens.
• Individuals are able to complete unfinished work with the dying patient or
person. (express feeling ,spend quality time ,practice forgiveness ask them
about funeral wishes)

26. TYPES
3. COMPLICATED GRIEF -
It is defined as lack of adapting to the loss of loved one that persist for more than
one year in adult & more than 6 month in child.
• Minimal grief – a grief pattern in which the person has no, or only a few signs
of distress or problems that occur.
• Chronic grief – a grief pattern in which symptoms of common grief last for a
much longer time than usual , these symptoms are a lot like ones occurs with
major depression or PTSD.

27. TYPES
4. ABSENT GRIEF -
The kind of grief in which the person affected blocks their feelings they try to
act as nothing happening.
5. DELAYED GRIEF –
Delayed grief is a reaction to loss which occurs at present but emotional
responses are not felt or expressed at same time.
Some time its associated to PTSD . ( Disaster , Accident)

28. TYPES
6. EXAGGREATED GRIEF -
• A person with exaggerated grief response self destructive or maladaptive
behaviors.
• Person may experiences nightmares, suicidal thought or cope up with loss
through Substance abuse or using drugs.

30. INTRODUCTION
• THE FIVE STAGES OF GRIEF MODEL WAS DEVELOPED BY
ELISABETH KÜBLER-ROSS, AND BECAME FAMOUS AFTER SHE
PUBLISHED HER BOOK ON DEATH AND DYING IN 1969.
• ELISABETH KÜBLER-ROSS (JULY 8, 1926 – AUGUST 24, 2004)
WAS A SWISS-AMERICAN PSYCHIATRIST, A PIONEER IN NEAR-
DEATH STUDIES, AND AUTHOR OF THE INTERNATIONALLY
BEST-SELLING BOOK, ON DEATH AND DYING (1969), WHERE
SHE FIRST DISCUSSED HER THEORY OF THE FIVE STAGES OF
GRIEF, ALSO KNOWN AS KÜBLER-ROSS THE " MODEL".

31. 1. DENIAL – Refusal to believe the loss has occurred.
Acts as a defense mechanism to give you a chance to
understand the news.
EX. – THIS CANT’T BE HAPPENING TO ME, IT IS
TRUE? HE/SHE REALLY GONE ?

32. 2. ANGER – Experiencing anger after the loss, may
blame themselves or others.
EX. WHY ME ? IT IS NOT FAIR…..

33. 3. BARGAINING – Making promises to change if the loss is
returned to them , Often accompanied by guilt.
EX. IF ONLY I WOULD HAVE OR MAKR THIS GO AWAY
I WILL…….. OR TAKE ME INSTEAD……….

34. 4. DEPPRESION – Feeling od sadness, regret, fear, loneliness,
loss of interest.
EX. THERE IS NO HOPE OR I JUST WANT TO BE ALONE .

35. 5. ACCEPTANCE – Accepting the reality that the loved one is
physically gone and that this new reality is permanent .
EX. MY LIFE WILL NEVER BE THE SAME BUT I AM AT
PEACE WITH WHAT HAS HAPPENED.