Stages and Types of Grief, Types of Comfort Care

So first up, we're going to talk about the stages of grief. And now, what I want to mention here before we even start is that your patient will not move from one to the other in a nice, neat, linear fashion. They're going to ping around all over the place, and even after feeling acceptance, they may go back and feel some of these other emotions, and that's okay. That's normal. That's part of grief. But for the purposes of nursing education and tests, we're going to talk about it as a linear progression. So the phases, the stages of grief are going to be denial, anger, bargaining, depression, and acceptance. Again, we're going to talk about these as if they occur one after the other, but in reality, they're going to be all over the place. Denial is often the first reaction when someone is faced with a loss or a tragedy. It's a defense mechanism that helps the person cope with the overwhelming emotions. They may say things like, "This can't be happening" or "It's not true." They might even act as if everything is normal and try to go on with their usual routines. Denial is a way of buying time, of not facing the painful reality. It allows the person to gradually come to terms with the loss. After denial comes anger. Anger is a natural response to loss. The person may feel angry at themselves, at others, or even at the situation itself. They might ask, "Why did this happen?" or "Why me?" Anger can be directed towards healthcare providers, family members, friends, or even towards the deceased person. It's important to remember that anger is a normal part of the grieving process, but it should not turn into aggression. As the nurse, you can offer a listening ear and provide a safe space for the person to express their anger. Next is bargaining. Bargaining is when the person tries to negotiate with a higher power or with fate in an attempt to reverse or postpone the loss. They may make promises or offer to change themselves if only things could go back to the way they were. Bargaining is a way of seeking control and finding meaning in the loss. It's important to provide support and reassurance during this stage, as the person may feel guilty or ashamed for thinking that they could have prevented the loss through bargaining. Following bargaining is depression. Depression is often the longest and hardest phase of grief. It's a deep sadness that can feel overwhelming and paralyzing. The person may feel hopeless, empty, and withdrawn. They might lose interest in activities they used to enjoy and have trouble sleeping or eating. It's important to validate their feelings and offer empathy and support. Encourage them to seek professional help if needed. Finally, we have acceptance. Acceptance does not mean that the person is completely okay with the loss. It means that they have come to terms with the reality of the situation and have found a way to live with it. They may find a new sense of purpose or meaning in their life. Acceptance does not mean forgetting or moving on. It's a way of integrating the loss into their identity and moving forward. That concludes our discussion on the stages of grief. Next, let's talk about the different types of comfort care. Bargaining, depression, and then acceptance. So denial is that immediate feeling of being shocked, disbelief that this is happening. For instance, let's say somebody I love was diagnosed with cancer. I'm in denial. I don't think it's happening. I'm like, "Yeah, yeah." I'm just living my life. And I'm thinking about it, right, but it's not that serious. It's going to be fine. That might be something, I would say, in the denial stage. In anger, this is, "Why is this happening to him? I love him. This isn't fair." That's going to be anger. Bargaining, you'll typically see this from the person affected by a disease such as, "If I can just make it to my daughter's wedding, then I can die, then I will feel okay leaving this earth." That's bargaining. Or I might say, "I just want my dad to be here for my wedding. That's all I want." And then I'll be okay with it." That's bargaining. "Please let this person stay a little bit longer," or "I'll give up this. I'll give up all of my vices if I can live a little bit longer." Now, depression is going to be that really deep sadness point in time. That's when I'm feeling that emptiness, that sadness, and that withdrawal, maybe, from other people. Then, acceptance is going to be that point in time where I've come to terms with what's going on. I maybe feel at peace with something. It does not mean that I'm okay with the loss or the impending loss, or anything like that. It just means that I found a way to integrate that grief into my life and continue functioning. Now, let's talk about the different types of grief, and there's a few on this card, so I really want you to pay attention because it's different. There's different types. So the first is anticipatory. Anticipatory, same root word as anticipating, right? This is a loss I have not yet experienced but is impending. It's upcoming. So, for instance, when my dad was diagnosed with terminal pancreatic cancer, he was still alive and I could still call him and talk to him at any time, but my grief was anticipatory because I knew that he was terminally ill. Normal grief. Normal is what we refer to as uncomplicated or what the patient experiences on average. So most people are going to feel grief for 6 to 12 months. That grief will resolve to the point that they can continue functioning. It does not impair their ability to function. Now, complicated grief, see, we don't call it abnormal grief. It's complicated grief because grief is complicated, but complicated grief is grief that persists for longer than one year and interferes with the individual's ability to function. So examples of this might be if somebody experiences a loss and they won't touch any of their loved ones' items. They keep their side of the bed and the room completely as it is, and they can't get out of bed. They're devastated. They can't work because they are so overcome with grief. That would be complicated grief because it is actually impairing their ability to function on a daily level. Now, disenfranchised grief. So I want to give you a brief content warning. I'm going to discuss miscarriage here. So when you talk about disenfranchised grief, this means a loss or grief that is not publicly acknowledged. Now, one of the examples on the card is miscarriage, and the reason I want to bring this up is not all miscarriages are going to be disenfranchised grief. Personally, I have experienced eight miscarriages. My first three, I would say, were disenfranchised. I did not share with anybody. I did not tell anyone. I just kept it to myself and suffered in silence, and that is what I want you to think of with disenfranchised, suffering in silence. For some reason, I don't feel comfortable or it's taboo, or I don't want to share this loss with somebody, that's disenfranchised. Now, when I did choose to share about it and talk to my friends and family and tell them what I was going through, it was no longer disenfranchised. So I just want to put a little parenthetical there and say, "Not all miscarriages will be disenfranchised, but they can be." Another example on this card is the death of an extramarital lover. So if somebody is having an extramarital affair and that lover dies, they may not be able to grieve that publicly. That's going to be disenfranchised grief. So I hope that makes sense. Let me know in the comments if you have any other examples of disenfranchised grief because I would like to hear them. Okay. So moving on, our last card that we're going to cover here is types of comfort care. There's a lot of bold, red text here, so I would really pay attention to this. So palliative care versus hospice. Palliative. The word palliative means to provide comfort, to take away pain. So palliative care is aimed at reducing a patient's pain or symptoms of a disease or illness, but usually, we are managing their symptoms and pain along with having curative treatment. So for instance, a friend of mine had bone cancer when she was a child, and she had curative treatment. Right? She underwent chemotherapy and radiation. She also received palliative treatment, meaning that she was seeing a pain management specialist to manage her symptoms and her pain. So, this is focused on increasing the quality of life and decreasing suffering, but can be for someone who is not terminally ill. It can also be for somebody terminally ill, but both scenarios are okay. Now, let's talk about hospice care. Hospice care is focused on symptom management for life-threatening or life-limiting illnesses. In other words, it is for terminal illnesses. When my father was dying of pancreatic cancer, he was on hospice care. This care was not provided in a specific location; instead, he received it in his own home. He didn't go to the hospital or anything like that. Hospice care is a philosophy of care aimed at decreasing symptoms and managing pain as the patient approaches the end of their life. Normally, it is for people who have been diagnosed with a terminal illness and are estimated to have less than six months to live (although this is just an estimation). Now, what happens if someone lives longer than six months? Months? Nothing. You stay on hospice. That's okay. It's just that's the physician's best estimate. Now, for Medicare, you do have to have that prognosis. For private insurance, it may be different based on the timing of an individual's disease progression. It does not require DNR status. I know that might seem counterintuitive, but just pay attention to that. You do not have to be DNR to be in hospice care. And then the other thing is, if the prognosis changes, if the physician thought you were terminally ill and now you are not, you can be discharged from hospice care, and that's okay. Big takeaways here: palliative care, we are treating symptoms, we are managing pain, and this can be for people who are terminally ill or who have a chronic, lifelong condition. Hospice care typically is going to be six months or less. to give it a thumbs up and leave a comment. Your feedback is greatly appreciated. In our next video, we will be discussing the effects of immobility, deep vein thrombosis, and nursing care for immobility. This is vital information for nursing school and the NCLEX, so make sure you don't miss it. Thank you for watching and happy studying! And hit the like button, and leave a comment to let us know what you found particularly helpful.