Fundamentals - Practice & Skills, part 8: Grief and Comfort Care

by Meris Shuwarger July 28, 2021 Updated: July 29, 2021

Full Transcript

Hi. I'm Meris, and in this video, we're going to be talking about the types and stages of grief along with the different types of comfort care. I'm going to be following along with our Fundamentals of Nursing flashcards. These are available on our website, If you already have a set, you can follow along with me. I will be starting on card number 65. Let's get started. 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 test, 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 then, acceptance. So denial is that immediate feeling [you're?] 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 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 intergrade 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 one's 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 disenfranchise. 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 quality of life and decreasing suffering but can be for someone who is not terminally ill. Can be for somebody terminally ill also, but both. Okay?

Now hospice care. Hospice care is going to be symptom management for life-threatening-- or life-limiting illness. I'm sorry. Let's say it that way. So terminal illnesses. So when my father was dying of pancreatic cancer, he was on hospice care. This was not a location. He was in his own home. He didn't go to the hospital or anything. This was a philosophy of care that was aimed at decreasing his symptoms and managing his pain as he was exiting this earth. So this is typically for people who have a diagnosis of terminal illness with estimated - meaning we're guessing - less than six months to live. What happens if you live longer than six months? Nothing. You stay on hospice. That's okay. It's just that's the physician's best estimate. Now, for Medicaid-- excuse me, 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 live, and this is going to be not aimed at curative treatment. This is going to be more about managing pain as a person is actively dying.

Okay. So that is it for talking about the different stages and types of grief and the different types of comfort care. If you liked this review, please like this video. It would mean a lot to us. And if you have anything to add in the comments, you know I love to hear it. Be sure to subscribe to our channel so that you can be the first to know when the next video posts. And in that video, I'm going to be talking about effects of immobility, deep vein thrombosis, and nursing care for immobility. I'm just going to give you a heads-up. That is very important content for nursing school and the NCLEX, so you don't want to miss it. Thanks so much, and happy studying.

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