Emergency Nursing - Palliative and End-of-Life Care in Critical Care Setting PDF

EMERGENCY NURSING LUNA BATCH 2025 ST. LUKE’S COLLEGE OF NURSING PALLIATIVE AND END-OF-LIFE CARE IN CRITICAL CARE SETTING A. CRITICAL CARE SETTINF IN PALLIATIVE CARE CRITICAL CARE SETTING LEVEL 3: Critical care represents the...

EMERGENCY NURSING LUNA BATCH 2025 ST. LUKE’S COLLEGE OF NURSING PALLIATIVE AND END-OF-LIFE CARE IN CRITICAL CARE SETTING A. CRITICAL CARE SETTINF IN PALLIATIVE CARE CRITICAL CARE SETTING LEVEL 3: Critical care represents the CRITICAL highest level of care and is Support and treat reversible causes of dedicated to patients with critical illness, maintaining life and life-threatening or severely relieving suffering. critical conditions. Patients in ICU or critical care units These patients require constant monitoring, requires level 2 and 3 support. This is advanced life support, and because they need potentially life-saving specialized medical measures requiring staff with specialist interventions. skills and knowledge, in addition to the use Critical care units often of medical technology. include Intensive Care Units (ICUs) where highly skilled healthcare professionals LEVELS OF CARE manage patients with the most critical needs. LEVEL 1: Typically refers to standard WARD in-patient care provided on hospital wards. CRITICAL CARE SETTING IN PALLIATIVE CARE Patients in Level 1 may have general medical conditions In a critical care setting, palliative care that do not require intensive plays a crucial role in providing relief, monitoring or specialized comfort, and support to patients with interventions. life-limiting illnesses or those facing They are often stable and end-of-life decisions. can receive care on standard Palliative care in the critical care hospital wards. environment is focused on improving the LEVEL 2: Represents a higher level of quality of life for patients and their ENHANCED monitoring and intervention families, even when curative treatments compared to standard ward may no longer be effective or desired. care. Patients in Level 2 may have B. PHASES OF CARE IN CRITICAL CARE more complex or severe medical conditions that Medical technology and interventions require closer observation actively support and can even replace the and specialized nursing care. function of some organ systems during Enhanced care units often the severe stages of organ failure. provide an intermediate level of support between the It is often not possible to involve patients in general ward and critical discussions about their care as they are care. seriously ill, at times unconscious and may be unable to communicate. PROPERTY OF KATE GUTIERREZ 13 EMERGENCY NURSING LUNA BATCH 2025 ST. LUKE’S COLLEGE OF NURSING The serious illness may have developed During this phase, the rapidly, within minutes or hours, and emphasis is on finally, other services such as a hospice or ensuring that the palliative care teams may have had more patient's final days and time to plan end of life care with the moments are as patient and loved ones. comfortable and peaceful as possible PHASE 1: HOPE Patients are admitted to C. NURSING THE DYING PATIENT OF RECOVERY the critical care environment because they are looking forward Intensive Care Units (ICU)’s are physically for the good limited that can prove challenging in management and fast maintaining dignity and support for the recovery relatives when providing palliative and This phase encompasses end-of-life care the early stages of critical care when medical PAIN, DISTRESS, AND ANXIETY teams are working to stabilize the patient, Common symptoms experienced by diagnose the underlying patients receiving palliative care, which is issues, and initiate appropriate treatments. aimed at improving the quality of life for During this time, there is individuals facing life limiting illnesses. an emphasis on Addressing these symptoms is a central providing the best component of palliative care, and it possible care to support requires a multidisciplinary approach to the patient's recovery. provide comprehensive support to PHASE 2: THE This involves recognition patients and their families. TRANSITIONAL that the treatment is not STAGE effective in the planned VISUAL ANALOG SCALE recovery of the patient as interventions have not Measurement tool used to assess or resulted in an quantify subjective experiences or improvement of the characteristics, such as pain, mood, or patient’s condition. other sensations. Respondents are asked to mark a point on PHASE 3: A When it becomes clear CONTROLLED that the patient's medical the line that best represents their DEATH condition is no longer perception or experience. responding to curative treatment, and the focus of care shifts to providing comfort, dignity, and support as the patient nears the end of life. PROPERTY OF KATE GUTIERREZ 14 EMERGENCY NURSING LUNA BATCH 2025 ST. LUKE’S COLLEGE OF NURSING PHARMACOTHERAPY 1. Medication Routes 2. Dosing and Titration 3. Side Effect Management SYMPTOM MANAGEMENT 1. Pain Management a. Opioids: Morphine i. Antidote: Naloxone b. NSAIDs: Contraindicated d/t GI bleeding 2. Nausea and Vomiting HOSPITAL ANXIETY AND DEPRESSION SCALE a. Antiemetics: Metoclopramide 3. Breathlessness Self-assessment questionnaire used to a. B2 Agonist: Salbutamol measure the severity of anxiety and 4. Anxiety and Depression depression in patients with physical health a. Anxiolytics b. Antidepressants: SSRI - mood problems, particularly in a hospital or regulator clinical setting. 5. Constipation Widely used in healthcare to screen for a. Laxatives: WOF: Diarrhea and assess symptoms of anxiety and 6. Delirium depression in patients with various a. Antipsychotics medical conditions 7. Secretions a. Suction b. Anticholinergics: Atropine PHARMACOTHERAPY/SYMPTOM MANAGEMENT c. Mucolytics: N-Acetylcistein 8. Pruritus (Itching) AKA medication management, is a critical a. Antihistamine: Diphenhydramine component of symptom management in b. Corticosteroids: Contraindicated palliative care. d/t immunosuppresion The primary goal of pharmacotherapy in 9. Agitation and Aggression: palliative care is to alleviate distressing a. Anxiolytics symptoms and improve the quality of life for individuals with life-limiting illnesses. HOSPICE/COMFORT CARE Symptoms addressed by pharmacotherapy in palliative care can be Specialized form of healthcare provided to diverse and include pain, nausea, individuals with life limiting illnesses, breathlessness, anxiety, depression, and typically when curative treatments are no other physical and psychological longer effective or desired. symptoms. PROPERTY OF KATE GUTIERREZ 15 EMERGENCY NURSING LUNA BATCH 2025 ST. LUKE’S COLLEGE OF NURSING The primary focus of hospice care is to ADVANCE DIRECTIVES provide comfort, improve the quality of life, Legal documents that outline a person's and support the emotional and healthcare choices. psychological well-being of patients and their families during the end-of-life LIVING WILL journey. Outlines the medical treatments an HOSPICE / COMFORT CARE individual would or would not want if they were unable to communicate their wishes. 1. Holistic Care It typically addresses situations like 2. Pain and Symptome Management end-of-life care, such as resuscitation, 3. Quality of Life mechanical ventilation, and artificial 4. Emotional and Psychological Support 5. Family Involvement nutrition. 6. Respect for Patient’s Wishes 7. Home-Based Care DURABLE POWER OF ATTORNEY FOR 8. Interdisciplinary Team HEALTHCARE (HEALTH CARE PROXY) 9. Bereavement Support 10. Medication and Treatment Designates a trusted person to make medical decisions on an individual's behalf if they are unable to do so. It's important to ADVANCE CARE PLANNING (ACP) choose someone who understands and Process that allows individuals to make respects the individual's preferences. informed decisions about their future medical care, especially in situations where DO-NOT-RESUSCITATE (DNR) ORDERS they may be unable to communicate their These are specific advance directives that preferences due to illness or indicate a person's preference not to incapacitation. receive cardiopulmonary resuscitation ACP helps people clarify their healthcare (CPR) if their heart stops or they stop wishes and document their choices in breathing. advance, ensuring that their values and preferences are respected when it comes COMMUNICATION AND PALLIATIVE CARE to medical treatment and end-of life care. To improve and ensure effective END-OF-LIFE CARE communication, during meeting, it should include relative/ family member, member 1. CPR (Cardiopulmonary Resuscitation) of nursing team and one doctor involve in 2. Ventilator Use the care of the patient. 3. Artificial Nutrition (Tube Feeding) and Artificial Hydration 4. Comfort Care PROPERTY OF KATE GUTIERREZ 16 EMERGENCY NURSING LUNA BATCH 2025 ST. LUKE’S COLLEGE OF NURSING INVOLVING THE FAMILY IN THE CARE COMPASSION FATIGUE Family of the patient wants to be more Gradual and cumulative emotional and actively involved in some of the practical physical exhaustion resulting from the aspects of the patient’s care. prolonged exposure to the suffering and Family members can be involved in distress of others. assisting in administering some AKA secondary traumatic stress or procedures for the patient like personal vicarious trauma. hygiene routines Phenomenon that can affect individuals Nurses need to encourage the family who provide care and support to others, member to talk to the patient. By particularly in high-stress and emotionally supporting relatives to talk to the patient demanding professions such as you can assist the family to feel a healthcare, social work, counseling, and connection with him or her. first responders. FIVE PRIORITIES OF CARE SIGNS AND SYMPTOMS 1. The possibility that a person may die 1. Chronic Fatigue within the next few days or hours is 2. Emotional Numbing recognized and communicated clearly, 3. Anxiety, Depression decisions made, and actions taken in 4. Irritability accordance with the person’s needs and 5. Difficulty Sleeping wishes and these are regularly reviewed, 6. Decrease Sense of Personal and decisions revised accordingly. Accomplishment 2. Sensitive communication takes place between staff and the person who is dying and those identified as important TREAMENT to them. 3. The dying person and those identified 1. Prevention and Coping Strategies as important to them are involved in 2. Self-Care decisions about treatment and care to 3. Seeking Help the extent that the dying person wants 4. Support and Awareness 4. The needs of families and others identified as important to the dying person are actively explored, respected ORGAN DONATION and met as far as possible Process of surgically removing organs or 5. An individual plan of care, which includes food and drink, symptom tissues from a living or deceased person control and psychological, social and (the donor) and transplanting them into spiritual support, is agreed, coordinated another person (the recipient) who has and delivered with compassion. organ failure or a life-threatening medical condition. Organ transplantation can save lives and improve the quality of life for individuals in need of a new organ. PROPERTY OF KATE GUTIERREZ 17 EMERGENCY NURSING LUNA BATCH 2025 ST. LUKE’S COLLEGE OF NURSING CULTURAL ISSUES IN PALLIATIVE AND END-OF-LIFE CARE A. CULTURAL CONSIDERATION ACCULTURATION CULTURE Process of social, psychological, and Social behavior and norms found in cultural change that stems from the human societies as well as the knowledge, balancing of two cultures while adapting beliefs, arts, laws, customs, capabilities and to the prevailing culture of the society. habits of the individuals in these groups Occurs over a large span of time throughout a few generations. CULTURAL DIFFERENCE More commonly, the process occurs through social pressure or constant In palliative care, attending to and being exposure to the more prevalent host aware of cultural differences is one of the culture central pillars of unique individualized care nurses you provide at the end of life. Each dying patient may experience similar BENEFITS OF ACCULTURATION diagnoses and symptoms, but each of 1. Closer cultural integration them may attach a different meaning of 2. Better understanding of each other these. 3. Enhanced quality of life 4. Improve cultural competent care 5. Dignified death REMEMBER! To provide patient-centered care, nurses will INFLUENCE OF CULTURE need to recognize individual and cultural differences. Unique aspects of culture—beliefs, mores, norms, standards, and guidelines—can play a significant role in how nurses and TYPES OF CULTURE clients handle the dying process 1. Descriptive a. Activities of behaviors CULTURE AND PAIN MANAGEMENT 2. Psychological a. Learning and problem solving Nurses, physicians, psychologists, social skills workers, pharmacists, spiritual advisors, 3. Historical alternative and complementary therapists, a. Heritage and traditions and other allied health professionals are associated with a group of people among the individuals who will assess and 4. Structural help relieve physical suffering, as well as a. Societal and organizational psychological, social, and spiritual/ structures 5. Normative religious distress. a. Rules and norms 6. Genetic a. Origins PROPERTY OF KATE GUTIERREZ 18 EMERGENCY NURSING LUNA BATCH 2025 ST. LUKE’S COLLEGE OF NURSING B. CONCEPTS OF DEATH AND DYING ACROSS REMEMBER! CULTURE It is important to communicate the patient’s CULTURAL VIEWS ON DEATH AND DYING beliefs and values about pain if they may affect their response to pain, treatment options, and Some cultures' spirit of someone who has whether they wish to use traditional healing died directly influences the living family practices versus Western medical treatments. members. Family members are comforted by the belief that their loved one is ALTERNATIVE OR COMPLEMENTARY PAIN watching over them. MANAGEMENT PRACTICES Some cultures believe that their deceased loved ones can come back from the dead 1. Herbal Remedies to join in the Day of the Dead celebration. 2. Therapeutic Touch Grief is often viewed as acceptable and 3. Acupuncture respectful of the deceased loved one. 4. Acupressure 5. Application of Heat Some cultures believe that when a child passes away, they are thought to become angels that go to heaven. HEALING ACTIVITIES Cultural beliefs and practices strongly TIBET SKY BURIAL Sky burial is common influence end-of-life views and the care in Tibet among that needs to be provided during this time. Buddhists who Clients’ requests for culturally specific end believe in the value of of-life rituals and ceremonies such as sending their loved ones’ souls toward funeral, burial, and mourning practices are heaven. In this ritual, important and should be conveyed to bodies are left those who love them as well as to their outside, often cut into caregivers. pieces, for birds or other animals to devour. HEALING ACTIVITIES This serves the dual purpose of 1. Journal Writing eliminating the now 2. Family Photos empty vessel of the 3. Music body and allowing 4. Life Assessment the soul to depart, 5. Engaging in prayer or medication while also embracing the circle of life and giving sustenance to animals. PROPERTY OF KATE GUTIERREZ 19 EMERGENCY NURSING LUNA BATCH 2025 ST. LUKE’S COLLEGE OF NURSING FAMADIHANA “Dancing with the THE PARADE A tradition from dead” Varanasi, India, involves The Malagasy people parading the dead of Madagascar open through the streets, the the tombs of their bodies dressed in colors dead every few years that highlight the and rewrap them in virtues of the deceased fresh burial clothes. (red for purity or yellow Each time the dead for knowledge, for get fresh wrappings, example). they also get a fresh In an effort to dance near the tomb encourage souls to while music plays all reach salvation, ending around. the cycle of This ritual—translated reincarnation, the as the “turning of the bodies are sprinkled bones”—is meant to with water from the speed up Ganges River and then decomposition and cremated at the town’s push the spirit of the main cremation dead toward the grounds afterlife. TOWER OF One Zoroastrian WATER Many cultures, especially SILENCE tradition requires BURIAL in Nordic countries, have vultures to keep its embraced water in their ancient burial ritual rituals of choice for the alive. dead, Water Burial from In that tradition a dead laying coffins atop cliffs body is believed to faced toward the water to defile everything it actually using the water touches—including the as a burial ground. Some ground and fire—and set bodies adrift in “death raising a corpse to the ships,” either along a river sky for vultures to or sent out into the devour was historically ocean, giving the bodies the only option. back to the gods or Bull’s urine is used to places most valued by clean the body before the people of the area. tools, which are later destroyed, are used to cut off clothing. The corpse is then placed atop a Tower of Silence, out of the way PROPERTY OF KATE GUTIERREZ 20 EMERGENCY NURSING LUNA BATCH 2025 ST. LUKE’S COLLEGE OF NURSING of the living who could FILIPINO During the Pre-Hispanic be tainted by it BURIAL period, the early Filipinos PRACTICES believed in a concept of ASHES TO While countless burial life after death. DEATH traditions around the Both indigenous BEADS world include ancestral veneration and cremation, South strong family and Koreans have taken it a community relations step further by turning within tribes, prompted the ashes of the the Filipinos to create deceased into beads. burial customs to honor Placed inside glass the dead through prayers vases or even open in and rituals. dishes, the beads can The Tinguian people then take center stage dress the deceased in the inside a home, a more fanciest of clothes and sit decorative choice than the body on a chair, often a conventional urn placing a lit cigarette in the lips, while the FUNERAL Wake that usually Benguet people blindfold RITES occurs in a funeral their dead before placing parlor. The body is them in chairs at the present and prayers entrance of the home. and eulogies are The Cebuano people offered by family and dress children attending friends. funerals in red to lessen The funeral mass is next the chance that they will which includes an see ghosts. opening prayer, bible The Sagada region readings, liturgy, features coffins hung communion, and a from cliffs, bringing the concluding rite. souls of the dead closer to The funeral then moves heaven, while people in to the cemetery where Cavite often entomb the a blessing of the grave, deceased vertically in a scripture reading, and hollowed-out tree chosen prayers conclude the by the person before funeral ritual. death. Present-day: holding a wake and a following mourning period. Modern traditions reflect indigenous values as well as influences of the PROPERTY OF KATE GUTIERREZ 21 EMERGENCY NURSING LUNA BATCH 2025 ST. LUKE’S COLLEGE OF NURSING Philippines' Spanish, person (example: Money, American, and Chinese house); loss of animate (pets) inhabitants. FAMILIAR Separation of environment or ENVIRONMENT people who provide security C. CONCEPTS OF LOSS, GRIEF, AND and care for one person BEREAVEMENT LOVED ONES Losing loved one or valued In a clinical setting, nurses encounter person through illness, clients who may experience grief divorce, separation or death related situations. LOSS OF LIFE Dying person may also feel May interact with dying clients and sadness / fear / pain about the their families or caregivers in a variety concept of death and he/she settings is living permanently The nurse should understand the significance of loss and develop the GRIEF ability to assist clients The total response to the emotional LOSS experience related to loss Permits to cope with the loss and An actual or potential situation in accept it as a part of reality which something that is valued is Social Process – best shared with changed or no longer available assistance of others People can experience the loss of body Experienced not only by the person image, a significant other, a sense of who faces the death of a loved one but well-being, a job personal possessions also by the person who suffers other of beliefs. kinds of losses. Permits the individual to cope with the TYPES OF LOSS loss gradually and to accept it as a part 1. Actual Loss of reality. 2. Perceived Loss It is a social process; it is best shared 3. Situational Loss and carried out with the assistance of 4. Anticipatory Loss others. 5. Developmental Loss BEREAVEMENT SOURCE OF LOSS Subjective response experienced by ASPECT OF Physical changes and SELF physiological function loss the surviving loved ones EXTERNAL Loss of inanimate objects that OBJECTS have importance to the PROPERTY OF KATE GUTIERREZ 22 EMERGENCY NURSING LUNA BATCH 2025 ST. LUKE’S COLLEGE OF NURSING MOURNING Masked grief can be in the form of Behavioral process through which grief physical is eventually resolved or altered symptoms or other negative GRIEVING PROCESS behaviors that are out of The grieving process is often harder character. Someone when the person has unresolved experiencing feelings towards or conflicts with the masked grief is person who has died. unable to People who are struggling with recognize that these symptoms complicated grief may find it helpful to or behaviors are talk with a counselor. connected to a May include a clinical social worker, loss psychologist, or spiritual counselor. Delayed Feelings are TYPES OF GRIEVING PROCESS purposely or subconsciously ABBREVIATED Brief but genuinely felt, suppressed until GRIEF normal a much later time. ANTICIPATORY Experience in advance GRIEF of the event Exaggerated Use of DISENFRANCHISED Unable to acknowledge dangerous GRIEF the loss to other people activities as a method to lessen COMPLICATED / To cope maladaptively pain. UNHEALTHY GRIEF The normal flow Unresolved/chronic grief of grief is like a Same signs of roller coaster normal. But the ride, with lots of bereaved person ups and downs. If may also have you are not difficulty expressing experiencing this the grief, may deny variety of the loss or may emotion, your grieve beyond the grief may be expected time. "stuck." One emotion is Inhibited often distorted, Hidden and you find grievance of a yourself feeling it person. frequently, such PROPERTY OF KATE GUTIERREZ 23 EMERGENCY NURSING LUNA BATCH 2025 ST. LUKE’S COLLEGE OF NURSING as anger or In Tibet, the Buddhist mourning depression. period following a funeral lasts 49 days. During this time the family gathers to make clay figures and prayer flags, FACTORS INFLUENCING THE LOSS AND GRIEF allowing for a collective expression of RESPONSES grief. 1. Human Development 2. Coping Strategies GRIEVING TIMES VARY BY CULTURE 3. Personal Relationships 4. Socioeconomic Status After a bereavement, a steady return to 5. Spiritual and Religious Beliefs 6. Nature of the Loss normal functioning can typically take 7. Culture two or more years. Experts no longer talk of “moving on”, D. CULTURAL PRACTICES IN GRIEVING but instead see grief as a way of adapting to loss while forming a COLLECTIVE GRIEF IS COMMON continuing bond with the lost loved one. When it comes to grieving in the west, In Bali, Indonesia, mourning is brief the focus is often placed on the and tearfulness is discouraged. If family individual. members do cry, tears must not fall on The reality is that the family – or for the body as this is thought to give the many Indigenous people, the tribe – person a bad place in heaven. To cry for grieves collectively, and in some too long is thought to invoke cultures this is more pronounced than malevolent spirits and encumber the others dead person’s soul with unhappiness. In Hindu families in India, for example, In Egypt, tearfully grieving after seven relatives and friends come together to years would still be seen as healthy support the immediate family in an and normal. elaborate 13-day ritual. A widow ceases to be the head of the household and SIGNS FROM ABOVE her place is taken by the wife of her oldest son. In many African societies, spiritual Typical of Native American culture, the connection to the deceased is Lakota tribe elders use the phrase considered normal and very real. “mitakuye oyasin”, meaning “we are all In sub-Saharan Africa, the traditional related”. The death of anyone in the belief is that the dead become spirits tribe is felt by all. but remain in the living world on Earth. They are thought of as the living dead. The spirit may appear in dreams in their human form. PROPERTY OF KATE GUTIERREZ 24 EMERGENCY NURSING LUNA BATCH 2025 ST. LUKE’S COLLEGE OF NURSING E. STAGES AND THEORIES OF GRIEVING SANDER’S PHASES OF BEREAVEMENT ENGEL’S STAGES OF GRIEF SHOCK client denies the loss and George Engel (a psychiatrist who refuses to accept it specialized in working with grief) AWARENES OF client begins to argued that the loss of a loved one is THE LOSS acknowledge the loss psychologically traumatic to the same extent that a severe wound is CONSERVATION client will withdraw from AND others and attempt to traumatic. WITHDRAWAL restore their physical and He equated mourning to healing (in emotional wellbeing the physical sense). HEALING OR client will move from THE TURNING emotional distress to the ENGEL’S STAGES OF GRIEF POINT point where they are able to learn how to live without SHOCK AND client denies the loss and the loved one DISBELIEF refuses to accept the fact that the loss has actually occurred RENEWAL client is able to during the shock and disbelief independently live without stage; the loved one DEVELOPING client discards the previous AWARENESS denial and begins to develop BOWLBY’S FOUR PHASES an awareness and acknowledgement of the loss; John Bowlby (1907-1990) was a British psychologist and psychiatrist who was RESTITUTION grieving person works through the mourning a pioneer of attachment theory in process, and they often children. He speculated and tested perform spiritual and cultural theories that attachment was a rituals during this stage; survival mechanism in human evolution, and that children mourned RESOLVING client seeks out of social THE LOSS support systems to resolve the separations from their primary grief after which the client caregivers. may deify and idealize the lost When a loss occurs, Bowlby suggested one; that grief was a normal adaptive response. He felt the response was IDEALIZATION client may deify* and idealize the lost one; and based on the environment and psychological make-up of the griever, OUTCOME client adjusts to and cope with and that there were normal reactions the loss one might expect. The ‘affectional bond’ had been broken, which resulted in grief. PROPERTY OF KATE GUTIERREZ 25 EMERGENCY NURSING LUNA BATCH 2025 ST. LUKE’S COLLEGE OF NURSING BOWLBY’S FOUR PHASES REMEMBER! SHOCK AND Sense the loss seems not Grief does not go away nor is it fully NUMBNESS real and seems resolved, but for Bowlby, the loss recedes impossible to accept. There is physical distress, and shifts to a hidden section of the brain, which can result in where it continues to influence us but is not somatic symptoms. at the forefront of the mind. YEARNING AND Clients are acutely aware SEARCHING of the void left by the WORDEN’S FOUR TASKS OF MOURNING loss. They search for comfort and try to fill the William Worden, a psychologist and void of their absence. grief counselor, developed the "Four They continue Tasks of Mourning" model, which identifying with the provides a framework for person who has died, understanding the grieving process looking for constant reminders of them and and the tasks individuals often face ways to be close to them. when dealing with a significant loss. Emphasizes the idea that mourning is DESPAIR AND Clients have accepted an active process that involves working DISORGANIZATION that everything has through specific tasks. changed and will not go back to the way it was or the way they imagined. WORDEN’S FOUR TASKS OF MOURNING There is hopelessness and despair, as well as TASK 1: anger and questioning. Clients may withdraw To accept the reality of the loss from others. TASK 2: RE-ORGANIZATION Clients’ faith in life starts AND RECOVERY to be restored. They Experience the pain of the lost and express it establish new goals and without judgement patterns of day-to-day life. Clients slowly start to TASK 3: rebuild and come to realize that your life can Adjust to the new reality without the lost person still be positive, even or object after the loss. Trust is slowly restored. TASK 4: Re-establish and re-invest in emotional ties PROPERTY OF KATE GUTIERREZ 26 EMERGENCY NURSING LUNA BATCH 2025 ST. LUKE’S COLLEGE OF NURSING RANDO’S “R” PROCESS MODEL READJUST Involves gradually letting The "R" Process Model, developed by TO THE NEW go of the emotional WORLD attachment to the Therese A. Rando, is a grief model that deceased and adjusting to provides a structured framework for life without their physical understanding and working through presence the mourning process. This model outlines six distinct REINVEST IN Individuals invest in their processes that individuals typically go THE NEW future and new possibilities. through when coping with grief. REALITY They may channel their These processes are often experienced energy and emotions into in a non linear and cyclical manner, new interests, relationships, and individuals may move back and and goals while continuing forth between them as they navigate to carry the memory of the deceased with them their grief journey. DUAL PROCESS MODEL OF COPING WITH RANDO’S “R” PROCES MODEL BEREAVEMENT RECOGNIZE THE Acknowledging and LOSS accepting the reality of the The Dual Process Model of Coping with loss. Bereavement, developed by Margaret Stroebe and Henk Schut, is a REACT TO THE Individuals experience a prominent psychological theory that PAIN wide range of emotional responses to the loss, provides insights into how individuals including sadness, anger, cope with the death of a loved one. guilt, and anxiety. This model was first proposed in the late 1990s and has since become RECOLLECT AND People reminisce about widely recognized and studied in the RE-EXPERIENCE their relationship with the deceased and engage in field of grief and bereavement. activities that help them remember and relive LOSS-ORIENTED STRESSORS memories. It's a way to keep the connection with the Involves facing and dealing with the deceased person alive. emotional impact of the loss itself. It encompasses activities such as RELINGQUISH Involves gradually letting go mourning, remembering the deceased, THE OLD of the emotional and processing the feelings of sadness, ATTACHMENT attachment to the anger, and despair deceased and adjusting to Acknowledges the importance of life without their physical allowing oneself to grieve and presence experience the emotions associated with loss. PROPERTY OF KATE GUTIERREZ 27 EMERGENCY NURSING LUNA BATCH 2025 ST. LUKE’S COLLEGE OF NURSING RESTORATION-ORIENTED STRESSORS DELAYED In some cases, grief reactions GRIEF may be delayed, and individuals Involves addressing the practical and may not fully process their loss functional changes that result from the until sometime after it has loss. occurred. May include dealing with financial matters, managing household responsibilities, or adapting to new roles KUBLER-ROSS STAGES OF GRIEF and relationships. Concerned with maintaining one's daily The Kübler-Ross model, also known as life and functioning. the five stages of grief, was developed by psychiatrist Elisabeth Kübler-Ross in her 1969 book "On Death and Dying." BONANNO’S TRAJECTORIES OF Outlines the emotional and BEREAVEMENT psychological stages that many people George A. Bonanno is known for his go through when facing a terminal research on bereavement and illness or dealing with the death of a resilience, and he has examined loved one. various trajectories or patterns of grief Not everyone experiences all of these that individuals may experience when stages, and they may not necessarily faced with the loss of a loved one. occur in a linear order. People may move back and forth between stages, skip stages, or experience them in a BONANNO’S TRAJECTORIES OF BEREAVEMENT different order. RESILIENCE Some individuals exhibit minimal KUBLER-ROSS STAGES OF GRIEF distress and are able to adapt relatively quickly to the loss, DENIAL individuals may have trouble showing resilience in their accepting the reality of the grieving process situation. They may deny that the illness is terminal or that the RECOVERY Others may initially experience death has occurred. Denial can significant distress but gradually serve as a protective mechanism, adapt and recover over time, allowing people to process the eventually returning to a state of news in smaller, more relative emotional well-being. manageable doses. CHRONIC Some individuals struggle with ANGER people may feel frustration, GRIEF prolonged and intense grief resentment, and anger about the symptoms, which may persist for situation. This anger can be an extended period, without directed at themselves, the significant improvement. deceased person PROPERTY OF KATE GUTIERREZ 28 EMERGENCY NURSING LUNA BATCH 2025 ST. LUKE’S COLLEGE OF NURSING BARGAINING individuals often make deals or bargains with a higher power or the universe in an attempt to reverse or postpone the loss. Bargaining can provide a sense of hope, even if it's unrealistic. DEPRESSION as the reality of the situation sets in and bargaining efforts fail, people may experience deep sadness and despair. This is often characterized by feelings of helplessness, hopelessness, and a sense of emptiness. It's an important stage for processing the loss and coming to terms with it ACCEPTANCE coming to terms with the reality of the situation. It doesn't necessarily mean that a person is "okay" with the loss, but they have reached a point where they can begin to move forward with their lives. They have accepted the inevitability of the loss and can find a way to live with it PROPERTY OF KATE GUTIERREZ 29