BEREAVEMENT

CARE, DEATH AND

LAST OFFICES.
GROUP 7
MEMBERS
• KITOLO JOSHUA KAINDI KITOLO............CLM/M/1652/09/22
• KARIMI VALENTINE…………………………….CLM/M/2371/09/22
• MARY WOKABI…………………………………..CLM/M/2164/09/22
• SHEILA CHEROTICH...............................CLM/M/1807/09/22
• MWAKIRETI DARIUS MAGHANGA........CLM/MG/2464/09/21
• PATRICK FRANCIS MULWA………………….CLM/M/3658/09/22
• NAOMI CHEPKIRUI……………………………..CLM/MG/1515/09/22
BEREAVEMENT CARE
• Bereavement care refers to the support and assistance
provided to individuals who are grieving the loss of a
loved one.
• It encompasses a range of services aimed at helping
people cope with their emotions, navigate the mourning
process, and adjust to life after the death of a
significant person in their lives.
• Bereavement care can be provided by various
professionals and organizations, including counselors,
therapists, support groups, religious leaders, and
healthcare providers.
Key components of bereavement care may
include:
• Emotional support: Providing a safe space for individuals to express their feelings of
grief, sadness, anger, guilt, or any other emotions they may be experiencing.
• Counseling and therapy: Offering individual or group counseling sessions to help
individuals process their grief, gain insight into their emotions, and develop coping
strategies.
• Education: Providing information and resources about the grieving process, common
reactions to loss, and healthy coping mechanisms.
• Practical assistance: Helping with practical tasks such as funeral arrangements,
legal matters, and financial planning.
• Support groups: Facilitating support groups where individuals can connect with
others who are experiencing similar losses, share their stories, and find comfort in
knowing they are not alone.
• Spiritual guidance: Offering spiritual support and guidance for individuals who draw
strength from their faith or spiritual beliefs during times of grief.
• Follow-up and long-term support: Checking in with individuals periodically to
assess their ongoing needs and provide continued support as they navigate the
various stages of grief.
DEATH
• Is irreversible cessation of circulatory and respiratory functions or
irreversible cessation of all functions of the entire brain, including the
brainstem.
Impending death
• Impending death refers to the period preceding an
individual's death when signs and symptoms indicate
that death is approaching.
• This phase can vary in duration and presentation
depending on factors such as the underlying health
condition, age, and overall health of the individual.
• Impending death may involve physical, emotional, and
behavioral changes that indicate the body is gradually
shutting down. Some common signs of impending death
include:
• Physical Changes: Cooling of the extremities, Changes in
skin color, decreased blood pressure etc.
• Mental and Emotional Changes: Confusion, disorientation,
Restlessness or increased agitation, Hallucinations or visions.
• Reduced Consciousness: Progressive loss of
consciousness, Inability to be aroused or respond to stimuli,
Lapse into a coma-like state.
• Decreased Appetite and Thirst: Loss of interest in food
and fluids, Inability to swallow or difficulty swallowing, Dry
mouth or throat.
• Social and Spiritual Signs: Increased focus on spiritual or
religious matters, Desire for solitude or, conversely, a desire
for the presence of loved ones, Expressions of gratitude or
forgiveness.
Factors that might constitute a
good death
• Pain Management: Effective pain relief through medication, massages, or alternative
therapies.
• Comfort and Symptom Management: Addressing nausea, shortness of breath, or anxiety to
ensure physical comfort.
• Dignity and Respect: Honoring cultural and spiritual beliefs, providing privacy, and
respecting autonomy.
• Emotional and Spiritual Support: Compassionate care from healthcare providers, chaplains,
and counselors.
• Effective Communication: Open discussions about prognosis, treatment options, and end-of-
life preferences.
• Presence of Loved Ones: Having family and friends present for emotional support and
meaningful connections.
• Closure and Completion: Resolving conflicts, expressing forgiveness, and finding peace.
• Control and Autonomy: Respecting the dying person's preferences regarding treatment and
decision-making.
• Practical Considerations: Addressing legal and financial affairs, making end-of-life
arrangements.
• Legacy and Meaning-Making: Sharing life experiences, leaving behind a meaningful legacy
for loved ones.
• What is Grieving and Loss?
• Grieving is a unique and personal emotional and psychological reaction to a
perceived or real loss. It encompasses a range of manifestations, such as
physical symptoms, emotional distress, and behavioral changes.
• Grief can be defined as the neuropsychological response to any kind of
significant loss, with elements both typical and unique to each individual or
situation. The grief response is generally associated with degrees of suffering,
at times intense or even unbearable, and of widely variable duration (Walsh &
Walsh-Burke, 2021).
• Loss pertains to the absence of something valuable, be it an object, person,
emotion, or idea. There are various categories: Actual Loss, which is
acknowledged by others; Perceived Loss, which is internal and might not be
recognized by others; Maturational Loss, a natural part of growth; Situational
Loss, which arises unexpectedly; and Ultimate Loss or Death, impacting both
the deceased and those left behind, potentially serving as a growth opportunity
for the survivors.
• Mourning is defined as the public display of grief. Mourning emphasizes the
external or public expressions of grief. It can be influenced by one’s beliefs,
religious practices, and cultural context (PDQ Supportive and Palliative Care
Editorial Board, 2022).
• Bereavement is defined as the objective situation one faces after having
lost an important person through death. Bereavement is conceptualized
as a statement of the objective reality of a situation of loss via death.
• Anticipatory grief is the expression of the symptoms of grief prior to
the actual loss, the grief period following the loss may be shortened and
the intensity lessened because of the previous grief. This term is most
often used when discussing the families of dying persons, although dying
individuals themselves can experience anticipatory grief. Anticipatory
grief has been defined as the total set of cognitive, affective, cultural, and
social reactions to expected death felt by the client and family.
• Acute grief involves a period of intense emotions with a preoccupation
with thoughts and memories of the deceased person that may result in a
period of reduced engagement with life and prior activities. (Szuhany et
al., 2021)
• Integrated grief means that the individual has
adapted to the loss so that grief is more in the
background and they can meaningfully reengage in a
life without the deceased.
• Prolonged grief disorder is characterized by elevated
and persistent mental distress following the loss.
Factors contributing to prolonged grief reactions are
maladaptive thoughts, avoidance behaviors, inability to
manage painful emotions, differences in health and
social status, and lack of social support that interferes
with adaptation to loss.
Loss
• It pertains to the absence of something valuable, be it an object,
person, emotion, or idea. There are various categories:
• Actual Loss: This refers to a tangible, concrete loss that is easily
identifiable. It involves the physical absence of something or
someone that was once present. Examples of actual loss include the
death of a loved one, the end of a relationship, the loss of a job, or
the loss of a home due to natural disaster or other circumstances.

• Perceived Loss: Perceived loss refers to a subjective experience of

loss that may not necessarily involve a tangible or concrete absence.
It's based on the individual's perception and interpretation of the
situation rather than an objective reality.
Cont..
• Anticipatory Loss: Anticipatory loss occurs when
individuals experience grief and mourning before an
actual loss has occurred. This often happens when
someone is facing a terminal illness or when a
significant change is expected in the future.
Grieving Process
• There are three phases of grief:
• Protest. Lack of acceptance, concerning the loss,
characterized by anger, ambivalence, and crying
• Despair. Denial and acceptance occur simultaneously
causing disorganized behavior, characterized by crying
and sadness
• Detachment. Loss is realized; characterized by
hopelessness, accurately defining the relationship
with the lost individual and energy to move forward in
life.
Kubler’s 5 Stages of Grieving
• Denial: Initially, individuals may deny the reality of the situation. They might refuse to
believe the news or minimize its significance, creating a buffer against the shock of the
loss.
• Anger: As reality sets in, individuals may feel anger and frustration. They might direct
their anger towards themselves, others, or even the situation or object of their loss. It's
a common reaction to feeling out of control or powerless.
• Bargaining: In this stage, individuals may attempt to negotiate in an attempt to regain
what they've lost or to postpone the inevitable. They may make deals with themselves,
others, or a higher power, seeking ways to change the outcome.
• Depression: As the reality of the loss becomes more evident, individuals may
experience profound sadness and despair. This stage involves coming to terms with the
inevitability of the loss and its implications. It's a period of mourning and introspection.
• Acceptance: In this final stage, individuals come to terms with the reality of the
situation. They accept the loss and begin to integrate it into their lives. This doesn't
necessarily mean they're happy about it, but they've reached a point of understanding
and peace regarding the situation.
Grief reactions: 6 stages of grieving
according to Engel (1964):
• Shock and Disbelief: This initial stage involves the feeling of
disbelief or numbness following a significant loss. Individuals may
have difficulty processing the reality of the situation and may feel
overwhelmed by emotions.
• Developing Awareness: In this stage, individuals begin to come
to terms with the reality of the loss. They start to recognize and
accept the fact that the loss has occurred, although they may still
experience disbelief and confusion.
• Restitution: During this stage, individuals may focus on practical
matters related to the loss, such as making funeral arrangements,
settling legal matters, or addressing financial issues. It's a phase of
taking action to deal with the consequences of the loss.
CONT…
• Resolving the Loss: In this stage, individuals engage in emotional
processing and begin to work through their feelings of grief. They may
experience a range of emotions, including sadness, anger, guilt, and
regret, as they come to terms with the impact of the loss on their lives.
• Idealization of the Deceased (or Lost Object): During this stage,
individuals may idealize the person or thing that was lost. They may
focus on positive memories and attributes, romanticizing the past and
overlooking any negative aspects.
• Outcome: Engel's model doesn't specify a final stage, but it suggests
that individuals eventually reach a point where they can integrate the
loss into their lives and move forward. This doesn't necessarily mean
they stop grieving, but rather that they find a way to live with the loss
and continue to grow and adapt.
Last offices
Last Offices, also known as "final care" or "end-of-life
care," refers to the care provided to a deceased person
immediately after death.
This care is typically carried out with respect and dignity
to prepare the body for viewing by loved ones or for
transfer to a mortuary.
Practices involved in last offices
include
• Confirmation of Death: Healthcare professionals confirm the patient's death by
checking for vital signs such as pulse, breathing, and responsiveness.
• Privacy and Dignity: The deceased person is covered with a sheet to maintain
privacy and dignity.
• Removal of Tubes and Lines: Any medical tubes, lines, or equipment are removed
from the body.
• Cleaning and Positioning: The body is gently cleaned to remove any bodily fluids
or debris. It is then positioned with the head slightly elevated, arms at the sides, and
eyes closed.
• Care of Personal Belongings: Personal belongings are gathered and secured for
return to the family.
• Documentation and Reporting: Healthcare professionals document the time and
circumstances of death, as well as any relevant information about the care provided.
• Family Support: Healthcare staff offer support and comfort to the deceased
person's family members, answering questions and providing guidance on what to
expect next.
• Last Offices are performed with sensitivity and respect
for cultural and religious beliefs, as well as the wishes of
the deceased person and their family. The goal is to
ensure that the final moments with the deceased loved
one are peaceful and dignified.
REFERENCES
1. Jevon, P. (2009). Care of the dying and deceased patient: A practical guide for nurses. John
Wiley & Sons.
2. Old, J. L., & Swagerty, D. (2007). A practical guide to palliative care. Lippincott Williams &
Wilkins.
3. Perry, A. G., Potter, P. A., Ostendorf, W. R., & Laplante, N. (2021). Clinical nursing skills and
techniques - E-book: Clinical nursing skills and techniques - E-book. Elsevier Health Sciences.