Grief is a normal, emotional reaction to an external and consciously known loss. It usually subsides gradually and is time – limited. Mourning and bereavement are terms commonly being incorrectly interchanged with the word grief.However, these terms have something in common – loss. A loss provokes the sentiment of grieving and mourning. Examples of loss could be: loss of a loved one, a change in one’s life situation where goals are hindered, a deprivation of something that was before was present.
The grieving process comprises several stages until acceptance is resumed. Kubler- Ross identified five stages of grief which are: (1) Denial – when disbelief and signs of shock is observable; (2) Anger – when a dying client shows irritability and difficulty in dealing his illness, more often the client questions God for his illness; (3) Bargaining – it is when the client gradually accepts his fate but is not yet ready to face it; (4) Depression – it is the most complicated situation not only for the client but also for the his family because it is really hard to see a dying loved one mourn for his future loss; and (5) Acceptance – the stage when the client already accepted his fate with all his will, strengthening him with inner peace.
The five stages of grief could be explained in a listed manner back in our lecture session about death and dying. However, true experience of anticipatory loss and actual loss are simply overwhelming. Sometimes these stages are combined in one setting or at times client go back to the previous stage of grief and again continue to other stages. To some who adapts rapidly to stress, they jump and skip other stages and gain acceptance immediately.
Death is irreversible and accepting it is much easier than accommodating the truth of your loved one’s impending passing away. It actually varies from one person to another. In short, making oneself strong is much challenging to beat.
The role of a nurse in providing a peaceful death is considered the most sensitive and critical area of practice. It involves a no – tears philosophy and a tough heart like a stone. Emotional break outs are a no – no in the nursing profession. But, as nurses what can we do to help our dying clients in their path of fate?
If there are five stages of grief, there are also five wishes that a nurse could offer to her client during end –of- life condition.
1. Ask your client to state the name of whom will decide for his treatments and health care modalities; it is advised to ask the client who he wants to decide for his health care treatments especially if he cannot decide on his own like being put to a hospice care setting or a home care institution.
2. Give him the right to decide on what treatment options he would like to have or not.With this, the right to self- determination and autonomy could be still practiced. In return clients somehow develop a sense of self appreciation despite critical health condition.
3. Let him state on how he wants himself to be as comfortable as possible.Choices should be given to him through a list of daily activities, food preferences, relaxation techniques and pain management.
4. Ask him how he wants other people treat him.This answers the spiritual needs of the client, for instance, he wants his children to be there always at bedside, or he wants his family pray with him every night, or if he wants a chaplain or a priest to talk to and or if he wants to die at home or in the hospital setting.
5. Encourage him to verbalize how he wants to be remembered. It is the most challenging portion among the five wishes because it may become too emotional for the client to explain how he wants his loved ones know his upcoming loss. It may also include what clothes would he want to wear during his funeral and the like.
Advanced care planning is a facilitated discussion that involves the discussion of the client’s desires. It needs much consideration on his values and goals. In the Philippines, advanced care planning is not really practiced, unless in some special circumstance. The five wishes stated above are helpful in discussing the advanced care planning and being a supportive nurse during the imminent death will be most appreciated by the dying client.