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Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Chapter 10 Nurse-Patient Relationships During Grief, Mourning, and Loss Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Grieve big and small losses throughout life Weddings, graduations; off to kindergarten, college Divorce Loss of a job (financial security) Loss of loved ones Losses associated with illness (self-esteem, belief systems, faith, hope, dreams) Often producing feelings of guilt Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Patient-Safe Strategies for Crying Use empathy: “I can see you’re upset” Allow emotional release through tears and words Raging and crying—allow patient to regain control (blow off steam); keep silent and accept response Quiet crying—sit on same level, hold hand, offer tissues Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Encouraging Emotional Release Using Tears: “ A Good Cry” Tears reduce emotional pain levels Release of stress-related tensions and hormones in tears Relieve feelings of loss, sadness, grief, frustration and anger Initial release of catecholamines increases heart rate and blood pressure, followed by parasympathetic response generating systemic relaxation Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety What not to say….. “There’s no need to cry. You’re doing fine.” (stop) “Please stop crying now.” “Get hold of yourself.” (stop) “Think positive.” (advice) “Think of your family.” (guilt) “You must be strong.” “You must be a man about this.” “It’s time to get on with your life.” “I know how you feel.” Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Gender Differences Women vent tensions, anger, and frustrations by crying; across cultures, women cry more than men Men more often yell or shout Pressure for men not to cry for fear of being labeled “sissy” or “crybaby”: “You’re a big boy. Big boys don’t cry.” Men generally tend not to express emotions as much as women Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Why Do Women Cry and Express Themselves More Freely? Socialization? Girls encouraged to express themselves and cry Physiological? Women secrete a hormone prolactin (30 times more than men) involved in tear production Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Grief Associated With Death and Significant Loss Shock, disbelief, denial Anger—Lack of control Guilt and fear—Am I being punished? Depression and sadness—Nothing will ever be the same again Come to terms with loss and make plans Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Before helping others grieve/mourn losses: You must recognize your own vulnerability to loss and pain Acknowledge you can never be in “total” control of your life Acknowledge your own mortality Anticipatory grieving—emotional responses to potential loss Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Grief work: After death of loved one, intense and painful Loss of pet—20 hrs crying Spouse, parent, friend, child—200 to 300 hrs crying Talk through tears; review good and bad memories Restructure and rebuild lives without the loved one Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Grief work takes 1-3 years People, events, objects evoke memories of the deceased, bringing on feelings of sadness, depression, tears Holidays, special events Dysfunctional grieving: Unsuccessful responses at working through the process of loss Sadness turns into depression Emotional depression – unable to function in personal lives or jobs Physiological depression of immune system Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Successful Resolution of Grief Never forget but go on without the other Become actively involved in meaningful activities once more; still see purpose in life Greater understanding of life, greater compassion for suffering and the needs of others Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Emotions are contagious We feel the same emotions as those around us We must acknowledge and accept the emotions in ourselves and our patients Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Health-Care Providers Cry, Too! When caring for patients and families, you will become close to some and experience grief along with them. Crying with a family member or patient is fine, as long as the other cries first. Avoid crying unless the patient cries first. If you are upset, you may need to excuse yourself and go to a private place. Discuss your feelings with a trusted nursing student/ faculty. Journaling to express feelings. Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Non-emotional health-care provider doing tasks, procedures, paperwork comes across as uncaring, task-oriented, too busy to be bothered