Summary

In all areas of care, nurses will encounter patients experiencing death, dying, loss, or grief. Understanding the concepts of loss and grief, particularly in relation to death and dying, prepares the nurse to support patients physically and emotionally. Grief is complicated, with no one-size-fits-all treatment plan. Many factors play a role in how people react to loss and experience grief. Grief, bereavement, and mourning are unique experiences for each individual and are affected by personal values and specific cultural beliefs. Nurses must maintain a nonjudgmental attitude in caring for grieving patients and consider cultural differences associated with bereavement and mourning.

Nurses must be prepared to address the physical, social, and emotional experiences of grief. Physical symptoms associated with grief, such as heart palpitations, dizziness, fatigue, and muscle tension, often overlap with emotional dysregulation, such as depression, anxiety, and anger. The social effects of grieving occur in response to these physical and emotional experiences and impact family and community relationships. Grief is triggered by loss, which may be actual, perceived, anticipatory, maturational, or situational. Regardless of the type of loss, nursing actions focus on the individual patient response. Although grief is highly variable, nurses can anticipate patterns and responses based on the stages of grief outlined by theorists such as George Engel and Elisabeth Kübler-Ross. Nurses knowledgeable about the variations in grief and other responses to loss are empowered to offer meaningful support to their patients.

Nurses must have a clear understanding of the dying process to provide appropriate interventions and education to patients and families faced with death and dying. Equipped with this knowledge, nurses can effectively create individualized care plans as patients begin to experience the stages of death. By anticipating individual and family needs during physical, psychological, and societal death, nurses promote quality end-of-life care.

Educating family members on expectations at the end of life can reduce stress and create a greater sense of peace as they say goodbye to their loved ones. Education should focus on explaining expected physiological changes associated with respiration, circulation, digestion, urination, and cognition. Nurses must include anticipatory guidance on how these changes will affect the visual appearance and responsiveness of the patient.

Supporting individuals and family members facing a terminal illness diagnosis is complex. Terminal illness progression is highly variable between individuals and disease states. Supporting individuals through terminal illness involves an interdisciplinary team approach to provide emotional, physical, and psychosocial care. Quality of life and dignity during death can be maximized through palliative care, comfort care, and hospice services.

Responses to death and dying are highly individualized. However, there are commonalities in the factors that affect these responses. Type of death, timing, age, and maturation all affect how an individual perceives and processes death and moves through the grieving process. Family members experiencing a loss through death struggle with many emotional challenges, including fear, anxiety, and guilt, as well as a wide range of physical symptoms. After a death, family structure, financial situation, and dynamics may change. Socioeconomic factors such as financial stability, physical location, living arrangements, and transportation all impact an individual’s ability to seek and access quality care. The type of death—whether sudden (such as an accident, homicide, suicide, or illness) or anticipated (such as a terminal illness)—influences the grieving process. Suicide is a particularly devastating type of death that may leave individuals feeling extreme guilt, shame, and depression. Nurses must be sensitive to cultural differences in the experience of grief and differences linked to the type and timing of death.

Nurses must fully understand legal and ethical concepts surrounding death and dying, regardless of their practice setting. The complicated topics of euthanasia, provider-assisted death, and terminal weaning are a basis for understanding the legal and ethical aspects of death and dying in patients with terminal illnesses. Nurses will rely on state standards and federal regulations in regard to legal matters associated with provider aid in dying. Awareness of advance planning, POLST, and the concept of comfort measures at the end of life help nurses provide individualized care that fulfills the wishes of each patient. Nurses provide hands-on care to dying patients and are an essential part of end-of-life family support. Nurses may be involved in comfort measures, terminal weaning, and care that allows natural death. Nurses must evaluate their thoughts and beliefs about death with dignity, comfort care, and advance directives. After-death care focuses on the dignity of the patient and the care of the family. Nurses can create a peaceful atmosphere for families to express their cultural responses to death in a safe environment. Organ donation consent, preparation for autopsy, and immediate postmortem care are all critical aspects of nursing care, particularly in the hospital setting. Understanding these issues empowers nurses to advocate for their patients even in their final days. Cultural awareness and compassion are essential in postmortem care.