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LESSON PLAN ON COPING WITH LOSS,

DEATH AND GRIEVING

Submitted to- Mrs. Fareha Khan


Tutor

Submitted by - Ms. Sneha Sehrawat


MSc Nursing ( OBG)
Rufaida College of Nursing

IDENTIFICATION DATA
NAME

SNEHA SEHRAWAT

CLASS

M.SC NURSING 1ST YEAR

SUBJECT

ADVANCED NURSING PROCESS

UNIT

VIII

NAME OF THE UNIT

PSYCHOLOGICAL ASPECTS AND HUMAN RELATIONS

TOPIC

COPING WITH LOSS, DEATH AND GRIEVING.

GROUP

PEER ( MSC NURSING, 1ST YEAR)

SIZE OF GROUP

21

VENUE

M.SC NURSING 1ST YEAR CLASSROOM, RUFAIDA COLLEGE OF


NURSING

DURATION OF TEACHING

30min

METHOD OF TEACHING

LECTURE CUM DISCUSSION

AUDIO VISUAL AIDS USED

BLACK BOARD, FLASH CARD, CHARTS,FLIP CHART

DATE

31/10/2016

TIME

2-3 P..

NAME OF THE SUPERVISOR

MRS FAREHA

PREVIOUS KNOWLEDGE

The group has previous knowledge about various teaching coping with
loss,death and grieving from B.SC Nursing program.

GENERAL OBJECTIVES
Student point of view
After the class, students will be able to:
Acquire knowledge of topic- COPING WITH LOSS, DEATH AND GRIEVING.
Verbally share emotions felt after their first experience with the death of someone or something.
Identify and express emotions they have experienced while personally dealing with the death of someone or something, or
have observed another experiencing.
Nurses role in loss, grief, death and dying
Emotional reactions to loss.
Student- teacher point of view

To demonstrate effective teaching.


To gain confidence in facing the class.
To gain confidence in the effective use of audio-visual aids.
To gain knowledge in classroom management.
To acquire in depth knowledge about the topic.

TIME

SPECIFIC
OBJECTIVES

CONTENT

TEACHING-LEARNING
ACTIVITY

.
3 mins

INTRODUCTION
Birth and death are two
aspects of life, which will
happen to everyone. Dying
and death are painful and
personal experiences for
those who are dying and their
loved ones caring for them.
Death affects each person
involved in multiple ways
including physical,
psychological, emotional,
spiritual and financial.
Grieving is painful, and its
important that those who
have suffered a loss be
allowed to express their grief.
Its also important that they
be supported throughout the
process.

EVALUATION

Each person grieves


differently. The length and
intensity of the emotions
people go through varies
from person to person.
Although grief is described in
phases or stages, it may feel
more like a roller coaster,
with ups and downs that
make it hard for the bereaved
person to feel any progress in
dealing with the loss.

.
1min

ANNOUNCEMENT OF
TOPIC
Today, I, Ms. SNEHA
SEHRAWAT, would discuss
about COPING WITH LOSS,
DEATH AND GRIEVING.

At the end of the


class, students
will be able to:
2 min

10 mins

To define grief.

To enumerate
various types of
griefs.

Grief is a natural emotional response to


Student-teacher defines
loss. Its the emotional suffering you feel
micro-teaching using
when something or someone you love is
transparency..
taken away. The more significant the loss,
the more intense the grief will be.Grief is
the physical, psychological & spiritual
response of loss.The time grieving
depends on the significance of loss, the
length of time the person was known, the
anticipation of or preparation for the loss,
the persons emotional stability and
coping ability. Regardless of the duration
of the grieving process, there are two basic
goals:
1. Healing the self
2. Recovering from the loss.
Student teacher enumerates
Normal grief - It consists of normal
types of grief using charts.
feelings, behaviors and reactions to
loss. This response to a loss can prove
helping one to mature and develop as a
person. It includes resentment, sorrow,
anger,crying, loneliness and temporary

Define grief.

with drawl from activities .


Anticipatory grief - The process of
disengaging or letting go that occurs
before an actual loss of death has
occurred.
Complicated grief - When the person
has difficulty in progressing through
the normal process of grieving,
bereavement become complicated.
a) Chronic grief- begins as normal grief
but continues long term, with little
resolution of feelings and inability to
rejoin normal life.
b) Delayed grief- A grief that is put of
until a later time.
c) Exaggerated grief
d) Masked grief- Occurs when the person
is grieving but expressing the grief
through other types of behaviors.
Disenfranchised grief - Person
experiences grief when a loss is
experienced and cannot be openly
acknowledged, socially sanctioned, or
publically shared.

What do you
understand by
anticipatory
grief?

2 min

To define loss.

Loss can be defined as the undesired


change or removal of a person, object or
situation. The experience of loss is
painful , frightening, and lonely, and it
triggers an array of emotional responses.

10 min

To enlist various Types of losses are :Student teacher enlists and


types of losses.
describes different types of
Necessary loss- It is an integral part of losses.
each persons life. Natural losses are
something natural and positive. For egNatural growing up process, start or
leave school, change friends.
Actual loss- The loss of any person or
object that can no longer be felt, heard,
known or experienced. For eg- Loss
of body part, Child relationship, or role
at work.
Perceived loss- Any loss that is
uniquely defined by the grieving
client, may be less obvious to others.
They are easily overlooked and
misunderstood, yet the progression of
grief follows the same sequencing and
progression as the actual losses. For
eg- loss of confidence or prestige.

Maturational loss- Any change in the


developmental process that is naturally
expected during a lifetime. It is part of
normal life transition. For egwrinkles , age lines, receding hairline .
Situational loss- It includes any sudden
unpredictable external event. Often
these types of losses includes multiple
losses rather than single loss. For egAn automobile accident leaves the
driver paralyzed, unable to return to
work and grieving over the loss of
passengers in the accident.
Loss of external objects- Extend of
grief involves on objects value,
sentiments attached to it and its
usefulness. For eg- Loss,
misplacement, deterioration,
destruction by natural causes.
Loss of known environmentLoneliness or a new unfamiliar
environment threatens self esteem, and
makes grieving difficult. For eg moving to a new neighborhood,
hospitalization, new job.

Loss of significant others- Loss of


family member, friend , trusted people
or animal companion.
Loss of life- Loss of life created grief
for those left behind. People facing
death often fears pain, loss of control,
dependency on others.
5 min

To define
coping

Any effort directed to stress management, Student nurse defines coping


with lecture method.
including task-oriented and ego defense
mechanisms, the factors that enable an
individual to regain emotional equilibrium
after a stressful experience. It may be an
unconscious process.
Psychologists Richard Lazarus and Susan
Folkman scientifically defined coping as
the sum of cognitive and behavioral
efforts, which are constantly changing,
that aim to handle particular demands,
whether internal or external, that are
viewed as taxing or demanding. Simply
put, coping is an activity we do to seek
and apply solutions to stressful situations
or problems that emerge because of our
stressors.
In psychology, coping means to invest
own conscious effort, to solve personal

Give an
examples of
situational loss.

and interpersonal problems, in order to try


to master, minimize or tolerate stress and
conflict.The body has an interior set of
coping mechanisms for encountering
stress. This includes the "fight or flight"
reaction to high stress or trauma.
3 min

To enumerate
factors
influencing loss
and grief.

Factors influencing Loss and Grief:


The way an individual perceives a loss and
responds to it during bereavement is
heavily influenced by many factors.

Student nurse enumerates


factors influencing loss and
grief with the help of flash
cards .

1. Human development
2. Psychological perspective of loss and
grief
3. Socioeconomic status
4. Personal relationships
5. Nature of loss
6. Culture and ethnicity
7. Spiritual beliefs
10 min

To explain the
stages for grief
model .

Dr Elisabeth Kubler-Ross pioneered


methods in the support and counseling of
personal trauma, grief and grieving,
associated with death and dying. She also
dramatically improved the understanding
and practices in relation to bereavement
and hospice care. This is quite aside from
the validity of her theoretical work itself,

How personal
relationships can
influence loss
and grief?
Student nurse explains the
grief model of Kubler-Ross
with the help of charts.

on which point see the note, right.

Her ideas, notably the five stages of grief


model (denial, anger, bargaining,
depression, acceptance), are transferable to
varying degrees and in different ways, to
personal change and emotional upset
resulting from factors other than death and
dying.

Denial
Denial is a conscious or unconscious
refusal to accept facts, information, reality,
etc., relating to the situation concerned. It's
a defense mechanism and perfectly
natural. Some people can become locked
in this stage when dealing with a traumatic
change that can be ignored. Death of
course is not particularly easy to avoid or
evade indefinitely.

anger
Anger can manifest in different ways.
People dealing with emotional upset can
be angry with themselves, and/or with

others, especially those close to them.


Knowing this helps keep detached and
non- judgmental when experiencing the
anger of someone who is very upset.
Bargaining
Traditionally the bargaining stage for
people facing death can involve
attempting to bargain with whatever God
the person believes in. People facing less
serious trauma can bargain or seek to
negotiate a compromise. For example
"Can we still be friends?.." when facing a
break-up. Bargaining rarely provides a
sustainable solution, especially if it's a
matter of life or death.
Depression
Also referred to as preparatory grieving. In
a way it's the dress rehearsal or the
practice run for the 'aftermath' although
this stage means different things
depending on whom it involves. It's a sort
of acceptance with emotional attachment.
It's natural to feel sadness and regret, fear,
uncertainty, etc. It shows that the person
has at least begun to accept the reality.

acceptance
Again this stage definitely varies
according to the person's situation,
although broadly it is an indication that
there is some emotional detachment and
objectivity. People dying can enter this
stage a long time before the people they
leave behind, who must necessarily pass
through their own individual stages of
dealing with the grief.

4 min

To enlist various These undermentioned factors affects grief Student teacher enlists
factors affecting response various factors affecting grief
grief response.
responses.
Age
Significance of loss
Culture, spiritual beliefs
Gender
Socioeconomic status
Support systems
Cause of death
Verbalization of loss
Crying
Sleep disturbance
Loss of appetite
Difficulty concentrating

What are
different of
stages of
grieving process
proposed by
Kubler-Ross?

Enlist various
factor affecting
grief response.

2 min

To describe
DEATH - Death is a universal experience,
concept of
one that we will all eventually face
death and dying.
FUNCTIONAL DEATH- is the absence
of a heartbeat and breathing.

Student teacher describes the


concept of death and dying.

BRAIN DEATH- A state where brain


activity is nominal,it has become the
medical measure of death (no possibility
of restoring brain function).
After the death of a loved one, a painful
period of adjustment follows, involving
bereavement and grief
BEREAVEMENT- It is the
acknowledgment of the objective fact that
one has experienced a death.
GRIEF- It is the emotional response to
that loss.

What do you
understand by
functional
death?

5 min

To enlist nursing
diagnosis and
interventions
related to
coping.

NURSING DIAGNOSIS
Grieving r/t an actual or potential loss
Anticipatory grieving
Dysfunctional grieving
Impaired adjustment r/t incomplete
grieving over loss of physical function
Social isolation r/t death of a spouse
Altered family process
NURSING INTERVENTION
Facilitate understanding of the
mourning process
Providing information
Communicating with sensitivity
Supporting meaningfulness
Providing for human comfort and
support
Encouraging reality of loss
Communicating with sensitivity
Use simple, nonjudgmental statements
Refer to a loved one or object of loss
by name Appropriate use of touch
indicates caring
Respect the client's unique process of
grieving
Respect the client's personal beliefs
Be honest, dependable, consistent, and
worthy of the client's trust

The student teacher enlists


nursing diagnosis and
interventions related to
coping.

1 min

SUMMARY
Today we discussed about
grief, types of grief, loss,
types of loss, factors
influencing loss and grief ,
Kubler-Ross stages of
grieving, Death and dying
framework, Engels model of
grief response.

1 min

CONCLUSION
Grieving is painful, and its
important that those who
have suffered a loss be
allowed to express their grief.
Its also important that they
be supported throughout the
process. Each person grieves
differently. The length and
intensity of the emotions
people go through varies
from person to person.
EVALUATION
The students are evaluated on
the basis of questions being
asked to reinforce attention
while taking the teaching
session.

research input
1) Objective: The aim of this study was to
evaluate the stressful events of life within
1 year preceding onset or exacerbation of
skin disease in patients of psoriasis
vulgaris and chronic urticaria.
Method: Fifty consecutive clinically
diagnosed psoriasis patients and 50
consecutive clinically diagnosed chronic
urticaria patients were examined clinically
and administered Gurmeet Singh's
presumptive stressful life events scale
Role of stressful life events in induction or
exacerbation of psoriasis and chronic
urticaria.
Year:2008, volume: 74, issue:6, page:
594-599
2) Background: The possibility of a causal
influence of emotional stress, especially of
stressful life events, on the course of

various skin diseases has long been


postulated. Previous reports addressing its
influence on skin psoriasis and chronic
urticaria have been mainly anecdotal
Results: Stressful life events were seen in
26% of the patients in the psoriasis
vulgaris group and 16% of the patients in
the chronic urticaria group within 1 year
preceding onset or exacerbation of skin
disease.
In the psoriasis vulgaris group, the most
common stressful life event seen was
financial loss or problems (8%), followed
by death of close family member (4%),
sexual problems (4%), family conflict
(2%), major personal illness or injury
(2%),and transfer or change in working
conditions (2%), failure in examinations
(2%), family member unemployed (2%),
illness of family member (2%), getting
married or engaged (2%), miscellaneous
(2%).
Conclusion: Psychological stress plays a
significant role in triggering or

exacerbating dermatological diseases.


3) This study indicates the role of
relaxation therapies and stress
management programs in chronic diseases
such as psoriasis and chronic urticaria.
Psychological interventions can help
individuals to reinterpret events and
develop strategies to cope with stressful
events, thus decreasing morbidity due to
these diseases.

4) The effect of music on biochemical


markers and self-perceived stress among
first-line nurses: a randomized controlled
crossover trial.
The aim of this study was to examine the
effects of music on stress indices and to
examine the association between music
preference and stress.
FINDINGS:
Compared with chair rest, participants had
a lower perceived stress level, cortisol,

heart rate, mean arterial pressure and


higher finger temperature while listening
to music (P < 005). Significant
differences were also found between the
two conditions in terms of post-test heart
rate, cortisol levels, finger temperature and
mean arterial pressure (P < 005). Music
preference scores ranged between 7 and
10, with a mean score of 881 (sd = 105),
and was significantly associated with
mean arterial pressure, cortisol levels, selfperceived stress and finger temperature.
CONCLUSION:
The findings provided evidence for nurses
to use soothing music as a research-based
nursing intervention for stress reduction

BiBliography
Hayslip, B., & Peveto, C.A., (2005).
Cultural changes in attitudes toward
death, dying, and bereavement. New
York, NY: Springer Publishing

Company, LLC.
Scarre, G. (2012). Can there be a good
death?. Journal Of Evaluation In
Clinical Practice, 18(5), 1082-1086
Van Leuven, K. (2012). Advanced
care planning in health service users.
Journal Of Clinical Nursing,
21(21/22), 3126-3133.
Corr, C. A., Corr, D. M., & Nabe, C.
M. (1994). Death and dying life and
living. Belmont, CA: Wadsworth, Inc.
Neimeyer, R., Harris, D., Winokuer,
H., & Thornton, G. (2011). Grief and
bereavement in contemporary society:
Bridging research and practice. New
York, NY: Taylor and Francis Group.
Living with Death and Dying by
Elizabeth Kubler -Ross, M.D.