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Introduction

The client from our case scenario, Mr. Wu, who is a 35 years old fireman in Hong Kong and breadwinner of his family, he is married and has a son called Tim who are 15 years old. During an industrial building blaze, he was found unconscious by his teammates on the building’s fourth floor as firefighters were changing shifts to leave the site. He is admitted to my ward and I am the nurse responsible to take care of Mr. Wu. Unfortunately, Mr. Wu passes away one week after his hospitalization. Three months later, I have a chance to meet Mrs. Wu and Tim after Mr. Wu has passed away. According to Tim, Mrs. Wu stopped playing tennis, an activity that had been a passion of her. Mrs. Wu no longer attended church, stating that whatever faith she had was squashed when Mr. Wu was taken so cruelly from her. Mrs. Wu had lost 10 pounds and, previously well groomed, now always looked untidy and bewildered. She cried often and became angry when Tim asked if she wanted to go on a trip with him. She told Tim that she didn’t know what to do with herself and that she no longer had a purpose without Mr. Wu. One night, Tim had found her sitting on Mr. Wu’s favorite chair sobbing. Mrs. Wu told Tim that Mr. Wu had asked her to cook him breakfast at that fateful day, but she refused and go play tennis instead. Tim cried and told me that he needed his father back, he became angry and told me that his life was empty. I explained the signs of complicated grief to Tim and gave him pamphlets for the bereavement resource center and some reading materials and websites.

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In this essay, the Kübler-Ross model – five stages of grief is applied. The effect on Mrs. Wu and her son in psychological and social aspects on the death of Mr. Wu will be discussed and several strategies of therapeutic communication by the nurse when communicating with Mrs. Wu and her son are suggested. The resources on psychological financial support in the local health care system and in the community to help Mrs. Wu and Tim to go through the grief and bereavement process will also be identified.

Application of nursing theory during the hospitalization of client

During the hospitalization of Mr. Wu, as he is unconscious, he is considered as a dying patient. The five stages of grief developed by Elisabeth Kübler-Ross is applied in taking care of Mr. Wu and his family. The five stages of grief are denial, anger, bargaining, depression and acceptance (Kübler-Ross, 2005). It is a series of emotions that may be experienced by Mrs. Wu and Tim.

Mr. Wu’s wife, Mrs Wu and his son, Tim may first go through the stage of denial and shock. In this stage, people tends to reject and deny the fact of the dying situation of the loved one. Mrs. Wu and Tim may respond at first by being paralyzed with shock or blanketed with numbness after noticing the dying situation of Mr. Wu (Kübler-Ross, 2005). They may say that “Mr. Wu is not going to die” or “it is impossible that he is dying”. As a nurse, it is important to build rapport with Mr. Wu’s family by offering self and by their side to attend to their needs. Besides, a nurse should support the defense mechanism and reassuring them that denial is normal and show by our own behaviour and attitudes that it is permissible for them to express grief and allow them to express their feelings so they would know that they can trust the nurse with his feelings (NursingCrib,2014).

Mrs. Wu and Tim may move on to the anger stage after they discover that that denial cannot continue. Anger is necessary stage of the healing process, it may present in many ways which does not have to be logical or valid .They may experience guilt, when anger turn toward self. (Kübler-Ross, 2005). Mrs. Wu and Tim may emotionally blame the person who cause the fire accident which put Mr. Wu to the dying situation or even blame the god for taking away live of Mr. Wu who saves lives in a fire accident is not fair. Mrs. Wu told Tim that Mr. Wu had asked her to cook him breakfast at that fateful day, but she refused and go play tennis instead, Mrs. Wu felt guilty for her rejection to Mr. Wu and go to play tennis instead. At this situation, a nurse should allow them to talk and express feelings which helps the client to relieve distress. On the other hand, nurse can explain the role of anger in the grief process to help the Mrs. Wu and Tim focus on their grief rather than the perceived shortcomings (Williams, 2016).

Psychological and social effect on family members after the death of the client

In psychological aspect, the impacts of grief include emptiness and loneliness, anger, ongoing sadness, loss of interest in things that used to bring pleasure (New South Wales Health, 2016) Mrs. Wu and Tim is in the depression stage of grief, they showed emptiness and loneliness as Mrs. Wu said she didn’t know what to do with herself and that she no longer had a purpose without Mr. Wu, and Tim said that his life was empty. Mrs. Wu cried often has loss of interest in playing tennis which had been her favorite activity since she was guilty about she refused to cook breakfast for Mr. Wu and go to play tennis instead. Tim said that his life was empty. Mrs. Wu also show anger in not attending church as God had taken Mr. Wu so cruelly from her. It may become clinical depression in long term.

In social aspect, the impacts of grief include withdrawal and isolation (New South Wales Health, 2016). Mrs. Wu had withdrawn herself from social activities such as playing tennis and attending church and she has isolated herself. In this situation, she stop interacting with friends who used to play tennis and attend church with her and she have less chance to develop healthy social life. Besides, she no longer care for her image the she looked untidy and bewildered. Tim may also withdraw from his friends due to the grief.

Strategies of therapeutic communication

There are some strategies of therapeutic communication should be applied by the nurse when communicating with Mrs. Wu and her son. The first strategy is active listening, it involves showing interest in what Mrs. Wu have to say, acknowledging that we are listening and understanding, and engaging with them throughout the conversation by giving appropriate response (Engard,2017). Second, the nurse should stay focused with natural eye contact with them, do not judge what they have said and be patient. Third, making observations is necessary to help draw attention to some problems (Engard,2017), nurse should try to understand the emotion of Mrs.Wu and Tim behind their words by observing their body language and behavior. Fourth, paraphrasing or restate their words encourages more in-depth discussion and it could help clarify the informations(Carpinello, 2004). Finally, the nurse should ask more open-ended question when communicating with them because it allows them in exploring their feelings and thoughts more deeply. However, questions begin with “why” should be avoided which could make them feel offensive (Carpinello, 2004).

Resources of psychological and financial support in Hong Kong

There are resources in the local health care system and in the community to help Mrs. Wu and Tim to go through the grief and bereavement process with psychological and financial support. 

For financial support, Mrs. Wu can. apple a scheme called “Financial Assistance Scheme for Family Members of Those Who Sacrifice Their Lives to Save Other” developed the Labour and Welfare Bureau that aim to provide financial support to the family members of those who sacrifice their lives to save others. (Labour and Welfare Bureau, 2002).

For psychological support, Mrs. Wu and Tim could get support from the Social Welfare Department. It provides several types of clinical psychological services to the public as referred by the social workers from the Social Welfare Department. (Social Welfare Department, 2017) Besides, The Hospital Authority and the Mental Health Association of Hong Kong maintain 24-hour hotlines for people who need psychological help (GovHK, 2016). A number of other government departments and non-government organizations such as the Hong Kong Family Welfare Society also offer hotlines and mental health services for different target groups (GovHK, 2016).

Conclusion
In conclusion, people who had experienced loss, like Mrs. Wu and Tim in this case, would go through some stages or all five stages of grief. It would affect them in both psychological and social aspect like feeling of emptiness, loss of interest in activities and withdrawal from social activities etc. It is responsible for a nurse to handle clients and their family members with care and strategies of therapeutic communication such as active listening, focusing and making observations to help them accept and heal from the loss. There are adequate resources in Hong Kong that could help Mrs. Wu and Tim to go through the grief and bereavement process with psychological and financial support.
In the hope that Mrs. Wu and Tim could go through the grief and bereavement process soon and return to a normal and healthy life with the help of caregivers and the resources in the community.

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