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Chapter 42 Loss, Grief, and DyingKK

Terms in this set (70)

occurs when a valued person, object, or situation is changed or becomes inaccessible such that its value is diminished or removed
loss
can be recognized by others as well as by the person sustaining the loss, for example loss of a limb, a child, a valued object such as money and a job
actual loss
the loss of youth, financial independence, and a valued environment, is experienced by the person but is intangible to others
perceived loss
occurs when a person displays loss and grief behaviors for a loss that has yet to take place, such as in families of patients witha serious or life threatening illness
anticipatory loss
an internal emotional reaction to loss, occurs with loss caused by separation or by death, normal expressions of ____ may be physical, emotional, or spiritual
grief
the actions and expressions of that grief, including the symbols and ceremonies (funeral) that make up the outward expressions of grief
mourning
in a state of grieving from loss of a loved one
bereaved
abnormal or distorted, may be either unresolved or inhibited, in unresolved a person may have trouble expressing feelings of loss or may deny them, in unresolved grief thre is a state of bereavement that extends over a lengthy period
dysfunctional grief
a person who has sustained either 1) irreversible cessation of all functions of circulatory and respiratory functions or 2) irreversible cessation fo all functions of the entire brain, including the brainstem is ____
death
an illness in which death is expected within a limited period of time,
terminal illness
is care provided for people with limited life expectancy often in the home, focuses on the needs of the dying patient
hospice
written directive that allows people to state in advance what their choices for health care would be if circumstances should develop
advance directive
what are two types of advanced directive?
living wills and a durable power of attorny
medical order indicating a patient's wishes regarding treatments commonly used in medical crisis
physician order for life-sustaining treatment form
do not resuscitate order
no attempts are to be made to resuscitate a patient who is breathing or heart stops
comfort measures only order
indicates the goal of treatment is comfortable, dignified death and that further life sustaining measures are no longer indicated
gradual withdrawal of mechanical ventilation from a patient with a terminal illness or an irreversible condition with a poor prognosis
terminal weaning
mercy killing, the deliberate termination of the life of a person
euthanasia
taking specific steps to cause a patient's death
active euthanasia
withdrawing medical treatment with the intention of causing a patients death
passive euthanasia
lowering of patient consciousness using medication for the express purpose of limiting patient awareness of suffering that is intractable and intolerable
palliative sedation
what types of loss exist?
actual loss, perceived loss, anticipatory loss,
what are some components of grief?
mourning, grief reactions (Kublar ross), dysfunctional grief
5 stages of grief according to Kublar Ross
1) denial, 2) anger, 3) bargaining, 4) depression, 5) acceptance
what are the clinical signs of impending death?
difficulty talking or swallowing, nausea, flatus, abdominal distention, urinary/bowel incontinence or constipation, loss of movement, sensation, and reflexes, decreasing body temperature with cold or clammy skin, weak, slow, irregular pulse, decreasing blood pressure, noisy, irregular, or cheyne strokes respirations, restlessness/agitation, cooling, mottling, and cyanosis of the extremeties and dependent areas,
what happends in kublar ross's stage of dying denial?
this is the first stage the patient denies the reality of death and may repress what is discussed, the patient may think "they made a mistake in my diagnosis"
what happends in kublar ross's stage of dying- anger?
the patient expresss rage and hostility and adopts a "why me" attitude
what happends in kublar ross's stage of dying- bargaining?
the patient tries to barter for more time, "if i can just make it to my sons graduation" Many patients put their affairs in order, make wills, and fulfill last wishes, such as trips, visiting relatives, and so forth, it is important to meet these wishes, if possible because bargaining helps patients move to later stages of dying
what happends in kublar ross's stage of dying- depression?
the patient goes through a period of grief before death, the grief is often characterized by crying and not speaking much " I waited all these years to see my daughter get married"
what happends in kublar ross's stage of dying- acceptance?
the patient feels tranquil, the patient has accepted the reality of death and is prepared to die, the patient will think "I have tied up all of my loose ends made the will, now I can go in peace"
the ANA issued position statements stating that assisting in suicide and participating in active euthanasia are in violation of the
code for nurses , the ethical traditions and goals of the profession, and its covenent with society.
the physician order for life sustaining treatment form must be completed and signed by a health care professional and cannot be filled out by the patient, these forms are always completed in close consultation with the
patient to ensure that the patient's values and goals are accurately represented
explain factors that affect loss, grief, and dying
age
family relationships
socioeconomic position
cultural and religious influences
developmental considerations
cause of death
physiologic care of the dying patient includes what?
involves meeting physical needs such as personal hygiene, pain control, nutritional and fluid needs, movement, elimination, and respiratory care, personal hygiene includes cleanliness of the skin, hair, mouth, nose, eyes, frequent baths and linen changes may be necessary
psychological care of the dying patient includes what?
a fear of isolation, of having to face death alone, is a primary concern of a dying patient, support the patient by indicating your presence, giving full attention, and showing that you care, encourage the presence of family members in the room and sharing of reminiscences,
how should you address spritual needs of a dying patient?
help obtain the services of clergy or pastoral care workers as the situation indicates,
focused assessment for those experiencing loss, grief, and dying is directed toward determining the
adequacy of the patient's family's knowledge
assessment in the nursing process for grieving or dying patients and families includes what
it is directed toward determining the adequacy of the patient's and family's knowledge, perceptions, coping strategies, and resources
the data the nurse collects about how a patient or the patient's caregivers are responding to an actual or impending loss or to impending death may support several
different nursing diagnosis
in diagnosisng response to a loss can be used as both
problem and etiology
in the outcome identification and planning stage of the nursing process nursing care should be directed toward acheiving goals such as
demonstrates freedom to express feelings, needs, fears, and concerns
identify and use effective coping strategies
accept need for help as appropriate and useful available resources
make health care decisions reflecting personal values and goals,
declare preferences regarding treatment options,
report sufficient relief of pain to interact meaningfully with family and to attend everyday concerns
experience a dignified and comfortable death
resolve grief after a suitable period of mourning
in the implementation phase of the nursing process for grieving or dying patients and families,the nurse aims to
care for dying patients and their families which include facilitating coping of the dying person and family and promoting health and preventing illness of the family
implementation for the grieving or dying patients and families includes
developing a trusting nurse-patient/family relationship
explaining the patient's condition and treatment
teaching self care and promoting self esteem
teaching family members to assist in care
meeting the needs of a dying patient
meeting the needs of the family
providing postmortem care
when a patient dies what are the nurse's responsibilites when a patient dies?
caring for the patient's body
caring for the family
discarging specific legal responbilities
ensuring that the death certificate is issued and signed, labeling the body, and reviewing organ donation arragnments if any
what is the role of the nurse when caring for the family of a dying patient?
nurses play an important role in ensuring that timely prognostic information is givent to patients and families so that they can decide hwo to spend their last days together
Actual loss
can be recognized by others
Perceived loss
is felt by person but intangible to others
Physical loss versus psychological loss
example: someone who has lost their limbs and also feels like shameful of their body
Maturational loss
experienced as a result of natural developmental process
Situational loss
experienced as a result of an unpredictable event
Anticipational loss
loss has not yet taken place (hospice, terminal illness)
Grief
internal emotional reaction to loss
Bereavement
state of grieving from loss of a loved one
Mouring
actions and expressions of grief that make up outward expression of grief (ceremonies, funeral)
What are Engel's Six Stages of Grief
Shock and disbelief (refusal to accept the fact of loss, followed by a stunned or numb response)

Developing awareness (physical and emotional responses such as anger, feeling empty, and crying: Why me?)

Restitution: (involves the rituals surrounding--with death, religious, cultural, or social expression or mouring, such as funeral ceremonies)

Resolving the loss (dealing with the void left of loss)

Idealization: exaggeration of the good qualities that the person or object had, followed by acceptance of the loss and a lessened need to focus on it.

Outcome: The final resolution of the grief process, includes dealing with loss as a common life occurrence.
Definition of Death
An individual who has sustained either 1. irreversible cessation of all functions of circulatory and respiratory functions or 2 irreversible cessation of all functions of the entire brain, including the brainstem, is dead.
What are the component of a good death?
Control of symptoms
Preparation for death
Opportunity to have a sense of completion of one's life
good relationship with health care professionals
What are some clinical signs of impending death?
Difficulty talking or swallowing
Nausea, flatus, abdominal distention
Urinary and/or bowel incontinence or constipation
loss of movement, sensation, and reflexes
decreasing body temperature, with cold or clammy skin
weak, slow, or irregular pulse
decreasing blood pressure
noisy, irregular, or cheyne-stokes respirations
restlessness and/or agitation
Cooling, mottling, and cyanosis of the extremities and dependent ares
Kubler-Ross's Five stages of Grief
Denial and Isolation
Anger
Bargaining
Depression
Acceptance
Hospice
is care provided for people with limited life expectancy, often in the home. This is terminal and death is pending/ it is the result.
Palliative Care
is care that is appropriate across the spectrum of disease and illness. This is management of the symptoms. You care for the whole person body, mind, spirit, heart and soul. Give patients the best quality of life aggressive management of symptoms.
Advanced Directives
Who will make the decision when the patient is not capable
What kind of medical treatment the patient wants or doesn't
How comfortable the patient wants to be
How the patient wants to be treated by others
What the patient wants loved ones to know
Special Orders
Allow natural death, do not resuscitate, or no code orders
Terminal weaning
Voluntary cessation of eating and drinking
Palliative sedation
Factors affecting grief and dying
Developmental considerations (how children are affected vs. how the parents are affected)

Family (older siblings might be strong for the younger ones, parents for the kids)

Socioeconomical factors (may not be financially stable after loss of a loved one)

Cultural gender and religious influences (some keep inside, some are vocal)

Cause of death (army, crash)
Needs of Dying Patients
Physiologic needs: physical needs, such as hygiene, pain control, nutritional needs

Psychological needs: patient needs control over fear of the unknown, pain, separation, leaving loved ones, loss of dignity, loss of control, unfinished business, isolation

Needs for intimacy: patient needs ways to physically intimate that meets needs of both partners

Spiritual needs: patient needs meaning and purpose, love and relatedness, forgiveness and hope
Developing a Trusting Nurse-Patient Relationship
Explain the patients condition and treatment
Teach self-care and promoting self-esteem
Teach family members to assist in care
Meet the needs of the dying patient
Meet the family needs
Providing Postmortem Care
Care of the body
Care of the family
Discharging legal responsibilities
Death certificate issued and signed
Labeling body
Reviewing organ donation arrangements, if any
Care of other patients
Postmortem Care of the Body
Prepare the body for discharge
Place the body in anatomic position, replace dressings, and remove tubes (unless there is an autopsy scheduled)
Place identification tags on body
Follow local law if patient died of communicable disease
Postmortem care of the family
Listen to family's expressions of grief, loss, and helplessness
Offer solace and support by being an attentive listener
Arrange for family members to view the body
In case of sudden death, provide a private place for family to begin grieving
It is appropriate for the nurse to attend the funeral and make a follow-up visit to the family.
Care for the grieving nurse
Nurses need to asses their own emotional well-being
Self-reflection is a part of critical thinking that assesses whether sadness is related to caring or unresolved personal experiences.
Being a professional is knowing when to get away from the situation to care for yourself.
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