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CH 10 - Loss - Grief - Dying & Death
Terms in this set (55)
Signed & witnessed documents providing specific instructions for health care treatment in the event that a person is unable to make these decisions personally at the time they are needed.
To expect, await, or prepare oneself for the loss of a family member or significant other.
An examination performed after a person's death to confirm or determine the cause of death.
A common depressed reaction to the death of a loved one. --- Is a state of geat risk physically, as well as emotionally & socially.
Cessation of life.
DNR - DO NOT RESUSITATE
Means ONLY not to resuscitate...it does not mean to withhold any other care such as hygiene, nutrition, fluids, or medications.
DURABLE POWER OF ATTORNEY
Designates an agent, surrogate, or proxy to make health care decisions on his/her own behalf.
Unresolved grief or complicated mourning --- A delayed or exaggerated response to a perceived, actual, or potential loss.
Action deliberately taken with the purpose of shortening life to end suffering or to carry out the wishes of a terminally ill pt.
A pattern of physical and emotional responses to bereavement, separation, or loss. Is the subjective response of emotional pain to actual or anticipated loss. The total process of acting & responding to the losses in one's life. --- a normal and universal response to loss. Involves thought, feelings, & behaviors.
Mental treatment aimed at helping a pt. deal with the pain of loss; a program in assisting the bereaved to cope with their loss.
Adaptation process of mourning a loss.
A legal inquiry into the cause or manner of a death.
Written documents that direct treatment in accordance with a pts wishes in the event of a terminal illness or condition.
When any aspect of silf is no longer available to a person. --- Threatens self-concept, self-esteem, securit, and sense of worth.
Loss resulting from normal life transitions...ex. loss of childhood dreams...loss of "youth".
An illness or an abnormal condition --- both physical & mental.
The condition of being subject to death.
Person trained in the care of the dead.
Reaction activated by a person to assist in overcoming great personal loss --- refers to culturally defined patterns for expressions of grief. --- Ex: Funerals, wakes, memorials, black dress, & defined time of social withdrawal.
The prevention, relief, reduction, or soothing of symptoms of disease or disorders without effecting a cure.
Care of the pts body after death.
Loss occurring suddenly in response to a specific external event...ex. sudden death of a loved one, or unemployed person who suffers from loss of self-esteem
Those who study dying & death --- EX: Kubler-Ross's stages of dying & Martocchio's manifestations of grief.
The study of dying & death.
KUBLER-ROSS - STAGES OF GRIEVING/DYING
1. Denial & isolation ("No, not me") --- 2. Anger ("Why me?") --- 3. Bargaining ("Yes, but...") --- 4. Depression ("Yes, me") --- 5. Acceptance ("I am ready").
Easily identified...ex. a woman who has a mastectomy.
Less obvious & easily overlooked...ex. a woman who hopes to give birth to a boy, but has a girl.
Any significant loss that requires adaptation through the grieving process.
GOAL OF GRIEVING PROCESS
The resolution of the hurt & the reestablishment of one's life.
GRIEVING TASKS TO FACILITATE HEALTHY ADJUSTMENT TO LOSS
1. Accepting the reality of the loss --- 2. Experiencing the pain of grief --- 3. Adjusting to an environment that no longer includes the lost person, the object, or the aspect of self --- 4. Reinvesting emotional energy into new relationships
NURSES ROLE FOR GRIEVING PROCESS
To assess grieving behaviors, recognize the influence of grief on behavior, & provide empathetic support.
"OUT OF SEQUENCE" DEATH
The sudden death of someone who is not "supposed to die". (Sometimes the most difficult to bear).
REQUISITES FOR NURSES WORKING WITH DYING PTS.
1. Coming to grips with understanding the grief process --- 2. Appreciating the experience of the dying pt --- 3. Using effective listening skills --- 4. Acknowledging personal limits --- 5. Knowing when there is a need to get away & take care of the self.
When initial loss is compounded with an additional loss before resolution of the initial loss.
Critical to survival.
UNRELIEVED GRIEF & STRESS
Can lead to diminished well-being & inability to care for others.
PERSONAL SUPPORT SYSTEM
Should be in place continually if one is working in areas where a high # of deaths occur.
Term used when stresses exceed the rewards of the job and the individual nurse lacks the support of peers.
CONCEPTS & THEORIES OF GRIEF
Are only tools that can be used to anticipate potential needs of pts & families & to plan interventions to help them understand their grief while trying to deal with it. --- To expect pts to progress in some specific manner over a specified time would be incorrect, inappropriate & possibly harmful.
When there is some disturbance of the normal grieving progress towards resolution.
OCCURRANCE OF DYSFUNCTIONAL GRIEF
1. Gets "stuck" in the grief process & becomes depressed --- 2. Is unable to express feelings --- 3. Cannot find anyone in his or her daily life who acts as the listener he/she needs --- 4. Suffers a loss that stirs up other, unresolved losses & causes him/her to explore long-standing feelings or emotional concerns --- 5. Lacks the reassurance & support to trust the grief process & fails to believe that he/she can work through the loss.
MARTOCCHIO'S SURVIVOR'S REACTION: MANIFESTATIONS OF GRIEF & BEREAVEMENT
1. Shock & Disbelief ("Maybe this is not happening") --- 2. Yearning & Protest ("Why do I feel this way") --- 3. Anguish, Disorganization, & Despair ("Living is a chore", "All the joy has gone out of my life") --- 4. Indentification in Bereavement ("I am just like him"-dying or dead person) --- 5. Reorganization & Reinstitution ("Life goes on", "The sun has risen on a new day")
5 ASPECTS OF HUMAN FUNCTIONING
1. Physical --- 2. Emotional --- 3. Intellectual --- 4. Sociocultural --- 5. Spiritual
SUPPORTIVE CARE ASSESSMENT - PHYSICAL
Assess for: Sleeping patterns, Body Image, ADLs, Mobility, General health, Medications, Pain --- Goals: Energy conservation, Pain reduction techniques, Comfort measures, Promotion of sleep & rest, Increasing self-esteem through body image acceptance.
SUPPORTIVE CARE ASSESSMENT - EMOTIONAL
Assess for: Anxiety level, Guilt, Anger, Level of acceptance, Identification --- Goals: Accept pt/family's individual feelings, Offer encouragement & support, Give pt "permission to die" by assisting pt in saying good-bye.
SUPPORTIVE CARE ASSESSMENT - INTELLECTUAL
Assess for: Education level, Knowledge & abilities, Expectations they have in regard to how & when death will occur --- Goals: Keeping all informed of procedures, changes in condition of pt, & hospital policies --- Well informed decisions being made when necessary.
SUPPORTIVE CARE ASSESSMENT - SOCIAL
Assess for: Whether family members desire to assist in pts daily care, (NEVER ASSUME FAMILY WANTS TO DELIVER DAILY CARE), Learn whom the pt considers significant others,
SUPPORTIVE CARE ASSESSMENT - SPIRITUAL
Assess pts: Philosophy of life, Religious resources, How rituals of pts particular faith group have significance in dealing with his/her death. --- Interventions can come from clergy, friends, family, health care providers, & significant others --- Support pts/family's belief system & values.
Assist pt & family identify hopes that are important to them & will help them cope --- Is multidimensional & a changing life force --- Is the common thread identified in all stages of grief --- Characterized bgy confident yet uncertain expectation of achieving a goal --- Is not a single act, but a complex series of thoughts, feelings, & actions that changes often.
RELINQUISHMENT OF HOPE
Rapidly followed by death.
CONCEPT OF DEATH - INFANCY TO 5 YRS
Does not understand concept of death --- Infant's sense of separation forms basis for later understanding of loss & death --- Believes death is reversible, temporary departure, or sleep
CONCEPT OF DEATH - 5-9 YRS
Understands that death is final --- Believes own death can be avoided --- Associates death with aggression or violence --- Believes wishes or unrelated actions can be responsible for death
CONCEPT OF DEATH - 9-12 YRS
Understands death as the inevitable end of life --- Begins to understand own mortality --- Expressed as the interest in afterlife or as fear of death
CONCEPT OF DEATH - 12-18 YRS
Fears a lingering death --- May fantasize that death can be defied, acting out defiance through reckless behaviors --- Seldom thinks about death, but views it in religious & philosophical terms --- May seem to reach "adult" perception of death bu be emotionally unable to accept it.
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