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Death & Grief Chapter 36
Terms in this set (67)
What are the different types of losses?
What is an actual loss?
Occurs when a person can no longer feel, hear, see, or know a person or object
What is perceived loss?
uniquely defined by the person experiencing the loss and is less obvious to other people
What is situational loss?
-sudden, unpredictable external events
-Can be a loss of a body part from injury
What is necessary loss?
Learning to expect that most necessary losses are eventually replaced by something different or better
What is maturational loss?
Form or necessary loss and includes all normally expected life changes across the life span
What is maturational loss associated with?
Normal life transitions help people develop coping skills to use when they experience unplanned, unwanted, or unexpected loss.
What influences the depth and duration of the grief response?
-The type of loss
-Person's perception of it
What influences how a person approaches death?
-Previous experiences with death
-Degree of social support
What does coping with grief involve?
A period of mourning
Bereavement involves both?
Grief & mourning
What are the different types of grief?
-Complicated (chronic, exaggerated, delayed, masked
What is normal grief?
-Common & universal reaction characterized by complex: emotional, cognitive, social, physical, behavioral, & spiritual responses to loss & death
What are signs of normal grief?
When does a person experience anticipatory grief?
-Before the actual loss or death occurs
-Especially in situations of prolonged or predicted loss
(E.G: caring for a PT diagnosed with dementia or ALS)
When do people experience disenfranchised grief (ambiguous)?
-When their relationship to the deceased person is not socially sanctioned
-Can't be openly shared
-Seems of lesser significance
What is Ambiguous loss?
A type of disenfranchised grief
When does Ambiguous loss occur?
-When the lost person is physically present but is not psychologically available
-E.G in cases of severe dementia or brain injury
What does a person have with complicated grief?
-A person has a prolonged or significantly difficult time moving forward after a loss
-Experiencing a chronic & disruptive yearning for the deceased
-Has trouble accepting the death & trusting others
-Feels excessively bitter, emotionally numb, or anxious about the future
What does a person with chronic grief experience?
Normal grief response except it extends for a longer period of time
What does a person with exaggerated grief response exhibit?
-Self destructive or maladaptive behavior
-SUICIDE IS A RISK FOR THESE INDIVIDUALS
What is masked grief?
-When a grieving person behaves in ways that interfere with normal functioning
-But is unaware that the disruptive disorder is a result of the loss and ineffective grief resolution
How is a persons grief response?
Unusually delayed or postponed because the loss is so overwhelming that the person must avoid the full realization of the loss
What organizations assist in end-of-life care?
◦End-of-Life Nursing Consortium (ELNEC)
◦American Society of Pain Management Nurses
◦American Association of Critical Care Nurses
Why do nurses need to develop a plan of care?
To assist patients & family members who undergo loss, grief, or death experiences
What do nurses implement plans of care for?
End-of-Life Nursing Consortium (ENLEC)
Provides basic & advance curriculum for loss, grief, death, & bereavement
The American Nurses Association (ANA)
-Has developed the Scope and Standards for hospice and Palliative Nursing Practice
Both American Society of Pain Management Nurses and the American Association of Critical Care Nurses offer?
evidence-based practice guidelines for managing clinical and ethical issues at the end of life in many health care settings.
What factors influence loss & grief?
-nature of the loss
-spiritual and religious beliefs
What affects grief response?
Patient age & stage of development
•Patient age and stage of development affect the grief response.
•School-age children understand the concepts of permanence and irreversibility but do not always understand the causes of a loss.
•Young adults undergo many necessary developmental losses related to their evolving future.
For older adults the aging process leads to necessary and developmental losses.
What influences the grief response?
When loss involves another person, the quality & meaning of the lost relationship
When do grievers experience less depression?
They have highly satisfying personal relationships & friends to support them in their grief
Exploring the Nature of Loss will help us understand?
-The effect of the loss on the patient's behavior, health, & well-being
-Encouraging patients to share info about the loss will help us better develop appropriate interventions that meet the individualized needs of our patients
Nurses provide support by
Assessing patient's coping strategies, educate about new and healthy strategies, and encourage use of these strategies
How does socioeconomic status influence a person's grief process?
Direct & Indirect ways
During loss and grief, to provide the best care possible it is necessary to ask about?
Cultural beliefs & practices
What do you consider when assessing cultural influence on grief practices & death rituals?
-Family-make up (blended vs nuclear)
What does spirituality/religious beliefs provide?
A framework to navigate, understand, and heal from loss, death, and grief
In order to best support and care for our patients and their families what must be done?
Must remain open to the varying views and beliefs that are in contrast to our own in order to best support and care for patients and their families
What does caring for a patient in a holistic approach include?
Spirit, ensures that we're providing pt with the best possible individualized care
what should you assess for a terminally ill patient?
the wishes of the patient in family including:
- preferred place for death, desired level of intervention, expectations for pain and symptom management
how far does assessment of grief responses extend throughout?
the course of the illness into the bereavement period following a death
when should you discuss end of life care preferences?
early in the assessment phase
what are some nursing diagnoses relevant for patients experiencing grief, loss or death?
◦Compromised family coping
◦Risk for complicated grieving
◦Pain (acute or chronic)
what kind of care do nurses provide to patients experiencing grief, death or loss?
holistic, physical, emotional, social and spiritual care
what's the purpose of health promotion?
focus on coping and optimizing health
what is the primary goal of palliative care?
to help patients and families achieve the best possible quality of life
what is hospice care?
◦Care of terminally ill patients
◦Manage pain, provide comfort, ensure quality of life
◦Adheres to patient wishes
USUALLY HAVE <6 MONTHS TO LIVE
what is palliative care?
focuses on the prevention, relief, reduction, or soothing of symptoms of disease or disorders throughout the entire course of an illness
-PROVIDES PAIN MANAGEMENT WHEN A PT IS NOT ELIGIBLE FOR HOSPICE CARE
what request is done at the time of every death?
organ and tissue donation
What actions should nurses take when providing postmortem care?
-Leave dentures to maintain face shape
-Raise the head of the bed (to prevent discoloration
-Cover the body in a clean sheet
-DON'T REMOVE term-51tubes, equipment, & indwelling lines
what is postmortem care?
care of the body after death
What is facilitation of normal mourning?
Nurse openly acknowledging the loss and talk about the common renewal of grief feeling around the anniversary of an individual's death
Second bereavement phase
-Yearning & searching
-Emotional outbursts of tearful sobbing and acute distress
What is the numbing phase?
Family is protected from the full impact of the loss
What is disorganization and despair?
The reason why the loss occurred is constantly examined
What is attachment theory?
A person accepts the change and builds new relationships
What religion usually has people of the same gender to handle the body after death?
Hindus & muslims
How does jewish culture handle death?
Calls for family members or religious officials to stay with the body until the time of bruil
What do Buddhists handle deaths?
Often say prayers while touching & standing at the head of the deceased
What kind of breathing indicates impending death?
How does the skin look impending death?
How does urine look impeding death?
Decreased and dark color
How do muscles look impending death?
-Decreased muscle tone
-Relaxed jaw muscles
What do you document in end-of-life care?
-Time & death
-Location of body identification tags
-Time of body transfer and destination
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