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Death & Spirituality CH 43 & 46
Terms in this set (53)
an internal emotional reaction to loss caused by separation as well as loss caused by death
the actions and expressions that make up the outward expressions of grief.
occurs when a valued person, object, or situation is changed or becomes inaccessible so that its value is diminished or removed.
includes actual, perceived, and anticipatory.
•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.
loss of youth, of financial independence, and of a valued environment experienced by a person, but intangible to others
-occurs when a person displays loss and grief behaviors for a loss that has yet to take place.
-is often seen in the families of patients with serious and life-threatening illnesses and may lessen the effect of the actual loss of the family member
Engel's Six Stages of Grief
1. Shock and disbelief
2. Developing awareness
4. Resolving the loss
(1) irreversible cessation of all functions of circulatory and respiratory systems or
(2) irreversible cessation of all functions of the entire brain
one that allows a person to die on his or her own terms, relatively free of pain, with dignity, and free from avoidable distress and suffering for patients, families, and caregivers.
Protocols for Establishing Death
require two separate clinical examinations.
Medical criteria used to certify a death
Cessation of breathing
No response to painful stimuli
Lack of reflexes (such as the gag or corneal reflex) and spontaneous movement
Flat encephalogram (brain waves)
Clinical Sign of impending/approaching death
•Difficulty talking or swallowing
•Nausea, flatus, abdominal distention
•Urinary 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 or agitation
•Cooling, mottling, and cyanosis of the extremities and dependent areas
Kubler-Ross stages of dying
Kubler-Ross: Denial Stage
-The patient denies the reality of death and may repress what is discussed.
-The patient may think, "They made a mistake in the diagnosis. Maybe they mixed up my records with someone else's."
Kubler-Ross: Anger Stage
-The patient expresses rage and hostility and adopts a "why me?" attitude:
-"Why me? I quit smoking and I watched what I ate. Why did this happen to me?"
Kubler-Ross: Bargaining Stage
-The patient tries to barter for more time: -"If I can just make it to my son's graduation, I'll be satisfied. Just let me live until then."
-Many patients put their personal 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 into later stages of dying.
Kubler Ross Depression stage
-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. And now I may not be here to see her walk down the aisle. I can't bear the thought of not being there for the wedding—and of not seeing my grandchildren."
Kubler Ross Acceptance stage
-When this stage is reached, the patient feels tranquil.
-The patient has accepted the reality of death and is prepared to die.
-The patient may think, "I've tied up all the loose ends: made the will, made arrangements for my daughter to live with her grandparents.
-Now I can go in peace knowing everyone will be fine."
•can minimize difficulties by allowing people to state in advance what their choices would be for health care should certain circumstances develop; they include living wills and a durable power of attorney
Physician Orders for Life-Sustaining Treatment (POLST) and Medical Orders for Life-Sustaining Treatment (MOLST)
•are medical orders indicating a patient's wishes regarding treatments; they are commonly used in a medical crisis.
Do Not Resuscitate (DNR) or No Code
-To prevent the improper use of cardiopulmonary resuscitation, which is designed to prevent unexpected death, some health care providers write or have one of these, on the medical record of a patient if the patient or surrogate has expressed a wish that there be no attempts to resuscitate the patient.
-This order means that no attempts are to be made to resuscitate a patient whose breathing or heart stops.
indicate that the goal of treatment is a comfortable, dignified death and that further life-sustaining measures are no longer indicated.
provide specific instructions about the kinds of health care that should be provided or foregone in particular situations.
durable power of attorney for health care
appoints an agent the person trusts to make decisions in the event of subsequent incapacity.
the gradual withdrawal of mechanical ventilation from a patient with a terminal illness or an irreversible condition with a poor prognosis
Voluntary cessation of eating and drinking
When nurses care for patients who want to refuse food and fluids, they must ensure that this is an informed and voluntary choice and remember that honoring this preference requires the support of the family, physician, and health care team who focus on palliative measures as the dying process unfolds
-the lowering of patient consciousness using medication for the express purpose of limiting patient awareness of suffering that is intractable and intolerable.
-When patients who are imminently dying have pain and suffering that is unresponsive to other palliative interventions, palliative sedation to unconsciousness may be considered.
-Taking specific steps to cause a patient's death, while.
withdrawing medical treatment with the intention of causing the patient's death.
-Taking care of the whole person---body, mind, and spirit, heart and soul.
-The goal is to give patients with terminal illness the best quality of life they can have by the aggressive management of symptoms
care provided for people with limited life expectancy, often in the home
Indicators for hospice referral
Poor performance status
Declining cognitive status
Poor nutritional intake
Previous hospital admissions for acute decompensation
A Person's Reaction to Loss and Expression of Grief
-Many factors, including age, family relationships, socioeconomic position, and cultural and religious influences, affect a person's reaction to loss and expression of grief.
-Focused assessment for those experiencing loss, grief, and dying 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 impending death may support nursing diagnoses such as Death Anxiety, Grieving, and Hopelessness.
Nursing Interventions to meet the needs of dying patients
•Meeting bio-psycho-social and spiritual needs as well as the needs of the family and significant others.
•The nurse's responsibilities after death include caring for the patient's body, caring for the family, and discharging specific legal responsibilities.
•This is effective if patients meet the outcome of a comfortable, dignified death, and family members resolve their grief after a suitable time of mourning and resume meaningful life roles and activities.
Meeting bio-psycho-social and spiritual needs: BIO
Past Health History
Meeting bio-psycho-social and spiritual needs: PSYCHO
Mental Health Conditions
Dree of Hope
Meeting bio-psycho-social and spiritual needs: SOCIAL
Meeting bio-psycho-social and spiritual needs: SPIRITUAL
Connection with Society
Sense of Awe & Wonder
Centering and Mindfulness Practices
After the Death of the Patient
•The nurse's responsibilities include caring for the patient's body, caring for the family, and discharging specific legal responsibilities.
•The nursing care plan is effective if patients meet the outcome of a comfortable, dignified death, and family members resolve their grief after a suitable time of mourning and resume meaningful life roles and activities.
•An an examination of the organs and tissues of a human body after death.
•Consent is legally required by the closest surviving family member.
•If death is caused by accident, suicide, homicide, or illegal therapeutic practice, the coroner must be notified according to law.
•The coroner may decide that this is advisable and can order that one be performed, even if the patient's family has refused consent.
Paying attention to the spiritual dimension of health and well-being is integral to holistic care
Three spiritual needs
•underlie all religious traditions and are common to all people:
(1)need for meaning and purpose
(2) need for love and relatedness
(3) need for forgiveness.
anything that pertains to a person's relationship with a nonmaterial life force or higher power.
-generally refers to a confident belief in something for which there is no proof or material evidence.
a person who denies the existence of a higher power
one who holds that nothing can be known about the existence of a higher power
-can be defined as an organized system of beliefs about a higher power that often includes set forms of worship, spiritual practices, and codes of conduct.
-the ingredient in life responsible for a positive outlook, even in life's bleakest moments. It enables a person both to consider a future and to work to actively bring that future into being.
-develops from the basic human need to love and be loved; we cannot be spiritually whole or spiritually healthy unless this need is met.
Religious Beliefs or Practices
•Never presume to know what a patient's religious beliefs or practices are just because you learn a patient's faith tradition.
•Many religious groups and individuals work out their own sets of beliefs and practices, which may or may not be compatible with the tradition at large.
•Among the many factors that can influence a person's spirituality, the most important are developmental considerations, family, ethnic background, formal religion, and life events.
•More dialogue is needed on the interaction between religion and law, ethics, and medicine. Ideally, the religious freedom of patients and their families is respected, as is the moral autonomy of caregivers and the integrity of the healing professions. Nurses in these situations should seek the assistance of the ethics committee or ethics consultation service.
Religious Beliefs or Practices Cont.
•Because a person's spirituality and religious beliefs can influence every aspect of being, an assessment of the patient's spirituality---including beliefs and practices, the effect of these beliefs on everyday living, spiritual distress, and spiritual needs---should be included in each comprehensive nursing history.
NANDAs for Spirituality
•Readiness for Enhanced Hope
•Readiness for Enhanced Spiritual Well-being
•Impaired Religiosity (or Risk for Impaired Religiosity)
•Readiness for Enhanced Religiosity
Spirituality Nursing Plan & Interventions
•Before exploring spiritual care strategies, remind yourself of the importance of discussing spiritual concerns in a respectful manner and as directed by patients.
•Nurses can assist patients to meet spiritual needs by offering a compassionate presence; assisting in the struggle to find meaning and purpose in the face of suffering, illness, and death; fostering relationships (with a higher being/humans) that nurture the spirit; and facilitating the patient's expression of religious or spiritual beliefs and practices.
•The nurse working with a patient and family to achieve specified goals or outcomes to meet spiritual needs should evaluate the care plan in each patient interaction.
•Necessary to the evaluation are sensitivity to what the patient is saying and not saying, and observation of the patient when alone as well as when interacting with the family and nurses.
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