Grief PDF

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Summary

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Grief, Death, and Dying Types of Loss •

Actual loss—can be recognized by others

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Perceived loss—experienced by one person by cannot be verified by others

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Maturational loss—experienced as a result of natural developmental process

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Situational loss—experienced as a result of an unpredictable event (i.e. loss of job, death of child)

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Anticipatory loss—loss has not yet taken place

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Developmental—children leaving home

Definitions •

Grief—internal emotional reaction to loss

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Bereavement—state of grieving from loss of a loved one

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Mourning—actions and expressions of grief that make up outward expression of grief

Engel’s Six Stages of Grief •

Shock and disbelief

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Developing awareness

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Restitution

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Resolving the loss

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Idealization

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Outcome

Kubler-Ross’s Five Stages of Grief •

Denial and isolation

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Anger

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Bargaining

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Depression

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Acceptance

Manifestations of Grief •

Signs and symptoms of stress reaction

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Normal manifestations

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Verbalization of the loss

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Crying

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Sleep disturbance

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Loss of appetite

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Difficulty concentrating

Complicated Grieving •

Extended time of denial

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Depression

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Severe physiologic symptoms

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Suicidal thoughts

Grieving: Nursing Process •

Assessment (history, coping resources, physical assessment)

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Diagnoses

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Planning

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Implementation

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Provide comfort, maintain dignity, and promote independence

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Use therapeutic communication (attentive listening, silence, etc.)

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Explore and respect ethnic, cultural, religious, and personal values

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Teach what to expect in the grief process

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Encourage client to express and share grief with support people

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Teach family members to encourage client’s expression of grief

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Encourage client to resume activities on a schedule that promotes physical and psychologic health

Evaluation

Definition of Death 

Uniform Definition of Death Act: 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 brain stem, is dead.

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Medical criteria used to certify a death: cessation of breathing, no response to deep painful stimuli, and lack of reflexes (such as the gag or corneal reflex) and spontaneous movement

World Medical Assembly Guidelines for Death •

Most current guidelines for indications of death

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Total lack of response to external stimuli

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No muscular movement, especially during breathing

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No reflexes

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Flat encephalogram

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In instances of artificial support, absence of brain waves for at least 24 hours

Cerebral Death •

Occurs when cerebral cortex is irreversibly destroyed

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Permanent loss of cerebral and brainstem function

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Absence of responsiveness to external stimuli

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Absence of cephalic reflexes

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Apnea

Isoelectric EEG for at least 30 minutes in the absence of hypothermia and poisoning by CNS depressants

Components of a Good Death •

Pain and symptom management

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Clear decision making

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Preparation for death

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Completion

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Contributing to others

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Affirmation of the whole person

Clinical Signs of Impending Death •

Difficulty talking or swallowing

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Nausea, flatus, abdominal distention

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Urinary and/or bowel incontinence or constipation

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Loss of movement, sensation, and reflexes

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Decreasing body temperature with cold or clammy skin

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Weak, slow, or irregular pulse

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Decreasing blood pressure

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Noisy, irregular, or Cheyne-Stokes respirations

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Restlessness and/or agitation

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Cooling, mottling, and cyanosis of the extremities and dependent areas

Terminal Illness and Palliative Care •

Define terminal illness. o

Effect on patient

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Effect on family

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Describe palliative care and hospice.

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What types of clients require palliative care

Principles of Palliative Care •

Respects goals, likes, and choices of the dying person and his loved ones

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Looks after the medical, emotional, social, and spiritual needs of the dying person

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Supports the needs of family members

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Helps to gain access to needed healthcare providers and care setting

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Builds ways to provide excellent care at end of life

Advance Directives •

Decide who will make decisions for the patient in case he or she is unable.

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Decide the kind of medical treatment the patient wants or doesn’t want.

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Decide how comfortable the patient wants to be.

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Decide how the patient will be treated by others.

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Decide what the patient wants loved ones to know.

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Living Will

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DNR Forms/DNR orders

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Healthcare Surrogate Forms

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Durable Power of Attorney

Special Orders •

Do-not-resuscitate (DNR) or no-code

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Comfort measures only

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Do-not-hospitalize

Nurse-Client-Family Relationship (p.1561, Taylor) •

Explain the client’s condition and treatment

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Teach self-care and promoting self-esteem

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Teach family members to assist in care

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Meet the needs of dying client

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Meet family needs

Factors Affecting Grief and Dying •

Developmental considerations

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Family

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Socioeconomic factors

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Cultural, gender, and religious influences

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Causes of death

Needs of Dying Patients •

Physiologic needs—physical needs, such as hygiene, pain control, nutritional needs

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

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Sexual needs—patient needs ways to be physically intimate that meets needs of both partners

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Spiritual needs—patient needs meaning and purpose, love and relatedness, forgiveness and hope

Developing a Trusting Nurse-Patient Relationship •

Explain the patient’s condition and treatment.

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Teach self-care and promoting self-esteem.

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Teach family members to assist in care.

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Meet the needs of dying patient.

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Meet family needs.

Providing Postmortem Care •

Care of the body

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Care of the family

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Discharging legal responsibilities

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Death certificate issued and signed

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Labeling body

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Reviewing organ donation arrangements if any

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Care of other patients

Postmortem Care of the Body •

Prepare the body for discharge.

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Place the body in anatomical position, replace dressings, and remove tubes (unless there is an autopsy scheduled).

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Place identification tags on the body.

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Follow local law if patient died of communicable disease.

Postmortem Care of the Family •

Listen to family’s expressions of grief, loss, and helplessness.

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Offer solace and support by being an attentive listener.

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Arrange for family members to view the body.

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In the case of sudden death, provide a private place for family to begin grieving.

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It is appropriate for the nurse to attend the funeral and make a follow-up visit to the family.

Application •

How would you respond as a hospice nurse caring for a client with a terminal illness if he said to you: “I am in such pain and I can’t take it anymore; please help me die now.”

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Apply the nursing process to this scenario

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Discuss nursing goals for clients with terminal conditions.

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Make a list of responsibilities of the nurse after a client dies....