LOSS, GRIEF AND DEATH. Loss, Grief, Dying Class Objectives The nursing student will learn: nurses role in loss, grief, death and dying emotional reactions

LOSS, GRIEF AND DEATH

Loss, Grief, Dying Class Objectives

The nursing student will learn:

nurses role in loss, grief, death and dying

emotional reactions to loss

Engles stages of grief

Kubler-Ross Grief and Death Reactions

legal and ethic dilemmas with death and dying

to create a nursing care plan for a death and dying patient.

Loss

Occurs when a valued person, object, or situation is changed

• Actual Loss

• Perceived loss

• Anticipated loss

• Physical loss

• Psychological loss

Grief or Grieving-Grief is the Emotional Reaction to Loss Bereavement- state

of grieving during which a person goes through grief reaction.

Mourning-period of acceptance of loss and grief during which the person learns to deal with the loss.

Engels 6 Stages of Grief Reaction

Shock and disbelief Developing

awareness Restitution Resolving the loss Idealization Outcome

Kubler-Ross Grief and Death Reactions

Denial and isolation Anger Bargaining Depression Acceptance

Five Principles of Palliative Care- (Hospice care) Respects the goals,

likes and choices of the dying pt.

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

Supports the needs of the family members

Helps pt gain access to needed healthcare providers and appropriate settings

Builds ways to provide excellent end of life care

Ethical and Legal Dimensions

Managed death, Legalized physician

assisted suicide, Physician

administered lethal injections (aid in dying) – create ethical dilemmas.

Patients look to nursing for information, advice and support.

The nurse patient relationship is key to helping patient’s grieve

Advanced Directives

Living wills- provide specific instructions about the kinds of health care that should be provided or foregone in a particular situation

Durable power of attorney- appoints and agent the person trusts to make decisions in the event of the appointing person’s subsequent incapacity.

Do not resuscitate or No code orders

What is the difference between a DNR or a No code order

and

Comfort measures only order?

Factors that influence Grief and Dying

Developmental Family Socioeconomic Cultural Religious Cause of Death

Nursing Process

Assessing- determine the adequacy of the pt’s and families, knowledge, perceptions, coping strategies and resources.

Questions to ask• What have you been told

about your condition?

• Have you had any previous experience with this condition or death of a loved one?

• Tell me a little bit about how you are coping

• What is helping you get through this?

Nursing Diagnoses

Impaired adjustment Caregiver role strain Decisional conflict Ineffective coping Ineffective denial

Anticipatory grieving Dysfunctional

grieving Hopelessness Ineffective

management of therapeutic regimem

Planning expected outcomes

The pt and family will achieve:

• Demonstrate freedom in expressing feelings

• Identify and use effective coping strategies.

• Accept need for help as appropriate• Make healthcare decisions reflecting

personal values and goals.

Implementing

The nurses aim is to care for the dying pts and their families and promote health and preventing illness of the family

Nursing Diagnosis• Impaired adjustment

r/t newly diagnosed terminal illness

• Caregiver role strain r/t hospital discharged dying pt because of inadequate insurance.

• Dysfunctional grieving r/t inability to accept death of infant no grief resolution.

Nursing interventions

Monitor patient for anxiety

Monitor mood changes

Communicate willingness to discuss death

Encourage pt and family to share feelings about death

Monitor pain Facilitate obtaining

spiritual support for pt and family

Include the family in care decisions and activities as desired.

Evaluating

The plan of nursing care for dying pts. meets 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.

Nurses grieve too.

Clinical Signs of Impending Death

Muscle weakness Respiratory changes

• Cheyne-Stokes

• Death Rattle

Sensory changes Circulatory changes

Postmortem Care

Nursing prepares the body for viewing Identification Who to notify Jewelry and valuables Dentures, glasses, prosthetics

Question

A nurse is caring for a pt who is dying of terminal cancer. While assessing the pt. for signs of impending death, the nurse should observe the pt for:

A. Elevated B/PB. Cheyne-Stokes respirationsC. Elevated pulse rateD. Flushed skin

Question #1• A nurse caring for a 15 y/o pt with terminal

CA has assessed that the pt. is very quiet and has not expressed his feelings. The nurse will need to implement

1.A referral for bereavement resources to enhance care

2. Interventions for a pt in isolation and inner thought

3.Assessment skills to determine fear and anxiety4.Therapeutic skills to enhance communication

Question #2

A pt who has ovarian CA with metastasis to the liver complains of increased pain and dysphasia. A physician orders a barium enema. The patient states, “I don’t want this test. What should I do?” The nurse should

a. A inform her to refuse the testb. Inform the MD of her statementsc. Educate her on the test’s benefitsd. Educate her on the procedure

Question #3

A 39 y/o pt who is apparently dead is brought to the hospital by ambulance. A concerned neighbor found the pt alone in the apartment in this condition. The tentative cause of death is suicide. Even though the family has refuse an autopsy, an autopsy can be ordered by the

a. A families MDb. County courtc. City policy deptd. County coroner.

Question #4

You overhear a patient state, “If you make me well, God, I will try to be a better person.” You know that this type of statement is one of the stages of grieving known as

1. Anger

2. Bargaining

3. Denial

4. Depression

Question #5 The process of viewing the body after death

best supports which of the following statements?

1. Provides the resolution of the death experience for most families

2. Increases anxiety levels3. Allows family members an avenue of escape

from the truth4. Supports the family members’ decision for a

DNR

LOSS, GRIEF AND DEATH. Loss, Grief, Dying Class Objectives The nursing student will learn: nurses role in loss, grief, death and dying emotional reactions

acceptance of loss

actual loss perceived

dying person

dying pts

loss bereavement state

death reactions denial

death reactions legal

stages of grief reaction

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LOSS, GRIEF AND DEATH. Loss, Grief, Dying Class Objectives The nursing student will learn: nurses role in loss, grief, death and dying emotional reactions

Text of LOSS, GRIEF AND DEATH. Loss, Grief, Dying Class Objectives The nursing student will learn: nurses...