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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 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.
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
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
Comfort measures only order?
Factors that influence Grief and Dying
Developmental Family Socioeconomic Cultural Religious Cause of Death
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?
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.
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.
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.
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
• Death Rattle
Sensory changes Circulatory changes
Nursing prepares the body for viewing Identification Who to notify Jewelry and valuables Dentures, glasses, prosthetics
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
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
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.
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
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