chapter 21 loss and grief fundamentals of nursing: standards & practices, 2e
TRANSCRIPT
Chapter 21
Loss and Grief
Fundamentals of Nursing: Standards & Practices, 2E
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Loss
Loss is any situation (actual, potential, or perceived) in which a valued object is changed or is no longer accessible to the individual.
A maturational loss occurs as a result of moving from one developmental stage to another.
A situational loss occurs in response to external events.
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Types of loss• Actual loss• Perceived loss• Physical loss• Psychological loss
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Categories of loss• Loss of an external object• Loss of a familiar environment• Loss of aspect of self• Loss of significant other
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Grief
Grief is a series of intense physical and psychological responses that occur following a loss.
Loss leads to mourning - the period of time during which the grief is expressed, and resolution and integration of the loss occurs.
Bereavement is the period of grief following the death of a loved one.
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Theories of the grieving process• Lindemann• Engle• Bowlby• Worden
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Types of grief• Uncomplicated grief• Dysfunctional grief• Anticipatory grief
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Factors affecting grief• Developmental level• Religious and cultural beliefs• Relationship to the lost object• Cause of death
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Nursing Care of theGrieving Person
Assessment• Begins with a determination of the
personal meaning of the loss• Assess the stage of grief the client is
experiencing
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Diagnosis• NANDA-approved diagnoses
Dysfunctional grieving Anticipatory grieving
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Outcome identification and planning• Expected outcome criteria include
Verbalize feelings of grief Share grief with significant others Accept the loss Renew activities and relationships
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Implementation• The nurse must spend time listening.• The nurse’s nonjudgmental, accepting
attitude is essential while the bereaved expresses anger.
• The nurse should provide appropriate referrals to community support groups.
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Evaluation• Nurses usually do not have an
opportunity to be with the bereaved when grief work is completed.
• Important to teach grieving individuals that resolution of the loss is generally a process of life-long adjustment.
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Death
Stages of death and dying (Elizabeth Kubler-Ross)• Denial• Anger• Bargaining• Depression• Acceptance
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Nursing assessment of the dying client• Client’s awareness of the terminal
nature of illness• Availability of support systems• Physical condition• Emotional status
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• Presence of advance directives for health care decisions
• History of previous positive coping skills
• Unfinished business expressed by client or family
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Diagnosis• NANDA-approved diagnoses
Powerlessness Hopelessness
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Outcome identification and planning• Planning focuses on meeting the
holistic needs of the client and family.• A goal of nursing care is to promote an
optimal quality of life by treating the client and family in a respectful manner and providing a safe environment for the expression of feelings.
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Implementation• Physiological needs• Psychosocial needs• Spiritual needs• Support for the family
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• Hospice care Allows individuals to die with dignity and
surrounded by those who love them Palliative care
• Home care
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Learning Needs of Client and Family
Client and family knowledge deficits can be related to• Insufficient information about physical
condition• Information about the treatment regime• Inability to anticipate medical crises
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Inexperience with personal threat of death
Unfamiliarity with protocol to follow in case of need for emergency care when not in the hospital
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Care After Death
Physiological changes• Algor mortis• Liver mortis• Rigor mortis
Legal aspects• Autopsy• Organ donation
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Nursing care of the family may include• Informing the family of the type and
circumstances surrounding the death• Providing information about viewing
the body
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• Asking the family about organ donation• Offering to contact support people• Helping the family with decision
making regarding a funeral home, transportation, and removal of the deceased belongings
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Nurse’s self-care• Nurses need to talk about the intense
emotions associated with caregiving.• Use support from within the health care
agency - counselors, clergy, support groups.
• Find a way to say goodbye to the deceased client.