Grief Process, Death and Dying

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Grief Process, Death and Dying. Plaut & Roark. LOSS. Actual Perceived External Objects Known Environment Significant Other Aspect of Self Life. Kubler-Ross Stages of Grief. Denial Anger Bargaining Depression Acceptance. Death and Dying. - PowerPoint PPT Presentation

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  • Grief Process, Death and DyingPlaut &Roark

  • Roark, 2004LOSSActualPerceivedExternal ObjectsKnown EnvironmentSignificant OtherAspect of SelfLife

    Roark, 2004

  • Roark, 2004Kubler-Ross Stages of GriefDenialAngerBargainingDepressionAcceptance

    Roark, 2004

  • Roark, 2004Death and DyingAssisting the patient to Live well and Die well

    What does this mean to you?

    Roark, 2004

  • Roark, 2004 Common fears of the dying patientFear of LonelinessDistancing by support people and caregivers can occurDebilitation, pain, and incapacitationHospital, a place that can be very lonelyFear of dying alone

    Roark, 2004

  • Roark, 2004Fears of the dying clientFear of SorrowSadnessLetting go of hopes, dreams, the futureAwareness of own mortalityGrief about future lossesAnticipatory grief that involves mourning, coping skillsGrief related to diagnosis that has a long term effect on the body such as cancerPatient may feel well at time of diagnosis

    Roark, 2004

  • Roark, 2004Fears of the dying clientFear of the unknown:Death is an unknown stateWhat will happen after death?What will happen to loved ones, those left behind

    Roark, 2004

  • Roark, 2004Fears of the dying clientLoss of self concept and body integrityMutilation via therapyBody image changesLoss of role or statusLoss of standard of living

    Roark, 2004

  • Roark, 2004Fears of the dying clientFear of RegressionEgo is threatenedPhysical deterioration may occurMental deterioration may occurUnable to care for selfBecome dependent on others for care

    Roark, 2004

  • Roark, 2004Fears of the dying clientFear of Loss of Self ControlLoose ability to control life decisionsLoose ability to control ADLsLoss of control of body functionsLoss of control of emotionsLoss of independence

    Roark, 2004

  • Roark, 2004Fears of the dying clientFear of Suffering and PainMay be many different types of pain or suffering such as physical, emotional, social, or spiritual in natureAltered relationships with othersAnxiety related to the disease and consequences of the disease

    Roark, 2004

  • Roark, 2004Childs Response to Illness and DeathInfantToddlerPreschoolSchool AgedAdolescent

    Roark, 2004

  • Roark, 2004Cultural Backgrounds Affect Beliefs Concerning DeathBeliefs, attitudes, and values that stem from the patients cultural background will strongly influence their reaction to loss, grief, and deathExpressions of grief are governed by what is acceptable by the family and within the cultural contextComfort may be found through spiritual beliefs, and finding comfort in specific rites, rituals, and practices

    Roark, 2004

  • Roark, 2004Cultural Backgrounds Affect Beliefs Concerning DeathOrganized religious practicesNurses need to be in tune with patients spiritual needsBecoming familiar with cultural views will helpCan you name some cultural practices associated with loss, grief, and death?

    Roark, 2004

  • Roark, 2004Support the clientNurses can help to identify coping mechanisms, and encourage effective coping mechanismsAllow client/family to visit the chapel if desiredAllow family members around Client may have problems with conflicting feelings that do not align with culture or religious practices-nurse can evaluate coping and guide the client to appropriate interventions

    Roark, 2004

  • Roark, 2004Role of the ChaplainCan be a member of the health care teamAssist with religious practicesPerform ritesProvide prayer, support, and comfortAssist with mobilizing other support systems that are important to the clientSupport family members

    Roark, 2004

  • Roark, 2004Nurses response to the dying patientNurses grieve alsoNurses need to come to terms with personal meanings of life and deathBest prepared to work with terminal clients when the nurse has been given the time to come to terms with own mortalityCommon feelingsDevelop personal/professional support systems

    Roark, 2004

  • Roark, 2004Rationale for Communicating Truthfully about Terminal IllnessRight to knowTime frameNurse needs to assess whether or not the patient/family have been told and what was told to themTHE PHYSICIAN WILL TELL THE CLIENT FIRST, NOT THE NURSE

    Roark, 2004

  • Roark, 2004Communicating Terminal Illness, continuedThe nurse:Clarifies what was saidListens to concernsFosters communication between MD, client, and familyAllows patient to express lossFacilitate grief through nursing processBe available for patientAssist patient to identify needs/hopes for remainder of lifeConnect patient with proper resources

    Roark, 2004

  • Roark, 2004List nursing strategies appropriate for grieving personsOpen ended statementsPatient sets the paceAccept any grief reactionBe awarenurse may be target of angerRemove barriersAvoid giving adviceAllow patient to talkAllow patient to express signs of hopeSupport hope by helping focus

    Roark, 2004

  • Roark, 2004Assist Family to GrieveExplain procedures and equipmentPrepare them about the dying processInvolve family and arrange for visitorsEncourage communicationProvide daily updatesResourcesDo not deliver bad news when only one family member is present

    Roark, 2004

  • Roark, 2004Choices of Care SettingFamilies have choices of where to care for the dying loved oneAsk the patient and family preferencesSupport whatever the choiceHospital, Home/Hospice

    Roark, 2004

  • Roark, 2004Elements of Hospice CareHome care coordinated with hospitalControl of symptoms holisticallyPhysician directed careUtilization of variety of health care professionalsBereavement follow up careAcceptance based on need, not $

    Roark, 2004

  • Roark, 2004Nursing strategies to meet physical and psychosocial needs of the dying patientThorough pain controlMaintain independencePrevent isolationSpiritual comfortSupport the family

    Roark, 2004

  • Roark, 2004Signs/Symptoms of Approaching DeathMotion and sensation is gradually lostIncrease in temperatureSkin changes-cold, clammyPulse-irregular, and rapidRespirations-strenuous, irregular, Cheyne stokesDeath rattleDecrease Blood PressureJaw and Facial muscles relaxMOST POSITIVE SIGN OF DEATH=Absence of brain waves (Need two MDs to sign off)

    Roark, 2004

  • Roark, 2004Nursing care after deathAutopsy: examination performed after a persons death to confirm or determine cause of deathFor tissue and organ removal: Keep CV system goingCall donor bank representativeMust be agreed on by all family membersOr, patient decision before death

    Roark, 2004

  • Roark, 2004Nursing care after deathLegally, a person is considered dead when there is a lack of brain waves even though other body organs continue to functionThis definition allows for harvesting of organs and tissue for donationVital organs are: heart, liver, kidney, lung, pancreasNon-vital organs are: eye corneas, long bones, middle ear bones, and skin

    Roark, 2004

  • Roark, 2004Deceased patient, before viewing the bodyCheck orders for special requestsRemove equipmentRemove suppliesChange soiled linens and cleanse patientUse room deodorizerPlace patient in supine position, with small pillow under headInsert dentures

    Roark, 2004

  • Roark, 2004Deceased patient, before viewing the body continuedRemove valuables and give to familyStay with family, if requested

    After the family leaves:Tag patient according to hospital/agency policyWrap body in shroudPut ID tag on shroudTransfer to morgueDocument

    Roark, 2004

  • Roark, 2004Describe response of family to dying processRelated to cultural backgroundUnresolved grief issuesEmotionsRequestsPhysical symptoms may occurReorganizationIndividualized grief patterns

    Roark, 2004

  • Roark, 2004Behavioral responses that obstruct the expression of griefSudden, unexpected deathLengthy illness resulting in deathLoss of a childPerception that the death was preventableUnsteady relationship with deceasedMental illness of survivorLack of social support

    Roark, 2004

  • Roark, 2004ThanatologyThanatology= study of deathThe description of study of the phenomena of death, and of psychological mechanisms for coping with death

    Roark, 2004

  • Thank youRoark, 2004

    Roark, 2004

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