Loss, Grief, And Dying

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Loss, Grief, and Dying

Types of Loss Actual loss can be recognized by others Perceived loss is felt by person but intangible to others Physical loss versus psychological loss Maturational loss experienced as a result of natural developmental process Situational loss experienced as a result of an unpredictable event Anticipatory loss loss has not yet taken place

Definitions Grief emotional reaction to loss Bereavement state of grieving; person goes through grief reaction Mourning acceptance of loss; person learns to deal with loss

Engels Six Stages of Grief Shock and disbelief Developing awareness Restitution Resolving the loss Idealization Outcome

Kubler-Rosss Five Stages of Grief Denial and isolation Anger Bargaining Depression Acceptance

Clinical signs of Impending Death Inability to swallow Pitting edema Decreased gastrointestinal and urinary tract activity Bowel and bladder incontinence Loss of motion, sensation, reflexes Elevated temperature, cold or clammy skin, cyanosis Lowered blood pressure Noisy or irregular respiration Cheyne-Stokes respirations

Three Definitions of Death Traditional heart-lung irreversible cessation of spontaneous respiration and circulation Whole brain irreversible cessation of all functions of the entire brain Higher brain irreversible loss of all higher brain function

Components of a Good Death Pain and symptom management Clear decision-making Preparation for death Completion Contributing to others Affirmation of the whole person

Five Principles of Palliative Care Respects goals, likes, and choices of the dying person and his loved ones Looks after the medical, emotional, social, and spiritual needs of the dying person Supports the needs of family members Helps to gain access to needed healthcare providers and care setting 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. Decide the kind of medical treatment the patient wants or doesnt want. Decide how comfortable the patient wants to be. Decide how the patient will be treated by others. Decide what the patient wants loved ones to know.

Special Orders Do-not-resuscitate (DNR) or no-code Comfort measures only Do-not-hospitalize

Factors Affecting Grief and Dying Developmental considerations Family Socioeconomic factors Cultural influences Religious influences Causes of death

Developing a Trusting Nurse-Patient Relationship Explain the patients condition and treatment. Teach self-care and promoting self-esteem. Teach family members to assist in care. Meet the needs of dying patient. Meet family needs.

Needs of Dying Patients Physiological needs physical needs, such as hygiene, pain control, nutritional needs Psychological needs patient needs control over fear of the unknown, pain, separation, leaving loved ones, loss of dignity, loss of control, unfinished business, isolation Sexual needs patient needs ways to be physically intimate that meets needs of both partners Spiritual needs patient needs to practice religious faith

Providing Postmortem Care Care of the body Care of the family Discharging legal responsibilities Death certificate issued and signed Labeling body Reviewing organ donation arrangements if any Care of other patients

Postmortem Care of the Body Prepare body for discharge. Place body in anatomical position, replace dressings, and remove tubes (unless there is an autopsy scheduled). Place identification tags on the body. Follow local law if patient died of communicable disease.

Postmortem Care of the Family Listen to familys expressions of grief, loss, and helplessness Offer solace and support by being an attentive listener. Arrange for family members to view the body. In the case of sudden death, provide a private place for family to begin grieving. It is appropriate for the nurse to attend the funeral and make a follow-up visit to the family.


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