Foundations Final - Loss, dying & spirituality

Death as defined by the Uniform Definition of Death Act (1981)

An individual has sustained either (1) irreversible cessation of all functions of circulatory and respiratory function or (2) irreversible cessation of all functions of the entire brain, including the brain stem is dead

Loss

When valued person, object or situation is diminished or removed.

Actual loss

Reality of a loss by person and seen by others; (ie. job, death, illness)

Perceived loss

Experienced by person but not others. (ie. Financial independence)

Anticipatory loss

Perceived loss that has not occurred.

Grief

Internal emotional reaction to loss

Engel (1964) stages of grief (6)

(1) shock and disbelief
(2) developing awareness
(3) restitution
(4) resolving the loss
(5) idealization
(6) outcome

Dysfunctional grief

abnormal or distorted; unresolved or inhibited; person has trouble expressing their feelings; state of bereavement over lengthy amount of time

Inhibited grief

Person suppresses feelings and manifest physical symptoms (ie. Heart palpitations)

Mourning

Actions and expressions of the grief (ie. Funeral)

Bereaved

State of grieving from loss of a loved one.

Medical criteria to certify death

Cessation of breathing, No response to deep painful stimuli, Lack of reflexes (ie. Gag reflex or corneal reflex) and spontaneous movement), Cerebral EEG (x2) can be done to also confirm brain death

Kubler-Ross Stages of grief (1969)

Denial, Anger, Bargaining, Depression, Acceptance

Denial stage

Denies reality of death
"They made a mistake in the diagnosis. Maybe they mixed up my records with someone else's.

Anger stage

Rage/hostility
"Why me? I quit smoking and I watched what I ate. Why did this happen to me?

Bargaining stage

Barter for more time or "take me instead

Depression stage

Period of grief before death
"I waited all these years to see my daughter get married. And now I may not be here to see her walk down the aisle. I can't bear the thought of not being there for the wedding�and of not seeing my grandchildren.

Acceptance stage

Person prepared to die

Terminal illness

Illness which death is expected in certain time.

Palliative Care

Goal to improve quality of life; comfort care

Hospice care

End of life care; focuses on needs of dying patient

good death

Allows person to die as they wish; free of pain and dignity.

Advance Directives

Living will" outlines patient wishes for healthcare in the event they cannot make their own decisions

Durable power of attorney for healthcare

Designated person to make health decisions on patients behalf.

Do not resuscitate order (DNR)

No attempts made if heart stops

Comfort measures only

Comfort measures to aid dignified death

Terminal weaning

Gradual withdrawal from life support

Euthansia

Good dying"; can be active or passive

Active euthanasia

Doing something to end patients life

Passive euthanasia

Not doing anything to preserve patients life

Post-Mortem Care (7)

1. Identification of patient (RN legal responsibility)
2. Remove tubing/ dentures, personal belongings and LABEL
3. If patient on precautions, may need special handling
4. If autopsy ordered - leave all tubes/IV in place
5. Death certificate signed by MD

Steps In The Donation Process (Tissue or organ)

Referral -> evaluation -> approach -> management -> recovery

Donation Referral

Routine, timely referral of patients meeting clinical triggers ensures that every opportunity for donation is realized.

Donation Evaluation

Specialists conduct an evaluation of a patient's medical history and current status to determine the patient's ability to give the gift of organ and tissue donation.

Approach Stage of Donation

Done by NJ Sharing Network staff, in partnership with hospital staff, will begin a discussion with families about the opportunity for donation.

Management Stage of Donation

Recipients are identified and prepared for a life-saving transplant.

Recovery Stage of Donation

Recovery of organ and tissue is done in the hospital operating room, under sterile conditions and with utmost respect for the selfless gift of life that is being offered.

Referral Triggers

Call required within 1 hour
Any ventilator dependent patient meeting one of the following triggers:
-GCS (Glasgow Coma Score) of 5 or less
Absence of 2 or more neuro reflexes (i.e. no cough
no gag, no response to pain etc.) AND/OR
-Grave Prognosis/ Beginn

Is an autopsy always necessary?

No. However, in some circumstances, an autopsy is mandated by law.
Enables a Medical Examiner to obtain important evidence about the cause and manner of the person's death that could not be otherwise obtained.

The law requires an autopsy in deaths when death is __________ (5)

1. Involving a homicide
2. Occurring under unusual circumstances
3. Posing a threat to public health
4. Involving inmates in prison
5. Where children die unexpectedly

What if the family does not want an autopsy?

The Medical Examiner autopsy, unlike a hospital autopsy, does not require permission from the next of kin. It is done under statutory authority. If the family has a religious objection to the autopsy, the Medical Examiner will make every effort to limit t

Autopsy

External and internal examination of a body.
Licensed physicians, specifically forensic pathologists acting as medical examiners, will perform forensic autopsies to determine cause and manner of death.
After examination, the body is closed.
Specimens of b

Spirituality

Anything that relates to persons relationship with higher power

Faith

Confident belief in something with no proof or evidence

Atheist

Denies existence of higher power

Agnostic

One who is not committed to believing in either the existence or the nonexistence of God or a god.

Religion

Organized system of beliefs

Spiritual health

Condition when the spiritual needs for purpose, love and belonging are met

Spiritual belief

Practices associated with all aspects of persons life.

Spiritual healing

Movement from brokenness to wholeness.

Nursing interventions

1. Pastoral care referral
2. Listen to patients feelings
3. Encourage support persons
4. Encourage chapel service/spiritual resources
5. Support family

NANDA's re: Spirituality

Spiritual despair
Spiritual Loss
Anxiety

Signs of impending death

1. Loss of movement, sensation, reflexes
2. Decreasing body temperature
3. Cheyne-Stokes respirations
4. Restlessness / agitation
5. Cyanosis of extremities
6. Weak, slow or irregular pulse
7. Decreased blood pressure

Law that requires a nurse to inform patients about advanced directives

Patient Self-Determination Act of (1990)

Full code

Do all the life-saving measures

No code

DNR or ALD (Allow Natural Death)

Death Certificate

Mortician assumes responsibility for handling and filing death certificate with proper authorities; nurse is responsible to ensure that the death certificate is signed by the clinician

Living Will

Used to indicate healthcare wishes when no trustworthy person exists for a pt.

Adventist

Believe in the person's choice and God's sovereignty. The body is believed to be the temple of the Holy Spirit. The taking of all narcotics and stimulants is prohibited because the body is the temple of the Holy Spirit and should be protected. Many groups

American Muslim Mission

Accept the Koran as their sacred scripture (see Islam); most stress the importance of cooperation among blacks in business and education to build self-esteem. Members are encouraged to obtain health care provided by members of the black community. Major t

Baha'i International Community

Believe in a basic harmony between religion and science. Seek out competent medical care and pray for health. Obligatory prayers, holy days, and the 19-day fast. Permanent sterilization is prohibited, and abortion is discouraged.

Buddhism

Buddha�or "the Great Physician"�taught the Four Noble Truths to indicate the range of "suffering," its "origin," its "cessation," and the "way" that leads to its cessation. The real cause of human suffering is ignorant craving. The Noble Eightfold Path�wh

Christian Scientist

They deny the existence of health crises; sickness and sin are errors of the human mind and can be overcome by altering thoughts, not by using drugs or medicines. They will use orthopedic services to set a bone but decline drugs and, in general, other med

Church of Jesus Christ of Latter Day Saints (Mormons)

Devout adherents believe in divine healing through the "laying on of hands," though many do not prohibit medical therapy. The Church maintains an extensive and well-funded welfare system, including financial support for the sick. Disapprove of alcohol, to

Confucianism

Inherent in Confucianism is the appreciation of life and the desire to keep the body from untimely or unnecessary death. Appreciate life and desire to keep the body from untimely or unnecessary death. Historically emphasized public health solutions to imp

Daoism (Taoism)

Health is a manifestation of the harmony of the universe, obtained through the proper balancing of internal and external forces. Implicit throughout the Daoist tradition is the tendency to understand salvation in the biomedical sense of health and qualita

Hinduism

Doctrine of Transmigration. Moral factors, linked with the all-embracing doctrine of "karma," are believed to be significant in promoting health or causing disease. Hindu medicine shows a surprising openness to new ideas, at least in respect to practical

Islam

Allah, one God, who is only one, all seeing, all hearing, all speaking, all knowing, all willing, all powerful. Must be able to practice the Five Pillars of Islam. May have a fatalistic view of health. Obligatory prayers, holy days, and fasting (Ramadan),

Jehovah's Witnesses

They oppose the "false teachings" of other sects; opposition often extends to modern science, including medicine. Blood transfusions violate God's laws and, therefore, are not allowed. The courts have not supported the right of Jehovah's Witness parents t

Judaism

Formation closely bound with a divine revelation and with commitment to obedience to God's will. The Hebrew Bible is the authority, guide, and inspiration of the many forms of religion of the Jews (currently Reform, Conservative, Orthodox). For observant

Native American Religions

Difficult to generalize; notion of cosmic harmony, emphasis on directly experiencing powers and visions and a common view of the cycle of life and death. Death is not the end but the beginning of new life (reincarnation or transcendent hereafter). Rituals

Protestantism

Worship of the one God revealed to the world through Jesus Christ. Love of neighbor is a central tenet. Other beliefs include sin, redemption, salvation, and a final accounting with God. Care of the sick is encouraged. God the author and giver of life is

Roman Catholicism

Worship of the one God revealed to the world through Jesus Christ. Love of neighbor is a central tenet. Other beliefs include sin, redemption, salvation, and a final accounting with God. Care of the sick is encouraged. God the author and giver of life is

Unification Church

God is the living, eternal person who represents universal love and care. God created the world and humans to reflect his nature. The goal of the Unification Church is to unite Christians everywhere as one family under God. Most members are still healthy

Unitarian Universal Association of Churches and Fellowships

Encourage creativity, reason, and living an ethical life. No member is required to adhere to a given creed or set of religious beliefs. The inherent worth and dignity of every person is affirmed. Free to accept what they take to be best for their health

Common NANDA for spiritual issues

Spiritual distress