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