Loss
- does not mean only death
-can be loss of home, belongings, etc.
-affect the healing process
Necessary
�Maturational - age, kids going to school
Situational
sudden and unexpected
�Ex. Loss of child, hurricanes, MVAs
Actual
part of situational
�Animal, objects
Perceived
selfesteem, youth, beauty
Grief
emotional response to loss
Mourning
Bereavement - outward and emotional response
Types
-Normal (uncomplicated)
-Anticipatory - pt. expected to die
-Disenfranchised - grieving not accepted in society
�Gays, more than one wife
�Ambiguous - body is there but
Bereavement
outward and emotional response
Disenfranchised
grieving not accepted in society
�Gays, more than one wife
Ambiguous
body is there but mind is not
-Alzheimer's
Complicated (dysfunctional)
�Exaggerated, Delayed, Masked
Grieving
When caring for patients who have experienced a loss, facilitate the grief process by helping survivors feel the loss, express it, and move through their grief.
Loss comes in many forms based on the values and priorities learned within a person's sphere o
Theories of Grief
Kubler-Ross: Stages of Dying
Bowlby: Attachment Theory
Worden: Tasks of Mourning
Rando: The R Process Model
Dual Process Model: Moving back & forth between loss-oriented and restoration-oriented activities
Post Modern Grief Theories
Stages of Dying
Kubler-Ross
Attachment Theory
Bowlby
Tasks of Mourning
Worden
The R Process Model
Rando
Moving back & forth between loss-oriented and restoration-oriented activities
Dual Process Model
Nursing Knowledge Base
End-of-Life Nursing Consortium (ELNEC)
American Nurses Association (ANA)
Hospice and Palliative Care Nurses Association
American Society of Pain Management Nurses
American Association of Critical Care Nurses
Factors Influencing Loss and Grief
Human Development
Personal Relationships
Nature of the Loss
Coping Strategies
Socioeconomic Status
Culture & Ethnicity
Spiritual & Religious Beliefs
Hope
Assessment
Conversations about the meaning of loss to a patient often lead to other important areas of assessment:
-Patient's coping style
-The nature of family relationships
-Social support systems
-The nature of the loss
-Cultural and spiritual beliefs
-Life goals
Symptoms of Normal Grief
Feelings:
Sorrow
Fear
Anger
Guilt or self-reproach
Anxiety
Loneliness
Fatigue
Helplessness/hopelessness
Yearning
Relief
Cognitions (Thought Patterns):
Disbelief
Confusion or memory problems
Problems with decision making
Inability to concentrate
Feeling th
Diagnosis
Anticipatory grieving
Compromised family coping
Death anxiety
Fear
Impaired comfort
Ineffective denial
Grieving
Complicated grieving
Risk for complicated grieving
Hopelessness
Pain (acute or chronic)
Risk for loneliness
Spiritual distress
Readiness for en
Planning
Care plans for the dying patient focus on
-Comfort
-Preserving dignity and quality of life
-Providing family members with emotional, social, and spiritual support
Give priority to a patient's most urgent physical or psychological needs while also consider
Implementation: Health Promotion
Providing palliative care in acute and restorative settings
-Not cure disease; relieves pain
Providing hospice care
Using therapeutic communication
Providing psychosocial care
Managing symptoms
Promoting dignity and self-esteem
Ensuring a comfortable and
Hospice
-Philosophy & model of care for terminally ill patients
-Patient and family-centered
-Usually diagnosis of less than 6-12 months to live but can be extended
-Services available: Home, hospital, extended care
-Bereavement services for family
-Terminally il
Importance of Nurses' Self-Care
You cannot give fully engaged, compassionate care to others when you feel depleted or do not feel cared for yourself.
Frequent, intense, or prolonged exposure to grief and loss places nurses at risk for developing compassion fatigue.
Being a professional
1 Regarding the request for organ and tissue donation at the time of death, the nurse needs to be aware that:
1 Specially educated personnel make requests.
2 Requests are usually made by the nurse caring for the patient at the time of death.
3 Only patien
1 Specially educated personnel make requests.
Individuals specially trained in requesting organ donations facilitate the process. They are skilled in talking compassionately to people who have suffered a tragic, sudden loss and have answers to many questi
2 The nurse notes that a woman who recently began cancer treatment appears quiet and withdrawn, states that she does not believe the treatments will make any difference, does not ask about her progress, and missed two chemotherapy sessions. Based on the a
2 Hopelessness
The patient exhibits signs and symptoms of hopelessness. Manifestations of hopelessness include withdrawing, not following through with recommended treatment, and losing confidence that anything she does will be of help.
3 A family member asks a home care nurse what he should do if the patient's serious chronic illness worsens even with increased medical interventions. How does the nurse best begin a conversation about the goals of care at the end of life?
1 Encourage the
4 Begin the discussion by asking the patient to identify his or her beliefs about the goals of care while the family member is present
If you ask the patient first what he or she believes is best, you know how to discuss that option in more detail and giv
4 Which of the following nursing actions best reflects sensitivity to cultural differences related to end-of-life care?
1 Practice honesty with everyone, telling patients about their illness, even if the news is not good.
2 Ask family members if they pref
2 Ask family members if they prefer to help with the care of the body after death.
Giving people options in caregiving allows them to honor their cultural beliefs. Although western health care practices place a high value on honesty, people from some cult
5 A young man is diagnosed with a serious, life-changing illness. His conversations during his first 2 days of hospitalization are abrupt, superficial, and unrelated to his illness. What understanding about communication enhances your therapeutic communic
4 Remain alert for signals that the patient wants to discuss his illness.
Make no presumptions about this patient other than the fact that he is not yet ready to talk about his situation. However, stay alert for a time when he might want to talk to you. S
6 A woman experiences the loss of a very early-term pregnancy. Her friends do not mention the loss, and someone suggests to her that she can "always try again." The woman feels confusion over her sadness and stops talking about it with others. What type o
4 Disenfranchised
This woman's friends are not fully acknowledging the value of her pregnancy because of the short length of time the woman was pregnant or because, by comparison, the loss seems less than losing a child after birth. The loss does not seem
7 A nurse has the responsibility of managing a deceased patient's post-mortem care. Arrange the steps for post-mortem care in the proper order.
1 Bathe the body of the deceased.
2 Collect any needed specimens.
3 Remove all tubes and indwelling lines.
4 Po
6 Confirm that request for organ/tissue donation and/or autopsy has been made.
9 Elevate the head of the bed.
2 Collect any needed specimens
5 Speak to the family members about their possible participation.
7 Notify a support person (e.g., spiritual care
8 A family member of a recently deceased patient talks casually with the nurse at the time of the patient's death and expresses relief that she will not have to visit at the hospital anymore. What theoretical description of grief best applies to this fami
2 Anticipatory grief
If a person has been anticipating a loss for some time, he or she may have already experienced many of the emotions (sadness, shock) commonly associated with death
9 A self-care goal you set when caring for dying and grieving patients includes:
1 Learning not to take losses so seriously.
2 Limiting involvement with patients who are grieving.
3 Maintaining life balance and reflecting on the meaning of your work.
4 Ad
3 Maintaining life balance and reflecting on the meaning of your work.
Maintaining life balance is very important for emotional, spiritual, and physical well-being. Withdrawing or not seeing one's work with grieving people as serious does not help maintai
10 A nurse is providing postmortem care. Which action is the priority?
1 Locating the patient's clothing
2 Providing culturally and religiously sensitive care in body preparation
3 Transporting the body to the morgue as soon as possible to prevent body de
2 Providing culturally and religiously sensitive care in body preparation
At the end of life religious and cultural expectations are important for the lasting memories held by the family about the way their loved one's death occurred. Sensitive care contr
11 Which approach to helping grieving people is most consistent with postmodern grief theories?
1 Help the patient identify the tasks to be accomplished during his or her grief.
2 Encourage people to recognize stages of grieving in anticipation of what is
3 Listen carefully to a person's story of how his or her grief experience is unfolding.
Postmodern grief interventions focus on the uniqueness of the patient's story that unfolds and "writes" itself as the person lives through the experience of loss.
12 A patient who has a serious, life-limiting chronic illness wants to continue to engage in self-care and live as normally as possible. Which of the following nursing responses reflect a helpful understanding of patient self-care at the end of life?
1 "L
2 "Which activities are most important to you, and how can you continue to do them?"
Even seriously ill people want to carry on with life, doing what they can to maintain their identity and purpose. They know best how to regulate their energy and wishes f
13 The nurse suggests that a patient receive a palliative care consultation for symptom management related to anxiety and increasing pain. A family member asks the nurse if this means that the patient is dying and is now "in hospice." What does the nurse
2 Palliative care is for any patient, any time, any disease, in any setting.
4 Palliative care interventions relieve the symptoms of illness and treatment.
Palliative care is not reserved for people who are at the end of life. The goal of palliative care
14 You have identified three nursing diagnoses for a patient who is having anxiety and hopelessness as a result of a loss. Which general approach do you take to prioritize the nursing diagnoses? (Select all that apply.)
1 Use family members and physician
3 Ask the patient to identify the most distressing symptom and first address that diagnosis.
4 Use nursing knowledge to address the problem that is the underlying cause of other diagnoses.
When you are prioritizing nursing diagnoses, first get the patient
15 Regarding grief in older adults, which understanding helps guide your relationship with an elderly patient?
1 Older adults have usually sustained many losses in life, which influence the current loss.
2 Older adults with a poor memory experience grief
1 Older adults have usually sustained many losses in life, which influence the current loss.
Older adults have usually sustained more losses because they have lived longer. For people at any age, each loss influences the way one responds to subsequent los