Loss, Grieving and Death PPT

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Chapter 43:

Chapter 43 Loss, Grieving, and Death

Types of Loss:

Copyright 2008 by Pearson Education, Inc. Types of Loss Actual Recognized by others Perceived Experienced by one person but cannot be verified by others Anticipatory Experienced before loss occurs Can be actual or perceived Situational i.e., Loss of job, death of child Developmental i.e., Departure of children from home

Sources of Loss:

Copyright 2008 by Pearson Education, Inc. Sources of Loss Loss of an aspect of oneself Loss of an object external to oneself Separation from an accustomed environment Loss of a loved one or valued person

Kübler-Ross Stages of Grieving :

Copyright 2008 by Pearson Education, Inc. Kübler-Ross Stages of Grieving Denial Anger Bargaining Depression Acceptance

Engel Stages of Grieving :

Copyright 2008 by Pearson Education, Inc. Engel Stages of Grieving Shock and disbelief Developing awareness Restitution Resolving the loss Idealization Outcome

Sanders Phases of Bereavement :

Copyright 2008 by Pearson Education, Inc. Sanders Phases of Bereavement Shock Awareness of loss Conservation/withdrawal Healing: the turning point Renewal

Clinical Symptoms of Grief :

Copyright 2008 by Pearson Education, Inc. Clinical Symptoms of Grief Signs and symptoms of stress reaction Normal manifestations Verbalization of the loss Crying Sleep disturbance Loss of appetite Difficulty concentrating

Clinical Symptoms of Grief:

Copyright 2008 by Pearson Education, Inc. Clinical Symptoms of Grief Complicated grieving Extended time of denial Depression Severe physiologic symptoms Suicidal thoughts

Factors Affecting Grief Response:

Copyright 2008 by Pearson Education, Inc. Factors Affecting Grief Response Age Significance of the loss Culture Spiritual beliefs Gender Socioeconomic status Support systems Cause of death

Measures that Facilitate the Grieving Process :

Copyright 2008 by Pearson Education, Inc. Measures that Facilitate the Grieving Process Explore and respect ethnic, cultural, religious, and personal values Teach what to expect in the grief process Encourage the client to express and share grief with support people Teach family members to encourage the client’s expression of grief Encourage the client to resume activities on a schedule that promotes physical and psychologic health

Manifestations of Impending Death:

Copyright 2008 by Pearson Education, Inc. Manifestations of Impending Death Loss of muscle tone Slowing of the circulation Changes in respiration Sensory impairment

Traditional Clinical Signs of Death:

Copyright 2008 by Pearson Education, Inc. Traditional Clinical Signs of Death Cessation of Apical pulse Respirations Blood pressure

World Medical Assembly Guidelines for Death:

Copyright 2008 by Pearson Education, Inc. World Medical Assembly Guidelines for Death Total lack of response to external stimuli No muscular movement, especially during breathing No reflexes Flat encephalogram In instances of artificial support, absence of brain waves for at least 24 hours

Cerebral Death:

Copyright 2008 by Pearson Education, Inc. Cerebral Death Occurs when cerebral cortex is irreversibly destroyed Permanent loss of cerebral and brainstem function Absence of responsiveness to external stimuli Absence of cephalic reflexes Apnea Isoelectric EEG for at least 30 minutes in the absence of hypothermia and poisoning by CNS depressants

Helping Clients Die with Dignity :

Copyright 2008 by Pearson Education, Inc. Helping Clients Die with Dignity Introduce options available to the client and significant others to restore and support feelings of control: Location of care Times of appointments with health professionals Activity schedule Use of health resources Times of visits from relatives and friends

Helping Clients Die with Dignity:

Copyright 2008 by Pearson Education, Inc. Helping Clients Die with Dignity Assist clients to manage the events preceding death so they can die peacefully Help clients to determine their own physical, psychologic, and social priorities Support the client’s will and hope

Terminally Ill Patients Video:

Copyright 2008 by Pearson Education, Inc. Terminally Ill Patients Video Click here to view a video on terminally ill patients. Back to Directory

Strategies to Facilitate Discussions About Death:

Copyright 2008 by Pearson Education, Inc. Strategies to Facilitate Discussions About Death Identify personal feelings about death Focus on client’s needs Determine client’s usual ways of coping Establish communication relationship Determine what client knows about illness Respond with honesty and directness Make time to be available

Assisting Families or Caregivers of Dying Clients:

Copyright 2008 by Pearson Education, Inc. Assisting Families or Caregivers of Dying Clients Use therapeutic communication Provide an empathetic and caring presence Explain what is happening and what to expect Have a calm and patient demeanor Encourage to participate in the physical care as they are able: Assist with bathing Speak or read to the client Hold hands

Assisting Families or Caregivers of Dying Clients:

Copyright 2008 by Pearson Education, Inc. Assisting Families or Caregivers of Dying Clients Support those who feel unable to care for or be with the dying Show an appropriate waiting area if they wish to remain nearby May be therapeutic for the family to verbally give permission to the client to “let go” when ready

After Client Dies:

Copyright 2008 by Pearson Education, Inc. After Client Dies Encourage the family to view the body May wish to clip a lock of hair as a remembrance Children should be included in the events surrounding the death if they wish

The Grieving Client:

Copyright 2008 by Pearson Education, Inc. The Grieving Client

Care of the Body After Death:

Copyright 2008 by Pearson Education, Inc. Care of the Body After Death Follow policy of the hospital or agency Check the client’s religion rituals and make every attempt to comply If family or friends wish to view the body: Make the environment as clean and as pleasant as possible Make the body appear natural and comfortable All equipment, soiled linen, and supplies should be removed from the bedside Follow agency policy when caring for tubes

Care of the Body After Death:

Copyright 2008 by Pearson Education, Inc. Care of the Body After Death Place the body in a supine position Place arms either at sides, palm down, or across the abdomen Place one pillow under the head and shoulders Close the eyelids for a few seconds Insert dentures Close mouth

Care of the Body After Death:

Copyright 2008 by Pearson Education, Inc. Care of the Body After Death Wash soiled areas of the body Place absorbent pads under the buttocks Place a clean gown on the client Brush and comb the hair Remove all jewelry except a wedding band which is taped to the finger Adjust the top bed linen to cover the client to the shoulders Provide soft lighting and chairs for the family

After Body Viewed by Family:

Copyright 2008 by Pearson Education, Inc. After Body Viewed by Family Leave wrist identification tag on Apply additional identification tags Wrap the body in a shroud Apply identification to the outside of the shroud Take the body to the morgue Or arrange to have a mortician pick it up from the client’s room Handle the deceased with dignity

Post Test:

Copyright 2008 by Pearson Education, Inc. Post Test Use your clickers to complete the following post test.

Question 1:

Copyright 2008 by Pearson Education, Inc. Question 1 A client’s family tells the nurse that their culture does not permit a dead person to be left alone before burial. Hospital policy states that after 6:00 PM when mortuaries are closed, bodies are to be stored in the hospital morgue refrigerator until the next day. How would the nurse best manage this situation? Gently explain the policy to the family and then implement it. Inquire of the nursing supervisor how an exception to the policy could be made. Call the client’s primary care provider for advice. Move the deceased to an empty room and assign an aide to stay with the body.

Rationales 1:

Copyright 2008 by Pearson Education, Inc. Rationales 1 When possible, modifications of policy that demonstrate respect for individual differences should be explored. Correct. When possible, modifications of policy that demonstrate respect for individual differences should be explored. The primary care provider is in no position to modify the implementation of hospital policy. Utilizing an empty room and a staff member for a deceased client is an inappropriate use of resources.

Question 2:

Copyright 2008 by Pearson Education, Inc. Question 2 The shift changed while the nursing staff was waiting for the adult children of a deceased client to arrive. The oncoming nurse has never met the family. Which of the following greetings is most appropriate? “I’m very sorry for your loss.” “I’ll take you in to view the body.” “I didn’t know your father but I am sure he was a wonderful person.” “How long will you want to stay with your father?”

Rationales 2:

Copyright 2008 by Pearson Education, Inc. Rationales 2 Correct. This statement acknowledges the family’s grief simply. Avoid statements that may be interpreted as overly impersonal. Avoid statements that may be interpreted as false support. Avoid statements that may be interpreted as harsh.

Question 3:

Copyright 2008 by Pearson Education, Inc. Question 3 An 82-year-old man has been told by his primary care provider that it is no longer safe for him to drive a car. Which statement by the client would indicate beginning positive adaptation to this loss? “I told the doctor I would stop driving, but I am not going to yet.” “I always knew this day would come, but I hoped it wouldn’t be now.” “What does he know? I’m a better driver than he will ever be.” “Well, at least I have friends and family who can take me places.”

Rationales 3:

Copyright 2008 by Pearson Education, Inc. Rationales 3 This option does not demonstrate movement toward a goal of adaptation nor problem solving. This option does not demonstrate movement toward a goal of adaptation nor problem solving. This option does not demonstrate movement toward a goal of adaptation nor problem solving. Correct. Adaptive responses indicate the client can put the loss into perspective and begin to develop strategies for coping with the loss.

Question 4:

Copyright 2008 by Pearson Education, Inc. Question 4 When asked to sign the permission form for surgical removal of a large but noncancerous lesion on her face, the client begins to cry. Which of the following is the most appropriate response? “Tell me what it means to you to have this surgery.” “You must be very glad to be having this lesion removed.” “I cry when I am happy or relieved sometimes, too.” “Isn’t it wonderful that the lesion is not cancer?”

Rationales 4:

Copyright 2008 by Pearson Education, Inc. Rationales 4 Correct. The nurse needs to assess and explore the meaning of the client’s crying. Option 2 leaps to assumptions about the meaning of the tears and ignores the possibility of the client’s distress. Option 3 suggests that the client has the same feelings as the nurse, which may not be correct. Option 4 leaps to assumptions about the meaning of the tears and ignores the possibility of the client’s distress.

Question 5:

Copyright 2008 by Pearson Education, Inc. Question 5 A nursing care plan includes the desired outcome of “quality of life” for a client with a chronic degenerative illness who is likely to live for many more years. Which of the following is one example that would indicate the outcome has been met? The client demonstrates having adequate financial resources to pay for health care for many more years. The client spends the majority of his or her time in spiritual reflection. The client has no signs or symptoms of preventative complications of the illness. The client verbalizes satisfaction with current relationships with other persons.

Rationales 5:

Copyright 2008 by Pearson Education, Inc. Rationales 5 Although being able to pay for care may appear to contribute to good quality of life, only the client’s expression of satisfaction can provide the data the nurse requires to evaluate the goal. Although apparent spiritual peace may appear to contribute to good quality of life, only the client’s expression of satisfaction can provide the data the nurse requires to evaluate the goal. Although the absence of physiological complications may appear to contribute to good quality of life, only the client’s expression of satisfaction can provide the data the nurse requires to evaluate the goal. Answer : 4 Rationale : Quality of life is determined by the client and expressed in terms of his or her satisfaction with a variety of aspects of life.

Resources:

Copyright 2008 by Pearson Education, Inc. Resources Audio glossary American Association of Retired Persons Learn about listening Wizard Academy Well-known author answers questions and offers thoughtful advice Griefnet On-line professional support Counseling for Loss & Life Changes Counseling for loss and life changes

Resources:

Copyright 2008 by Pearson Education, Inc. Resources Crisis Grief & Healing: Men and Women (Tom Golden LCSW) Multiple resource listings for healing from loss Grief Loss & Recovery Articles, stories, and poems about grief, loss, and bereavement Children's Grief & Loss Issues Children facing grief and loss Anger Management From Leonard Ingram Anger tool kit and books MUNS--Pet Loss Veterinarian discusses grieving over the loss of a pet