Nursing Level I

  1. Barriers to a 'Good Death'
    • unfamiliar environments
    • focus on prolonging life and avoiding death
    • strangers caring for the dying
    • nurses uncomfortable with emotions of self/family of dying
    • viewed as personal/professional failure
    • talking about death discouraged
    • terminally ill folks remind us of our mortality
    • nurses grieve when we see others grieving
  2. Loss
    • removal, change, or reduction in value of something valued or held dear and the feelings that result
    • responses vary per person
    • Concrete-tangible
    • Psychologica-intangible
  3. Necessary Losses
    • Part of life/natural
    • recoverable or replaceable
    • maturational
    • -form of necessary loss, occurs during normal life transitions, help develop coping skills for unplanned/unwanted/unexpected
  4. Actual Loss
    • Tangible
    • person can no longer feel, hear, or know a person or object
  5. Perceived Loss
    • Intangible
    • Subjective-defined per individual
    • not easily identified by others
    • easily overlooked by others
    • individual interpretation of menaing affects the intensity of the grief
  6. Situational Losses
    • not part of expected maturation experiences
    • seems unnecessary
    • sudden, unpredictable external events
    • may result in multiple losses
  7. Grief
    • Inner emotional response to a loss, exhibited in ways unique to each individual
    • Coping process
    • Affected by-past experiences, culture, spiritual beliefs
  8. Normal Grieving
    • natural response to loss-physical, emotional, cognitive, behavioral
    • lead to personal growth for the bereaved
    • resolution of mental trauma of loss through a series of stages
    • grief work-effort to acknowledge the pain associated with loss and integrate the loss into the future
  9. Dysfunctional grieving
    • inability to accept the loss and move on with life
    • unresolved grief, not able to reconcile new life with the way life was before the loss
    • chronic/disruptive yearning
    • do not rush to this diagnosis
    • grief and time to grieve is very variable
  10. Anticipatory Grieving
    • unconscious process
    • may feel relief after the loss
    • intellectual and emotional responses and behaviors to help a person move on to a healthier emotional state
    • stressors may outweigh the benefits
  11. Disenfranchised Grief
    • Marginal or Unsupported grief
    • unable to openly acknowledge or publicly share grief
  12. Grief Response Variables
    • Cultural background
    • Developmental Factors - Age/Gender
    • Situation or circumstances surrounding dying
    • Psychosocial factors
    • Previous experiences with grief
    • Individual's physical condition
  13. Mourning
    • Internal experience of grief and its expression outside of oneself
    • Rituals of cultural/social ¬†acts to express thoughts and feelings of sorrow
    • psychological stages occurring as one adapts to loss
  14. Bereavement
    • both grief and mourning
    • inner feelings, emotional responses, and outward behaviors of a person experiencing loss
    • acute state of intense psychological sadness/suffering experienced after tragic loss of loved one
    • Traditionally defined as being deprived through death
    • Familial experience even communal ie 9/11
  15. Cultural & Religious Views of Death
    • Death-accepting/Death-denying
    • may be seen as end of existence or transition to another state of being/consciousness
  16. Death/Dying Attitudes
    • Kubler-Ross first described process of dying in 1960's
    • Traditionally viewed as preserved for the elderly
    • 2000 focus on active/healthy life, youth-oriented
    • Death gets in the way of Happy
  17. 5 stages of grief
    • Denial
    • Anger
    • Bargaining
    • Depression
    • Acceptance
  18. Factors influencing Loss/Grief
    • Developmental stages
    • Personal relationship
    • Nature of Loss
    • Coping Strategies
    • Socioeconomic Status
    • Culture/Ethnicity
    • Spiritual/Religious Beliefs
    • Hope
  19. Erikson's Developmental Stages
    • Trust/Mistrust
    • Autonomy/Shame-Doubt
    • Intiative/Guilt
    • Industry/Inferiority
    • Identity/Role Confusion
    • Intimacy/Isolation
    • Generativity/Self-absorption-Stagnation
    • Integrity/Despair
  20. Infant
    no concept of death
  21. Toddler 2-6yr
    Death is reversible such as sleep
  22. Young children 6-10yr
    • Can accept finality of death
    • associated with skeleton
    • able to hide from it
  23. Middle age adults
    more aware of own aging and physical changes
  24. Older Adults
    • begin to experience anticipatory grief: physical changes, loss of independence/employment/relationships
    • High risk for complicated grieving
  25. Support Systems
    • quality and meaning of relationship lost
    • availability of famliy, friends, health care workers
  26. Nature of the loss
    • meaning of loss
    • impact on patient's behavior, health, well-being
    • visible loss = support
    • private losses may mean less support
    • sudden loss vs. expected loss
    • violent deaths, suicides, multiple losses complicate the grief process
  27. Coping Strategies
    • May use usual
    • May need new strategy
    • Adaptive/maladaptive
    • Ego defense mechanisms
    • Emotional disclosure-venting
    • Focus on positive
    • Negative focus may indicate higher degree of distress
  28. Ego Defense Mechanisms
  29. Socioeconomic Status
    • Influences access to support systems & Resources
    • Affects financial, educational, and occupational resources
    • Money unable to replace tangible losses
    • Money unably to control issues of loss
  30. Culture/Ethnicity
    • background affects understanding and approach to grief process
    • some cultures have specific times for grieving through rituals
    • dictates acceptable expressions of grief
    • provides stability where there is chaos and loss
    • work/task oriented cultures
    • no public displays of emotion vs wailing, ripping of clothing, body mutilation
    • America - Individualism
  31. Spiritual Influences and Beliefs
    • Spiritual Resources: their faith, sources of hope, meaning of life, religious rituals
    • Spiritual well-being: higher power, connectedness to others and purpose of life - even in the end
  32. Hope
    • Energizes, comforts
    • Provides meaning & purpose
    • Determine sources of hope - spirtiuality, relationships, positive emotuions, anticipating the future, availability of resources, providing service for others
  33. Grieving Assessment
    • Physical
    • Psychological
    • Resources Available
  34. Physical Grieving
    • Sleep pattern/fatigue
    • weight
    • nutrition
    • activity level
    • pain & discomfort
    • S/S of Illness
  35. Psychological Grieving
    • Emotional state
    • Decision making process
    • Confidence level
    • Coping Strategies
    • Spirituality
  36. Resources during Grieving
    • relationships
    • social life
    • support system
    • financial situation
  37. Dysfunctional Grieving Assessment
    • behaviors that interfere with functioning
    • inadequate coping skills, poor relationships, substance abuse, loss of support systems, multiple unresolved losses
  38. Nursing Interventions for Grief & Loss
    • Therapeutic Communication
    • Support
    • Educate
    • References for other resources
  39. Expected Outcome of Nursing Diagnosis for Grief/Loss
    • Identify/Express feelings freely
    • FInish unfinished business
    • Acknowledge impact of grieving process
    • Dying with Dignity
  40. Palliative Care
    • symptom management, not curative
    • Good Death
    • Pain/Symptom Control
    • Psychological/Spiritual Care
    • Enhance Quality of Life
  41. Hospice
    patient's individual wishes are the focus and every attempt to meet those expectations is made
  42. Code Status
    • DNR
    • Full Code
    • via POLST form
    • Doctor's signature
  43. Active Euthanasia
    Patient requests assistance in death coming sooner
  44. Passive Euthanasia
    • Act of Omission
    • Pulling the Plug
  45. Dying Process
    • Emotional Signs
    • Psycosocial/Spiritual
    • Physiological Phases
  46. Nursing Interventions of Dying Process
    • Comfort Care
    • Positioning, cleansing
    • Nutrition
    • Communication
    • Manage Pain
Card Set
Nursing Level I
Grief & Loss