chapter 36.txt

  1. How can the nurse assist the client experiencing loss, grief, or death?
    • Nurses provide holistic, physical, emotional, social, and spiritual care to patients experiencing grief, death, or loss.
    • Nurses provide holistic, physical, emotional, social, and spiritual care to patients experiencing grief, death, or loss.
  2. What are the types of loss a client might experience throughout the life-cycle?
    • Actual losses
    • – Necessary losses
    • • Maturational losses
    • • Situational losses
    • • Perceived losses
  3. In what way might a client display grief?
    • Grief: An emotional response to a loss, manifested in ways unique to an individual based on personal experiences, cultural expectations, and spiritual beliefs.
    • – Normal (uncomplicated): common, universal reaction characterized by complex emotional, cognitive, social, physical, behavioral, and spiritual responses to loss and death.
    • – Complicated: exaggerated, delayed, masked; person has a prolonged or significantly difficult time moving forward after a loss.
    • – Anticipatory: the unconscious process of disengaging or “letting go” before the actual loss or death occurs,
    • – Disenfranchised (aka marginal or unsupported): when their relationship to the deceased person is not socially sanctioned, cannot be openly shared, or seems of lesser significance. Examples include the death an ex-spouse, a gay partner, or a pet or death from a stigmatized illness such as alcoholism or during the commission of a crime
    • -Ambiguous losses: type of disenfranchised grief, occurs when the lost person is physically present but not psychologically available, as in cases of severe dementia or severe brain injury. Particularly difficult to process because of the lack of finality and unknown outcomes
  4. What are the stages of dying?
    • Denial
    • Anger
    • Bargaining
    • Depression
    • Acceptance.
  5. What variables influence the way a person perceives and responds to loss?
    • Human development
    • Personal relationships
    • Nature of loss
    • Coping strategies
    • Socioeconomic status
    • Culture and ethnicity
    • Spiritual and religious beliefs
    • Hope
  6. How can the nurse assess a client experiencing grief?
    • • Listen carefully to the patient’s perceptions.
    • • Use culture-specific understanding.
    • • Use Professional Standards:
    • – Nursing Code of Ethics
    • – Dying Person’s Bill of Rights
    • – ANA Scope and Standards of Hospice and Palliative Nursing
    • • Use Clinical Standards: American Society of Pain Management Nurses’ Guidelines
  7. What are some questions the nurse can ask related to assessment of grief?
    • Nature of Relationships
    • • How long have you known _______ (the deceased person)?
    • • What role did (name person) play in your life?
    • • Tell me about your relationship with (name person).
    • Social Support Systems
    • • Who is “there for you?” Absent? Who provides support?
    • • What do others do for you that is most meaningful or helpful?
    • • Are family/friends available when needed? Which friends or relatives do you wish were here?
    • Nature of the Loss
    • • What does this loss mean to you?
    • • What other losses have you experienced?
    • Cultural and Spiritual Beliefs
    • • What is your belief about death? Meaning of life?
    • • Which rituals are important to you at the end of life?
    • • How do members of your culture or religious group respond to this loss?
    • Life Goals
    • • What are your life goals at this time?
    • • How have your goals changed because of this experience?
    • • Are you able to envision what you will do in the future?
    • Family Grief Patterns
    • • How have you/your family dealt with loss in the past?
    • • What are your family's strengths?
    • • How have family relationships changed as a result of your loss?
    • • What role do you assume in your family during stressful situations?
    • Self-Care
    • • Tell me how you are feeling.
    • • What are you doing to take care of yourself now?
    • • What helps you when you feel this sad? What doesn't help?
    • Hope
    • • What do you hope for right now?
    • • What helps you to remain hopeful? What causes you to lose hope?
    • How are the symptoms related to one another when they occur?
    • When did they begin?
    • Were they present before the loss?
    • To what does the person attribute them?
  8. What nursing diagnosis may be considered for a client experiencing loss or grief issues?
    • • 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 enhanced spiritual well-being
  9. How can the nurse facilitate successful coping and optimize physical, emotional, and spiritual health for the client and/or family experiencing loss and grief?
  10. How can the nurse involve the client in the evaluation phase of the nursing process?
    • Questions to help validate achievement of patient goals and expectations:
    • – What is the most important thing I can do for you at this time?
    • – Are your needs being addressed in a timely manner?
    • – Are you getting the care for which you hoped?
    • – Would you like me to help you in a different way?
    • – Do you have a specific request that I have
  11. What is hospice care?
    A philosophy and a model for the care of terminally ill patients and their families. Hospice is not a place but rather a patient- and family-centered approach to care.
  12. Describe the care of a client’s body after death. What are some cultural considerations?
    • a human body deserves the same respect and dignity as a living person and needs to be prepared in a manner consistent with the patient's cultural and religious beliefs. Death produces physical changes in the body quite quickly; thus you need to perform postmortem care as soon as possible to prevent discoloration, tissue damage, or deformities.
    • • African American: Care of the body after death depends on the African American's country of origin and degree of American acculturation. The presence of large extended family groups, including the church family, is common at time of death. The mourning period is relatively short, with a memorial service and a public viewing of the body or a wake before burial. Organ donation and autopsy are allowable.
    • • Chinese: Death is regarded as a negative life event, and there is no concept of an afterlife. The dead are treated with the same respect as the living and may be buried with food and other artifacts. Members of an extended family usually stay with the deceased for up to 8 hours after death. The oldest son or daughter bathes the body under direction from an older relative or a temple priest. They often believe the body should remain intact; thus organ donation and autopsy are uncommon
    • • Hispanic or Latino: Honoring family values and roles is essential in providing care and making decisions at the end of life. People in Hispanic and Mexican-American cultures often use special objects such as amulets or rosary beads, alternative healing practices (folk medicine), and prayer. Grief is expressed openly. Religious and spiritual rituals (predominantly Catholic) are essential at the end of life. Death is often believed to be the will of God
    • • Native American: Native Americans encompass diverse tribal groups with differing practices, traditions, and ceremonies. Traditional Navajos do not touch the body after death. Care of the body in the large Navajo tribe includes cleansing the body, painting the deceased's face, dressing in clothing, and attaching an eagle feather to symbolize a return home. Mourners also have a ritual cleansing of their bodies. The dead are buried on the deceased's homeland.
    • • Islamic: The deceased's body is ritualistically washed, wrapped, cried over, prayed for, and buried as soon as possible after death. The eyes and mouth are closed, and the face of the deceased is turned toward Mecca. Muslims of the same gender prepare the body for burial. Bodies are buried, not cremated. Autopsies interfere with a quick burial; make autopsy requests with sensitivity and only if necessary. The proximity of loved ones after death is important since it is believed that the soul stays with the body until it is buried. Organ donation is permissible by some Qur’an interpretations
    • • Buddhist: Buddhists believe in an afterlife in which humans manifest in different forms. Death is preferred at home, and a person's state at the time of death is important. Individuals usually minimize emotional expressions and maintain a peaceful, compassionate atmosphere. Male family members prepare the body. Buddhists recommend not touching the body after death to give the deceased a smoother transition to the afterlife. People often say prayers while touching and standing at the head of the deceased. The body is not left alone after death. Family and friends pay respects after death and before cremation of the body
    • • Hindu: The body is placed on the floor with the head facing north. Persons of the same gender handle the body after death. There are no general prohibitions against autopsy. Bodies are cremated after death to purify by fire
    • • Jewish: If the family practices Orthodox Judaism, determine if members from the Jewish Burial Society are coming to the facility before preparing the body. A family member often stays with the body until burial. Usually the burial occurs within 24 hours but not on the Sabbath. Some but not all types of Judaism avoid cremation, autopsy, and embalming.
  13. Identify methods for nurse self-care in grief and loss.
    Eating well, exercising, engaging in relaxing activities, laughing, and getting enough sleep. To promote emotional health, participate in calming activities such as meditation, daily gratitude reflections, deep breathing, walking, or listening to music ( Showalter, 2010 ). Activities for self-transcendence (spiritual awareness) include journal writing, sharing stories, recognizing one's own positive contributions and unique gifts, and connecting with one's self
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chapter 36.txt
Death loss grief Chapter 36