LOSS, GRIEF AND DEATH
Loss, Grief, Dying
Class Objectives
The nursing student Engles stages of
will learn: grief
nurses role in loss, Kubler-Ross Grief
grief, death and and Death Reactions
dying legal and ethic
emotional reactions dilemmas with death
to loss and dying
to create a nursing
care plan for a death
and dying patient.
Loss
Occurs when a • Physical loss
valued person,
object, or
• Psychological
loss
situation is
changed
• Actual Loss
• Perceived loss
• Anticipated loss
Grief or Grieving-Grief is the
Emotional Reaction to Loss
Bereavement- state Mourning-period of
of grieving during acceptance of loss
which a person goes and grief during
through grief which the person
reaction. learns to deal with
the loss.
Engels 6 Stages of Grief
Reaction
Shock and disbelief
Developing
awareness
Restitution
Resolving the loss
Idealization
Outcome
Kubler-Ross Grief and Death
Reactions
Denial and isolation
Anger
Bargaining
Depression
Acceptance
Five Principles of Palliative Care-
(Hospice care)
Respects the goals, Supports the needs
likes and choices of of the family
the dying pt. members
Looks after medical, Helps pt gain access
emotional, social, to needed healthcare
and spiritual needs of providers and
the dying person appropriate settings
Builds ways to
provide excellent end
of life care
Ethical and Legal Dimensions
Managed death, Patients look to
Legalized physician nursing for
assisted suicide, information, advice
Physician and support.
administered lethal
injections (aid in
dying) – create
ethical dilemmas.
The nurse patient relationship is
key to helping patient’s grieve
Advanced Directives
Living wills- provide Durable power of
specific instructions attorney- appoints
about the kinds of and agent the person
health care that trusts to make
should be provided decisions in the
or foregone in a event of the
particular situation appointing person’s
subsequent
incapacity.
Do not resuscitate or No code
orders
What is the difference between a
DNR or a No code order
and
Comfort measures only order?
Factors that influence Grief and
Dying
Developmental
Family
Socioeconomic
Cultural
Religious
Cause of Death
Nursing Process
Questions to ask
Assessing-
determine the • What have you been told
about your condition?
adequacy of the pt’s
• Have you had any previous
and families, experience with this condition
knowledge, or death of a loved one?
perceptions, coping • Tell me a little bit about how
strategies and you are coping
resources. • What is helping you get
through this?
Nursing Diagnoses
Impaired adjustment Anticipatory grieving
Caregiver role strain Dysfunctional
Decisional conflict grieving
Ineffective coping Hopelessness
Ineffective denial Ineffective
management of
therapeutic regimem
Planning expected outcomes
The pt and family will achieve:
• Demonstrate freedom in expressing
feelings
• Identify and use effective coping
strategies.
• Accept need for help as appropriate
• Make healthcare decisions reflecting
personal values and goals.
Implementing
The nurses aim is to Nursing Diagnosis
care for the dying pts • Impaired adjustment
and their families r/t newly diagnosed
and promote health terminal illness
and preventing • Caregiver role strain r/t
hospital discharged
illness of the family dying pt because of
inadequate insurance.
• Dysfunctional grieving
r/t inability to accept
death of infant no grief
resolution.
Nursing interventions
Monitor patient for Monitor pain
anxiety Facilitate obtaining
Monitor mood spiritual support for
changes pt and family
Communicate Include the family in
willingness to care decisions and
discuss death activities as desired.
Encourage pt and
family to share
feelings about death
Evaluating
The plan of nursing care for dying pts. meets
the outcome of a comfortable, dignified death
and family members resolve their grief after
a suitable time of mourning and resume
meaningful life roles and activities.
Nurses grieve too.
Clinical Signs of Impending
Death
Muscle weakness
Respiratory changes
• Cheyne-Stokes
• Death Rattle
Sensory changes
Circulatory changes
Postmortem Care
Nursing prepares the body for viewing
Identification
Who to notify
Jewelry and valuables
Dentures, glasses, prosthetics
Question
A nurse is caring for a pt who is dying
of terminal cancer. While assessing
the pt. for signs of impending death,
the nurse should observe the pt for:
A. Elevated B/P
B. Cheyne-Stokes respirations
C. Elevated pulse rate
D. Flushed skin
Question #1
• A nurse caring for a 15 y/o pt with terminal
CA has assessed that the pt. is very quiet
and has not expressed his feelings. The
nurse will need to implement
1. A referral for bereavement resources to enhance
care
2. Interventions for a pt in isolation and inner
thought
3. Assessment skills to determine fear and anxiety
4. Therapeutic skills to enhance communication
Question #2
A pt who has ovarian CA with metastasis to
the liver complains of increased pain and
dysphasia. A physician orders a barium
enema. The patient states, “I don’t want this
test. What should I do?” The nurse should
a. A inform her to refuse the test
b. Inform the MD of her statements
c. Educate her on the test’s benefits
d. Educate her on the procedure
Question #3
A 39 y/o pt who is apparently dead is
brought to the hospital by ambulance. A
concerned neighbor found the pt alone in
the apartment in this condition. The
tentative cause of death is suicide. Even
though the family has refuse an autopsy,
an autopsy can be ordered by the
a. A families MD
b. County court
c. City policy dept
d. County coroner.
Question #4
You overhear a patient state, “If you make me
well, God, I will try to be a better person.”
You know that this type of statement is one of
the stages of grieving known as
1. Anger
2. Bargaining
3. Denial
4. Depression
Question #5
The process of viewing the body after death
best supports which of the following
statements?
1. Provides the resolution of the death
experience for most families
2. Increases anxiety levels
3. Allows family members an avenue of escape
from the truth
4. Supports the family members’ decision for a
DNR