Grief Process, Death and Dying

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					Grief Process, Death and

         Nur 102
   Fundamentals of Nursing

            Roark, 2004
   Actual
   Perceived
   External Objects
   Known Environment
   Significant Other
   Aspect of Self
   Life

                        Roark, 2004
     Kubler-Ross Stages of Grief

   Denial
   Anger
   Bargaining
   Depression
   Acceptance

                 Roark, 2004
                 Death and Dying

   Assisting the patient
    to “Live well” and
    “Die well”

What does this mean to

                            Roark, 2004
Common fears of the dying patient

   Fear of Loneliness
       Distancing by support people and caregivers
        can occur
       Debilitation, pain, and incapacitation
       Hospital, a place that can be very lonely
       Fear of dying alone

                         Roark, 2004
          Fears of the dying client
   Fear of Sorrow
       Sadness
       Letting go of hopes, dreams, the future
       Awareness of own mortality
       Grief about future losses
       Anticipatory grief that involves mourning, coping skills
       Grief related to diagnosis that has a long term effect
        on the body such as cancer
       Patient may feel well at time of diagnosis

                             Roark, 2004
         Fears of the dying client

   Fear of the unknown:
       Death is an unknown state
       What will happen after death?
       What will happen to loved ones, those left

                         Roark, 2004
          Fears of the dying client

   Loss of self concept and body integrity
       Mutilation via therapy
       Body image changes
       Loss of role or status
       Loss of standard of living

                          Roark, 2004
         Fears of the dying client

   Fear of Regression
       Ego is threatened
       Physical deterioration may occur
       Mental deterioration may occur
       Unable to care for self
       Become dependent on others for care

                        Roark, 2004
          Fears of the dying client

   Fear of Loss of Self Control
       Loose ability to control life decisions
       Loose ability to control ADL’s
       Loss of control of body functions
       Loss of control of emotions
       Loss of independence

                           Roark, 2004
          Fears of the dying client

   Fear of Suffering and Pain
       May be many different types of pain or
        suffering such as physical, emotional, social,
        or spiritual in nature
       Altered relationships with others
       Anxiety related to the disease and
        consequences of the disease

                          Roark, 2004
     Child’s Response to Illness and
   Infant
   Toddler
   Preschool
   School Aged
   Adolescent

                  Roark, 2004
Cultural Backgrounds Affect Beliefs
         Concerning Death
   Beliefs, attitudes, and values that stem from the
    patient’s cultural background will strongly
    influence their reaction to loss, grief, and death
   Expressions of grief are governed by what is
    acceptable by the family and within the cultural
   Comfort may be found through spiritual beliefs,
    and finding comfort in specific rites, rituals, and
                         Roark, 2004
Cultural Backgrounds Affect Beliefs
         Concerning Death
   Organized religious practices
   Nurses need to be in tune with patients’
    spiritual needs
   Becoming familiar with cultural views will
   Can you name some cultural practices
    associated with loss, grief, and death?

                      Roark, 2004
             Support the client
   Nurses can help to identify coping mechanisms,
    and encourage effective coping mechanisms
   Allow client/family to visit the chapel if desired
   Allow family members around
   Client may have problems with conflicting
    feelings that do not align with culture or
    religious practices-nurse can evaluate coping
    and guide the client to appropriate interventions

                         Roark, 2004
          Role of the Chaplain

   Can be a member of the health care team
   Assist with religious practices
   Perform rites
   Provide prayer, support, and comfort
   Assist with mobilizing other support
    systems that are important to the client
   Support family members
                    Roark, 2004
      Nurses response to the dying
   Nurses grieve also
   Nurses need to come to terms with personal
    meanings of life and death
   Best prepared to work with terminal clients
    when the nurse has been given the time to
    come to terms with own mortality
   Common feelings
   Develop personal/professional support systems

                       Roark, 2004
      Rationale for Communicating
    Truthfully about Terminal Illness
   Right to know
   Time frame
   Nurse needs to assess whether or not the
    patient/family have been told and what
    was told to them

                     Roark, 2004
    Communicating Terminal Illness,
   The nurse:
       Clarifies what was said
       Listens to concerns
       Fosters communication between MD, client, and
       Allows patient to express loss
       Facilitate grief through nursing process
       Be available for patient
       Assist patient to identify needs/hopes for remainder
        of life
       Connect patient with proper resources

                            Roark, 2004
    List nursing strategies appropriate
            for grieving persons
   Open ended statements
   Patient sets the pace
   Accept any grief reaction
   Be aware—nurse may be target of anger
   Remove barriers
   Avoid giving advice
   Allow patient to talk
   Allow patient to express signs of hope
   Support hope by helping focus

                      Roark, 2004
         Assist Family to Grieve
   Explain procedures and equipment
   Prepare them about the dying process
   Involve family and arrange for visitors
   Encourage communication
   Provide daily updates
   Resources
   Do not deliver bad news when only one family
    member is present

                       Roark, 2004
        Choices of Care Setting

   Families have choices of where to care for
    the dying loved one
   Ask the patient and family preferences
   Support whatever the choice
   Hospital, Home/Hospice

                     Roark, 2004
       Elements of Hospice Care

   Home care coordinated with hospital
   Control of symptoms holistically
   Physician directed care
   Utilization of variety of health care
   Bereavement follow up care
   Acceptance based on need, not $
                     Roark, 2004
Nursing strategies to meet physical
  and psychosocial needs of the
           dying patient
   Thorough pain control
   Maintain
   Prevent isolation
   Spiritual comfort
   Support the family

                       Roark, 2004
    Signs/Symptoms of Approaching
   Motion and sensation is gradually lost
   Increase in temperature
   Skin changes-cold, clammy
   Pulse-irregular, and rapid
   Respirations-strenuous, irregular, Cheyne stokes
   “Death rattle”
   Decrease Blood Pressure
   Jaw and Facial muscles relax
   MOST POSITIVE SIGN OF DEATH=Absence of brain
    waves (Need two MDs to sign off)

                          Roark, 2004
         Nursing care after death
   Autopsy: examination performed after a
    person’s death to confirm or determine
    cause of death
   For tissue and organ removal:
       Keep CV system going
       Call donor bank representative
       Must be agreed on by all family members
       Or, patient decision before death

                        Roark, 2004
      Nursing care after death
Legally, a person is considered dead when there is
  a lack of brain waves even though other body
  organs continue to function
This definition allows for harvesting of organs and
  tissue for donation
Vital organs are: heart, liver, kidney, lung,
Non-vital organs are: eye corneas, long bones,
  middle ear bones, and skin

                      Roark, 2004
    Deceased patient, before viewing
               the body
   Check orders for special requests
   Remove equipment
   Remove supplies
   Change soiled linens and cleanse patient
   Use room deodorizer
   Place patient in supine position, with small pillow
    under head
   Insert dentures

                         Roark, 2004
    Deceased patient, before viewing
          the body continued
   Remove valuables and give to family
   Stay with family, if requested

After the family leaves:
 Tag patient according to hospital/agency policy
 Wrap body in shroud
 Put ID tag on shroud
 Transfer to morgue
 Document

                       Roark, 2004
     Describe response of family to
             dying process
   Related to cultural background
   Unresolved grief issues
   Emotions
   Requests
   Physical symptoms may occur
   Reorganization
   Individualized grief patterns
                     Roark, 2004
Behavioral responses that obstruct
     the expression of grief
   Sudden, unexpected death
   Lengthy illness resulting in death
   Loss of a child
   Perception that the death was preventable
   Unsteady relationship with deceased
   Mental illness of survivor
   Lack of social support
                     Roark, 2004

   Thanatology= study of death
   The description of study of the
    phenomena of death, and of psychological
    mechanisms for coping with death

                    Roark, 2004

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