n250 week 7 grief, death, and loss vopp
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Grief, Death, and LossGrief, Death, and LossChapter 36
Cheryl Smythe-Padgham DNP, RN,WHNP-BC
Grief, Death and LossGrief, Death and LossNurses play an important role in
helping clients and families cope with things that cannot be changed and facilitate a peaceful death
Health care professionals sometimes resist feeling the uncomfortable emotions associated with grief and death and view death as a personal and professional failure
Grief, Death and LossGrief, Death and LossClients and families need expert
nursing care through grief and death, perhaps more than at any other time
Scientific Knowledge BaseScientific Knowledge BaseLossLoss
Necessary losses◦ Life changes as we move forward in life
Maturational losses◦ Normally expected life changes
Situational losses◦ Sudden unpredictable external events
Actual losses◦ Death of loved one, loss of body part, loss of
job
Perceived losses◦ Uniquely defined by the person
Scientific Knowledge BaseScientific Knowledge BaseGriefGriefEmotional response to loss,
mourning is a form of coping with grief.
Normal (uncomplicated)
Complicated (dysfunctional)
Scientific Knowledge BaseScientific Knowledge BaseGriefGriefAnticipatory
Disenfranchised
Theories of Grief and Theories of Grief and MourningMourningKubler-Ross’s stages of dying (1969)
◦Denial◦Anger◦Bargaining◦Depression◦Acceptance
Grieving people do not experience the stages in any particular order or length of time
Theories of Grief and Theories of Grief and MourningMourningBowlby’s attachment theory (1980)
◦Numbing Protects person from the full impact of
loss
◦Yearning and seeking Tears, sobbing and acute distress
◦Disorganization and despair Examines loss and expresses anger
◦Reorganization Person begins to accept change, new role
or skills
Theories of Grief and Theories of Grief and MourningMourningWorden’s grief tasks model (1982)
◦Task 1- accept the reality of the loss ◦Task 2- work through the pain of
grief◦Task 3- adjust to the environment in
which the deceased is missing◦Task 4- emotionally relocate the
deceased and move on with life
Nursing Knowledge BaseNursing Knowledge BaseFactors Influencing Loss and Factors Influencing Loss and GriefGriefHuman development
◦ Age and stage of development affect the grief response
Personal relationships◦ The quality and meaning of the lost
relationship influences the grief responseNature of the loss
◦ There are different challenges and stressors when loss is sudden versus a debilitating chronic illness
Factors Influencing Loss and Factors Influencing Loss and GriefGriefCoping strategies
◦ Life experiences shape the coping strategies a person uses
◦ Emotional disclosure (like venting, talking about one’s feelings) is an important way to cope with loss
◦ Support systems◦ Prior experience with loss
Socioeconomic status◦ The ability to access support and resources
for coping with loss
Factors Influencing Loss and Factors Influencing Loss and GriefGriefCulture and Ethnicity
◦ Culture influences the interpretations of loss, establishes acceptable expressions of grief and provides stability and structure
Spiritual and religious beliefs◦ Spiritual resources include faith in a higher
power, community, friends, religious practices
Hope◦ Energizes and provides comfort
Critical ThinkingCritical ThinkingNursing Code of EthicsThe Dying Person’s Bill of RightsAmerican Society of Pain
Management Nurse Guidelines
Nursing Process and Nursing Process and Grief AssessmentGrief AssessmentEstablish a trusting helping
relationshipUse open ended questionsAssess the client’s coping style,
the nature of family relationships, personal goals, cultural and spiritual beliefs, support systems
Grief reactionsClient expectationsEnd of life decisions
Nursing DiagnosisNursing DiagnosisRisk for complicated grieving
related to the permanent loss of mobility
Death anxietyComplicated grievingSpiritual distressHopelessness
Nursing ProcessNursing ProcessPlanningPlanningGoals/outcomes
◦Client will be able to discuss expected course of disease within 1 week
◦Maintain a sense of controlSetting prioritiesCollaborative care- nurses,
physicians, social workers, pharmacist, clergy, hospice care
ImplementationImplementationHealth Promotion
◦Grant time for the grieving process◦Focuses on facilitating coping and
optimizing physical, emotional, and spiritual health
◦Therapeutic communication◦Provide psychosocial care- provide
information that help clients understand their condition, course of disease
◦Manage symptoms
ImplementationImplementationHealth promotion continued
◦Promote dignity and self-esteem◦Maintain comfortable and peaceful
environment◦Promote spiritual comfort and hope
ImplementationImplementationHealth promotion continued
◦Protect against abandonment and isolation
◦Support the grieving family◦Assist with end of life decision
making◦Facilitate mourning◦Hospice care◦Care after death- organ and tissue
donation, autopsy, postmortem care
Palliative carePalliative careThe prevention, relief, reduction or
soothing of symptoms of disease or disorders throughout the entire course of illness including care of dying and bereavement follow-up for the family.
Improves the quality of life of clients and families facing end of life issues
Hospice care is final phase of palliative care.No further medical care aimed towards cure is
given. Instead the focus becomes symptom relief and enhancing the quality of life remaining.
EvaluationEvaluationThe success of the evaluation
process depends partially on the bond you have formed with the client
Care for the Grieving Care for the Grieving NurseNurseNurses need to assess
their own emotional well-being
Self-reflection is a part of critical thinking that assesses whether sadness is related to caring or unresolved personal experiences
Being a professional is knowing when to get away from the situation to care for yourself
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