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DEATH & DYING GRIEF & LOSS

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Page 1: DEATH & DYING GRIEF & LOSS. Loss -Occurs when a valued person, object, or situation is changed Types of Losses -actual loss -perceived loss -anticipatory

DEATH & DYINGGRIEF & LOSS

Page 2: DEATH & DYING GRIEF & LOSS. Loss -Occurs when a valued person, object, or situation is changed Types of Losses -actual loss -perceived loss -anticipatory

Loss-Occurs when a valued person, object, or situation is changed

Types of Losses

-actual loss-perceived loss-anticipatory

loss

Page 3: DEATH & DYING GRIEF & LOSS. Loss -Occurs when a valued person, object, or situation is changed Types of Losses -actual loss -perceived loss -anticipatory

Grief or Grieving-Grief is the Emotional

Reaction to LossBereavement- a state of grieving during which a person goes through a grief reaction

Mourning-a period of acceptance of loss and grief during which the person learns to deal with the loss

Page 4: DEATH & DYING GRIEF & LOSS. Loss -Occurs when a valued person, object, or situation is changed Types of Losses -actual loss -perceived loss -anticipatory

Engels: 6 Stages ofthe Grief Reaction

Shock and DisbeliefDeveloping AwarenessRestitutionResolving the LossIdealizationOutcome

Page 5: DEATH & DYING GRIEF & LOSS. Loss -Occurs when a valued person, object, or situation is changed Types of Losses -actual loss -perceived loss -anticipatory

When I must leave you for a little whilePlease do not grieve and shed wild tears

And hug your sorrow to you through the yearsBut start out bravely with a gallant smile;

Reach out your hand in comfort and in cheerAnd I in turn will comfort you and hold you near;

And never, never be afraid to die,For I am waiting for you in the sky!

Page 6: DEATH & DYING GRIEF & LOSS. Loss -Occurs when a valued person, object, or situation is changed Types of Losses -actual loss -perceived loss -anticipatory

Stages of the Grief and Loss/Death & Dying Process

DenialAngerBargainingDepressionAcceptance

Page 7: DEATH & DYING GRIEF & LOSS. Loss -Occurs when a valued person, object, or situation is changed Types of Losses -actual loss -perceived loss -anticipatory

Five Principles of Palliative Care (Hospice Care)

respect the goals, likes and choices of the dying patient look after medical, emotional, social, and spiritual needs of the dying person

support the needs of the family membershelp the patient gain access to needed healthcare providers and appropriate settingsbuild ways to provide excellent end of life care

Page 8: DEATH & DYING GRIEF & LOSS. Loss -Occurs when a valued person, object, or situation is changed Types of Losses -actual loss -perceived loss -anticipatory

Ethical and Legal Dimensions

-managed death-legalized physician assisted suicidephysician- administered lethal injections create ethical dilemmas

patients look to nurses for information, advice and support

Page 9: DEATH & DYING GRIEF & LOSS. Loss -Occurs when a valued person, object, or situation is changed Types of Losses -actual loss -perceived loss -anticipatory

Advanced Directives

Living Wills- provide specific instructions about the kinds of health care that should be provided or foregone in a particular situation

Durable Power of Attorney-appoints an agent the person trusts to make decisions in the event of the appointing person’s subsequent incapacity

Page 10: DEATH & DYING GRIEF & LOSS. Loss -Occurs when a valued person, object, or situation is changed Types of Losses -actual loss -perceived loss -anticipatory

Factors That Influence Death and Dying

DevelopmentalFamilySocioeconomicCulturalReligiousCause of Death

Page 11: DEATH & DYING GRIEF & LOSS. Loss -Occurs when a valued person, object, or situation is changed Types of Losses -actual loss -perceived loss -anticipatory

Nursing Process

Assessing- determine the adequacy of the patient’s and family’s knowledge, perceptions, coping strategies and resources

Questions to AskWhat have you been told about your condition?Have you had any previous experience with this condition or death of a loved one?Tell me about how you are copingWhat is helping you get through this?

Page 12: DEATH & DYING GRIEF & LOSS. Loss -Occurs when a valued person, object, or situation is changed Types of Losses -actual loss -perceived loss -anticipatory

Nursing ProcessPlanning-the patient and family will:

demonstrate freedom in expressing feelings

identify and use effective coping strategies

accept need for help as appropriatemake healthcare decisions reflecting personal values and goals

Page 13: DEATH & DYING GRIEF & LOSS. Loss -Occurs when a valued person, object, or situation is changed Types of Losses -actual loss -perceived loss -anticipatory

Implementing- the nurse’s aim is

to care for the dying patient and their families as well as to promote health and prevent illness in

the family

Nursing Diagnosesimpaired adjustment r/t newly diagnosed terminal illnesscaregiver role strain r/t hospital discharged dying pt because of inadequate insurance.dysfunctional grieving r/t inability to accept death of infant

Nursing Process

Page 14: DEATH & DYING GRIEF & LOSS. Loss -Occurs when a valued person, object, or situation is changed Types of Losses -actual loss -perceived loss -anticipatory

Nursing Interventions

Monitor anxietyMonitor changes in mood/affectCommunicate willingness to discuss deathEncourage patient and family to share feelings about death

Monitor painFacilitate obtaining spiritual support for patient and family Include the family in care decisions and activities as desired

Page 15: DEATH & DYING GRIEF & LOSS. Loss -Occurs when a valued person, object, or situation is changed Types of Losses -actual loss -perceived loss -anticipatory

Evaluatingdoes the plan of nursing care for the dying patient meet the outcome of a comfortable, dignified death?do family members resolve their grief after a suitable time of mourning and resume meaningful life roles and activities?

Nursing Process

Page 16: DEATH & DYING GRIEF & LOSS. Loss -Occurs when a valued person, object, or situation is changed Types of Losses -actual loss -perceived loss -anticipatory

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:

A. A referral for bereavement resources to enhance care

B. Interventions for a pt in isolation and inner thought

C. Assessment skills to determine fear and anxiety

D. Therapeutic skills to enhance communication

Page 17: DEATH & DYING GRIEF & LOSS. Loss -Occurs when a valued person, object, or situation is changed Types of Losses -actual loss -perceived loss -anticipatory

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. Encourage her to refuse the testb. Inform the MD of her statementc. Educate her on the test’ s benefitsd. Educate her on the procedure


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