1. JUDITH M. WILKINSON LESLIE S. TREAS KAREN BARNETT MABLE H. SMITH FUNDAMENTALS OF NURSING Copyright © 2016 F.A. Davis Company Chapter 17: Loss, Grief, & Dying

2. Copyright © 2016 F.A. Davis Company Defining and Categorizing Loss The undesired change or removal of a valued object, person, or situation. Actual versus perceived loss Physical versus psychological loss External versus internal loss Loss of aspects of self Environmental loss Loss of significant relationships

3. Copyright © 2016 F.A. Davis Company What Is Grief? Grief: physical, psychological, and spiritual responses to a loss Mourning: action associated with grief Bereavement: mourning and adjustment time following a loss

4. Copyright © 2016 F.A. Davis Company Stages of Grief Four major theorists Engel Bowlby Rando Worden

5. Copyright © 2016 F.A. Davis Company Factors Affecting Grief Significance of the loss Support system Unresolved conflict Circumstances of the loss

6. Copyright © 2016 F.A. Davis Company Factors Affecting Grief (cont’d) Previous loss Spiritual/cultural beliefs and practices Timeliness of death Developmental stage of the bereaved

7. Copyright © 2016 F.A. Davis Company Types of Grief Uncomplicated Complicated –Chronic –Masked –Delayed Disenfranchised Anticipatory

8. Copyright © 2016 F.A. Davis Company How Is Death Defined? Historical definition Heart-lung death Whole-brain death Higher-brain death Uniform Determination of Death Act

9. Copyright © 2016 F.A. Davis Company Physiological Stages of Dying 1 to 3 months prior to death 1 to 2 weeks prior to death Days to hours prior to death Moments prior to death

10. Copyright © 2016 F.A. Davis Company Psychological Stages of Dying Five stages (Dr. Elizabeth Kübler-Ross) Denial Anger Bargaining Depression Acceptance

11. Copyright © 2016 F.A. Davis Company End-of-Life Care Palliative care: Holistic care for patients in managing the disease process; the treatment; or the side effects of either Does not mean the person is dying! Hospice care: Holistic care of dying clients

12. Copyright © 2016 F.A. Davis Company Legal and Ethical Considerations Advance directives http://www.azsos.gov/ser vices/advance-directives http://www.azsos.gov/ser vices/advance-directives Do not resuscitate (DNR)/allow natural death (AND) Assisted suicide Euthanasia Autopsy Organ donation www.dnaz.org

13. Copyright © 2016 F.A. Davis Company Sample: DNAR

14. Copyright © 2016 F.A. Davis Company Assessment for Terminally Ill Client and Family Knowledge base History of loss Coping abilities and support systems Meaning of the loss/illness Depression or grief? Physical assessment Cultural and spiritual assessment

15. Copyright © 2016 F.A. Davis Company Diagnosis for Terminally Ill Client and Family Most grief is normal, not dysfunctional. You can view the following: Loss and grieving as the problem Loss and grieving as the etiology

16. Copyright © 2016 F.A. Davis Company Planning Outcomes/Evaluation Planning Interventions/Implementation NOC Standardized Outcomes NIC Standardized Interventions

17. Copyright © 2016 F.A. Davis Company Therapeutic Communication Perfect your listening skills. Encourage and accept expression of feelings. Reassure it is not wrong to feel anger, relief, or other “unacceptable” feelings. Respond to nonverbal cues with touch and eye contact. Increase your self-awareness. Continue to communicate, even in case of coma.

18. Copyright © 2016 F.A. Davis Company Facilitating Grief Expressing feelings Recalling memories Finding meaning

19. Copyright © 2016 F.A. Davis Company Helping Families of Dying Clients Have family help with care, if able. Encourage questions. Provide follow-up for referrals as needed. Encourage visit to chapel or to talk with clergy. Provide anticipatory guidance. Acknowledge feelings of family.

20. Copyright © 2016 F.A. Davis Company Helping Families of Dying Clients (cont’d) Explore coping mechanisms. Remind family members and significant others to take care of themselves. Teach what to expect and provide reassurance. Ask directly if family wants to be present at time of death. At the moment of death, do not intrude.

21. Copyright © 2016 F.A. Davis Company Care of the Dying Person Meeting physiological needs Meeting psychological needs Addressing spiritual needs Addressing cultural needs

22. Copyright © 2016 F.A. Davis Company Providing Postmortem Care Care of the body: Follow agency policies and respect cultural and spiritual preferences.

23. Copyright © 2016 F.A. Davis Company Helping Families After the Death Provide emotional support immediately after the death. Provide grief education. Help children deal with loss.

24. Copyright © 2016 F.A. Davis Company Loss of a Patient It is normal for the nurse to feel grief when a client dies. You must also take care of yourself.

25. Copyright © 2016 F.A. Davis Company Think Like a Nurse Mr. Klein is an 86-year-old man whose wife died of heart disease 2 months ago. He has two adult children who regularly visit him. He also has a supportive pastor, Mr. Owens, who meets him in the park to share stories. Mr. Owens is 30 years old and has been raising his 5-year-old daughter alone after the sudden death of his wife 6 months ago in an automobile accident. His parents and siblings live out of state. Both of these men miss their wives very much. What factors do you think play a role in each man’s grief? Who do you think will “get over it” faster? What are some issues that may make each man’s grief uniquely difficult?