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

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Presentation on theme: "DEATH & DYING GRIEF & LOSS. Loss -Occurs when a valued person, object, or situation is changed Types of Losses -actual loss -perceived loss -anticipatory."— Presentation transcript:


2 Loss -Occurs when a valued person, object, or situation is changed Types of Losses -actual loss -perceived loss -anticipatory loss

3 Grief or Grieving- Grief is the Emotional Reaction to Loss Bereavement- 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

4 Engels: 6 Stages of the Grief Reaction Shock and Disbelief Developing Awareness Restitution Resolving the Loss Idealization Outcome

5 When I must leave you for a little while Please do not grieve and shed wild tears And hug your sorrow to you through the years But start out bravely with a gallant smile; Reach out your hand in comfort and in cheer And 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!

6 Stages of the Grief and Loss/ Death & Dying Process Denial Anger Bargaining Depression Acceptance

7 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 members help the patient gain access to needed healthcare providers and appropriate settings build ways to provide excellent end of life care

8 Ethical and Legal Dimensions -managed death -legalized physician assisted suicide physician- administered lethal injections create ethical dilemmas patients look to nurses for information, advice and support

9 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 persons subsequent incapacity

10 Factors That Influence Death and Dying Developmental Family Socioeconomic Cultural Religious Cause of Death

11 Nursing Process Assessing- determine the adequacy of the patients and familys knowledge, perceptions, coping strategies and resources Questions to Ask What 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 coping What is helping you get through this?

12 Nursing Process Planning- the patient and family will: 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

13 Implementing- the nurses aim is to care for the dying patient and their families as well as to promote health and prevent illness in the family Nursing Diagnoses impaired adjustment r/t newly diagnosed terminal illness caregiver role strain r/t hospital discharged dying pt because of inadequate insurance. dysfunctional grieving r/t inability to accept death of infant Nursing Process

14 Nursing Interventions Monitor anxiety Monitor changes in mood/affect Communicate willingness to discuss death Encourage patient and family to share feelings about death Monitor pain Facilitate obtaining spiritual support for patient and family Include the family in care decisions and activities as desired

15 Evaluating does 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

16 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

17 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 dont want this test. What should I do? The nurse should a. Encourage her to refuse the test b. Inform the MD of her statement c. Educate her on the test s benefits d. Educate her on the procedure

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