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Loss, Death, and Grieving Nursing Fundamentals NURS B20 Nursing Fundamentals NURS B20.

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Presentation on theme: "Loss, Death, and Grieving Nursing Fundamentals NURS B20 Nursing Fundamentals NURS B20."— Presentation transcript:

1 Loss, Death, and Grieving Nursing Fundamentals NURS B20 Nursing Fundamentals NURS B20

2 Loss, Death, Grieving  Nursing by its nature is involved in all processes of life from birth to death. Nurses interact daily with clients and families experiencing loss and grief.

3 Loss  Loss of external objects  Loss of known environment  Loss of a significant other  Loss of an aspect of self  Loss of life  Loss of external objects  Loss of known environment  Loss of a significant other  Loss of an aspect of self  Loss of life

4 Concepts and Theories of the Grieving Process  Engle’s Theory (1964) –Shock and Disbelief –Developing Awareness –Reorganization and Restitution  Engle’s Theory (1964) –Shock and Disbelief –Developing Awareness –Reorganization and Restitution

5 Concepts and Theories of the Grieving Process  Kubler-Ross Stages of Dying (1969) –Denial –Anger –Bargaining –Depression –Acceptance  Kubler-Ross Stages of Dying (1969) –Denial –Anger –Bargaining –Depression –Acceptance

6 Concepts and Theories of the Grieving Process  Rando –Avoidance –Confrontation –Accommodation  Rando –Avoidance –Confrontation –Accommodation

7 Hope  Hope is not a single act but a complex series of thoughts, feelings, and actions that change often. Clients and families facing terminal illness or serious loss experience different dimensions of hope. –Generalized hope- “I hope all is well” –Particular hope-A particular outcome  Hope is not a single act but a complex series of thoughts, feelings, and actions that change often. Clients and families facing terminal illness or serious loss experience different dimensions of hope. –Generalized hope- “I hope all is well” –Particular hope-A particular outcome

8 Assessment of the Grieving Client  Age –Toddler –Preschooler –School-age –Young adult –Middle age –Elderly  Nature of relationship  Nature of the loss  Cultural and spiritual beliefs  Gender roles  Socioeconomic status/ social support system  Age –Toddler –Preschooler –School-age –Young adult –Middle age –Elderly  Nature of relationship  Nature of the loss  Cultural and spiritual beliefs  Gender roles  Socioeconomic status/ social support system

9 Nursing Diagnoses  Anticipatory Grieving  Dysfunctional Grieving  Anticipatory Grieving  Dysfunctional Grieving

10 Implementation  Therapeutic communication  Maintenance of self-esteem  Promotion of return-to-life activities  Therapeutic communication  Maintenance of self-esteem  Promotion of return-to-life activities

11 The Dying Client  When does death occur? –Traditionally –Since the 1st transplantation –Who can pronounce a person dead?  When does death occur? –Traditionally –Since the 1st transplantation –Who can pronounce a person dead?

12 Coroner’s Case  Request family member consent and signature for autopsy. Several reasons for a death becoming a case for the coroner: –Death by suspicious means or not under a doctor’s care –Death resulting from an accident –Client has been hospitalized for less than 24 hours  Request family member consent and signature for autopsy. Several reasons for a death becoming a case for the coroner: –Death by suspicious means or not under a doctor’s care –Death resulting from an accident –Client has been hospitalized for less than 24 hours

13 Death with Dignity  Dying Persons’ Bill of Rights (page  Passive euthanasia  California Law (1976)- “Right to Die” bill  California Natural Death Act  Promotion of comfort  Dying Persons’ Bill of Rights (page  Passive euthanasia  California Law (1976)- “Right to Die” bill  California Natural Death Act  Promotion of comfort

14 Death with Dignity  Maintenance of independence  Prevention of loneliness and isolation  Promotion of spiritual comfort  Support for the grieving family  Hospice Care  Maintenance of independence  Prevention of loneliness and isolation  Promotion of spiritual comfort  Support for the grieving family  Hospice Care

15 Physical Changes Indicating Approaching Death  Temperature usually elevates to 104+  Pulse= fast, irregular, weak, difficult to find  Respirations= rapid, shallow, noisy, Cheyne-Stokes  BP= decreased  Peripheral circulation  Temperature usually elevates to 104+  Pulse= fast, irregular, weak, difficult to find  Respirations= rapid, shallow, noisy, Cheyne-Stokes  BP= decreased  Peripheral circulation

16 Physical Changes Indicating Approaching Death  Thirst= dry mouth  Sight fails  Aphagia  Mental alertness varies  Hearing- supposed to be last sense to be lost  Relaxation of muscles  Thirst= dry mouth  Sight fails  Aphagia  Mental alertness varies  Hearing- supposed to be last sense to be lost  Relaxation of muscles

17 After Death  Physical Changes After Death –Pupils- Fixed and dilated –Algor Mortis- Rapid cooling of the body –Rigor Mortis- Stiffening of the body, develops 2-4 hours after death –Livor Mortis- Purple discoloration of skin in dependent areas  Physical Changes After Death –Pupils- Fixed and dilated –Algor Mortis- Rapid cooling of the body –Rigor Mortis- Stiffening of the body, develops 2-4 hours after death –Livor Mortis- Purple discoloration of skin in dependent areas

18 Care After Death  Certification of death  Time of death  Notification nursing and admissions office  Client’s belongings  Removal of therapies  Dentures  Raise head of bed  Certification of death  Time of death  Notification nursing and admissions office  Client’s belongings  Removal of therapies  Dentures  Raise head of bed

19 Care After Death  Clean body  Remove valuables  Positioning  After the family views the body  Clean body  Remove valuables  Positioning  After the family views the body


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