Loss, Death, and Grieving

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Presentation transcript:

Loss, Death, and Grieving Nursing Fundamentals NURS B20

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.

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

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

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

Concepts and Theories of the Grieving Process Rando Avoidance Confrontation Accommodation

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

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

Nursing Diagnoses Anticipatory Grieving Dysfunctional Grieving

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

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

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

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

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

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

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

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

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

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

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