1. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Chapter 25 Loss and Grief

2. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Loss Actual, potential, or perceived Situation in which valued object changed or no longer accessible to individual –Maturational –Situational Loss as crisis

3. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Types of Loss Actual Perceived Physical Psychological (continued)

4. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Types of Loss Loss of: –External object –Familiar environment –Aspect of self –Significant other

5. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Grief Series of intense physical and psychological responses Occurs following loss Leads to mourning –Adaptive process (continued)

6. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Grief Theories of grieving process: –Lindemann –Engle –Bowlby –Worden (continued)

7. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Grief Types: –Uncomplicated –Dysfunctional –Anticipatory

8. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Factors Affecting Grief Developmental considerations: –Childhood –Adolescence –Early adulthood –Middle adulthood –Older adulthood (continued)

9. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Factors Affecting Grief Religious and cultural beliefs Relationship to lost object Cause of death –Unexpected –Traumatic –Suicide

10. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. The Grieving Person and the Nursing Process Assessment –Determine personal meaning of loss –Understand which stage of grief client is experiencing (continued)

11. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. The Grieving Person and the Nursing Process Diagnosis –NANDA statement Complicated grieving (continued)

12. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. The Grieving Person and the Nursing Process Outcome identification and planning –Verbalize feelings of grief –Share grief with significant others –Accept loss –Renew activities and relationships (continued)

13. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. The Grieving Person and the Nursing Process Implementation –Spend time listening –Avoid being judgmental –Allow for expression of feelings –Provide referrals (continued)

14. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. The Grieving Person and the Nursing Process Evaluation –Often not present when grief work completed –Teach grieving individuals that resolution of loss generally process of lifelong adjustment

15. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Death Stages of death and dying by Kübler- Ross: –Denial –Anger –Bargaining –Depression –Acceptance (continued)

16. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Death Ethical implications: –Killing or allowing someone to die –Euthanasia –Assisted suicide –Pain relief

17. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Death and the Nursing Process Assessment –Awareness of terminal nature of illness –Availability of support systems –Physical condition –Emotional status (continued)

18. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Death and the Nursing Process Assessment –Presence of advance directives for health care decisions –History of previous positive coping skills –Unfinished business expressed by client or family (continued)

19. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Death and the Nursing Process Diagnosis –NANDA-approved statements Powerlessness Hopelessness (continued)

20. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Death and the Nursing Process Outcome identification and planning –Be available to client –Offer to contact clergy –Balance needs –Keep information confidential –Focus on factual information (continued)

21. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Death and the Nursing Process Implementation –Physiological needs –Promotion of comfort –Hospice care –End-of-life (EOL) care –Home care (continued)

22. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Death and the Nursing Process Implementation –Psychosocial care –Spiritual needs –Family support –Learning needs of client and family

23. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Care after Death Care for body by: –Maintaining privacy –Preventing damage Physiological changes: –Algor mortis –Liver mortis –Rigor mortis (continued)

24. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Care after Death Legal aspects: –Autopsy –Organ donation (continued)

25. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Care after Death Care for family by: –Informing of type and circumstances surrounding death –Providing information about viewing body –Asking about organ donation (continued)

26. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Care after Death Care for family by: –Offering to contact support people –Helping with decision making regarding: Funeral home Transportation Removal of deceased’s belongings (continued)

27. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Care after Death Nurse’s self-care –Talk about intense emotions –Use counselors, clergy, and support groups –Find way to say good-bye to deceased client