1. Loss, Death, and Grieving
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

4. Concepts and Theories of the Grieving Process
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

6. Concepts and Theories of the Grieving Process
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

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

9. Nursing Diagnoses
Anticipatory Grieving
Dysfunctional Grieving

10. Implementation 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?

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

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

14. Death with Dignity 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

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

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

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

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