1. Intervening with Death and Dying Anita Rhodes, RN, MSN

2. Grief, Bereavement, and Mourning Grief- is the total response to the emotional experience to related to loss. Bereavement-is the subjective response experienced by the surviving loved ones after the death of a person with whom they have shared a significant relationship. Mourning-is the behavioral process through which grief is eventually resolved or altered; it is often influenced by culture, spiritual beliefs, and custom.

3. Types of Loss and Grief Sudden or Acute Anticipatory Dysfunctional Chronic Sorrow Complicated Grief Absent, Covered Grief Work

4. Stages of Dying Denial, Shock Anger, Volatile Emotions Guilt Bargaining Depression, Loss and Loneliness Acceptance, Relief and Re-establishment Shadow Grief

5. Common Issues Family Loss of Control Pain and Discomfort Helplessness Peaceful Death Fatigue Guilt Patient Fear Body Image Control Separation from family Life Review Pain Irritable and Withdrawn

6. Communication Principles Be Available Listen Give Factual Information Use correct terms but avoid medical terminology Help make plans and mend relations Be empathic Avoid false reassurance Remember that hearing is the last sense loss

7. Factors Influencing the Loss and Grief Responses Age –Childhood –Early and Middle Adulthood –Late Adulthood Significance of the Loss Culture Spiritual Beliefs Gender

8. Nursing Care Where Hospice Home Residential Acute Advance Directives Living Will Organ Donation Cure vs. Care Identify Individual and Family Needs Hydration Nourishment Elimination Hygiene Positioning Comfort Involving the Family

9. Factors Influencing the Loss and Grief Responses Socioeconomic Status Support System Cause of Loss or Death

10. Definitions and Signs of Death Clinical Signs of Death –Total lack of response to external stimuli –No muscular movement, especially breathing –No reflexes –Flat encephalogram Cerebral Death or Higher Brain Death

11. Legalities Related to Death Advance Directives Certification of Death Labeling the Deceased Autopsy Organ Donation Inquest Euthanasia Do-Not-Resuscitate Orders