1. Mental Health Nursing I NURS 1300 Unit VIII Spirituality, Death, and Grief

2. Objective 1 Discuss the basic concepts of spirituality Spirituality = searching for meaning in events that may be either joyous or tragic, and consists of transcendence, connection, balance, and purpose Transcendence = finding meaning larger than the person’s individual self and life

3. Objective 1 (cont’d) Connection = the integration of all the aspects of being human, which include the self, other people, the surrounding world, and, for some, a supreme being Balance = harmony with self, others, and nature

4. Objective 1 (cont’d) Purpose = a person’s understanding of the impact of his or her life and includes the understanding of the impact of his or her life and includes the understanding of life events Religion = the system of beliefs and practices that usually involves a community of like-minded people

5. Objective 1 (cont’d) The terms religion and spirituality are not necessarily interchangeable People with strong spiritual beliefs and lives may not be “religious” individuals Differentiation important because clients’ spirituality needs should be assessed even if they are not affiliated with a formal religion

6. Objective 2 Describe beliefs and practices related to dying and death Bereavement practices can be greatly influenced by cultural and religious beliefs Nurses should know what the client’s beliefs are in order to provide culturally sensitive care

7. Objective 3 Describe responses of clients and their families to terminal illness and impending death

8. Awareness of terminal illness closed awareness family and patient recognize patient is ill lack of awareness related to impending death mutual pretense patient, family, and care providers know of the terminal prognosis no one discusses the issue openly people make every effort to avoid the subject open awareness preferred by health care providers patient and others involved freely discuss impending death

9. Fears associated with terminal illness and death fear of pain tendency to associate death with pain pain control measures should be available to client to relieve pain and discomfort fear of loneliness most terminally ill patients don’t want to be alone many patients are afraid they will be abandoned by loved ones who can’t cope with imminent death fear of meaninglessness life review examination of actions and expression of regrets about what might have been patients need to look at positive aspects of their lives the worth of the dying person needs to be expressed

10. Objective 4 Identify nursing measures appropriate for the terminally ill client

11. Nursing Assessment Limited to essential data Abbreviated physical assessment Neurological assessment important

12. Nursing Interventions Open discussion of feelings Nonjudgmental listening Patient/family teaching grief response is normal honesty in answering questions and giving information Demonstrate respect for patient’s privacy and need to talk (or not to talk)

13. Nursing Interventions (cont’d) Encourage realistic hope within limits of the situation feelings of hopelessness and powerlessness common in terminal illness allow patient and family to identify and deal with what is within their control patient-identified goals can be encouraged to restore sense of power Physical care maintenance of physical needs/comfort

14. Objective 5 List categories of loss Change in self-image Developmental changes Loss of possessions Loss of significant others

15. Objective 6 Discuss factors which influence a grief reaction Developmental considerations Religious and cultural beliefs Relationship with the lost entity Cause of death

16. Objective 7 Discuss age-related beliefs about death Infancy to 5 years (preschool) little or no understanding of death death is temporary and reversible, like sleep 6-9 years (school age) death is final own death can be avoided death is related to violence wishing or hoping for death can make it happen

17. Objective 7 (cont’d) 10 to 12 years (preadolescent) death is an inevitable end to life grasps own mortality by discussing fear of death or life after death expresses feelings of death based on adult attitudes 13 to 18 years (adolescent) afraid of prolonged death may act out defiance for death through dangerous or self-destructive acts has a philosophical or religious approach to death seldom thinks about death

18. Objective 7 (cont’d) 19 to 45 years (young adulthood) cultural and religious beliefs influence attitudes death is seen as a future event 45 to 65 years (middle adulthood) accepts own mortality as inevitable faces death of parents and peers may experience death anxiety

19. Objective 7 (cont’d) 65 years and older (older adulthood) afraid of prolonged health problems faces death of family members and peers sees death as inevitable examines death as it relates to various meanings, such as freedom from discomfort

20. Objective 8 Explore the nurse’s response to working with the terminally ill client Not immune to feelings of loss when caring for terminally ill or dying clients Feelings of helplessness and powerlessness when dealing with death Need to express feelings of sorrow, guilt, and frustration Must be able to identify what can and can not be controlled

21. Objective 9 Define the following terms: anticipatory grief, grieving process, denial, palliative, hope, hospice, loss, and respite care

22. Anticipatory grief = the occurrence of grief work before an expected loss Grieving process = a total individual experience associated with thoughts, feelings, and behaviors that is usually most profound when the loss experienced is death Denial = refusal to acknowledge a loss; serves to protect the patient, family, or both from the reality of the loss Palliative = care provided for the sole purpose of providing comfort to the client rather than curing any problems

23. Hope = a belief in a positive outcome related to events and circumstances in one’s life Hospice = a type of care for the terminally ill which allows individuals to die with dignity and be surrounded by those who love them; clients enter hospice care when aggressive medical treatment is no longer an option or when the client refuses further aggressive medical treatment

24. Loss = the real or potential absence of someone or something that is valued Respite care = the temporary care of an aged or disabled person provided on behalf of and in the absence of the usual caregiver to allow that caregiver relief from the stresses and responsibilities of providing continued care