1. Chapter 21 Loss and Grief Fundamentals of Nursing: Standards & Practices, 2E

2.  Copyright 2002 by Delmar, a division of Thomson Learning 21-2 Loss  Loss is any situation (actual, potential, or perceived) in which a valued object is changed or is no longer accessible to the individual.  A maturational loss occurs as a result of moving from one developmental stage to another.  A situational loss occurs in response to external events.

3.  Copyright 2002 by Delmar, a division of Thomson Learning 21-3  Types of loss Actual loss Perceived loss Physical loss Psychological loss

4.  Copyright 2002 by Delmar, a division of Thomson Learning 21-4  Categories of loss Loss of an external object Loss of a familiar environment Loss of aspect of self Loss of significant other

5.  Copyright 2002 by Delmar, a division of Thomson Learning 21-5 Grief  Grief is a series of intense physical and psychological responses that occur following a loss.  Loss leads to mourning - the period of time during which the grief is expressed, and resolution and integration of the loss occurs.  Bereavement is the period of grief following the death of a loved one.

6.  Copyright 2002 by Delmar, a division of Thomson Learning 21-6  Theories of the grieving process Lindemann Engle Bowlby Worden

7.  Copyright 2002 by Delmar, a division of Thomson Learning 21-7  Types of grief Uncomplicated grief Dysfunctional grief Anticipatory grief

8.  Copyright 2002 by Delmar, a division of Thomson Learning 21-8  Factors affecting grief Developmental level Religious and cultural beliefs Relationship to the lost object Cause of death

9.  Copyright 2002 by Delmar, a division of Thomson Learning 21-9 Nursing Care of the Grieving Person  Assessment Begins with a determination of the personal meaning of the loss Assess the stage of grief the client is experiencing

10.  Copyright 2002 by Delmar, a division of Thomson Learning 21-10  Diagnosis NANDA-approved diagnoses  Dysfunctional grieving  Anticipatory grieving

11.  Copyright 2002 by Delmar, a division of Thomson Learning 21-11  Outcome identification and planning Expected outcome criteria include  Verbalize feelings of grief  Share grief with significant others  Accept the loss  Renew activities and relationships

12.  Copyright 2002 by Delmar, a division of Thomson Learning 21-12  Implementation The nurse must spend time listening. The nurse’s nonjudgmental, accepting attitude is essential while the bereaved expresses anger. The nurse should provide appropriate referrals to community support groups.

13.  Copyright 2002 by Delmar, a division of Thomson Learning 21-13  Evaluation Nurses usually do not have an opportunity to be with the bereaved when grief work is completed. Important to teach grieving individuals that resolution of the loss is generally a process of life-long adjustment.

14.  Copyright 2002 by Delmar, a division of Thomson Learning 21-14 Death  Stages of death and dying (Elizabeth Kubler-Ross) Denial Anger Bargaining Depression Acceptance

15.  Copyright 2002 by Delmar, a division of Thomson Learning 21-15  Nursing assessment of the dying client Client’s awareness of the terminal nature of illness Availability of support systems Physical condition Emotional status

16.  Copyright 2002 by Delmar, a division of Thomson Learning 21-16 Presence of advance directives for health care decisions History of previous positive coping skills Unfinished business expressed by client or family

17.  Copyright 2002 by Delmar, a division of Thomson Learning 21-17  Diagnosis NANDA-approved diagnoses  Powerlessness  Hopelessness

18.  Copyright 2002 by Delmar, a division of Thomson Learning 21-18  Outcome identification and planning Planning focuses on meeting the holistic needs of the client and family. A goal of nursing care is to promote an optimal quality of life by treating the client and family in a respectful manner and providing a safe environment for the expression of feelings.

19.  Copyright 2002 by Delmar, a division of Thomson Learning 21-19  Implementation Physiological needs Psychosocial needs Spiritual needs Support for the family

20.  Copyright 2002 by Delmar, a division of Thomson Learning 21-20 Hospice care  Allows individuals to die with dignity and surrounded by those who love them  Palliative care Home care

21.  Copyright 2002 by Delmar, a division of Thomson Learning 21-21 Learning Needs of Client and Family  Client and family knowledge deficits can be related to Insufficient information about physical condition Information about the treatment regime Inability to anticipate medical crises

22.  Copyright 2002 by Delmar, a division of Thomson Learning 21-22  Inexperience with personal threat of death  Unfamiliarity with protocol to follow in case of need for emergency care when not in the hospital

23.  Copyright 2002 by Delmar, a division of Thomson Learning 21-23 Care After Death  Physiological changes Algor mortis Liver mortis Rigor mortis  Legal aspects Autopsy Organ donation

24.  Copyright 2002 by Delmar, a division of Thomson Learning 21-24  Nursing care of the family may include Informing the family of the type and circumstances surrounding the death Providing information about viewing the body

25.  Copyright 2002 by Delmar, a division of Thomson Learning 21-25 Asking the family about organ donation Offering to contact support people Helping the family with decision making regarding a funeral home, transportation, and removal of the deceased belongings

26.  Copyright 2002 by Delmar, a division of Thomson Learning 21-26  Nurse’s self-care Nurses need to talk about the intense emotions associated with caregiving. Use support from within the health care agency - counselors, clergy, support groups. Find a way to say goodbye to the deceased client.