LOSS, GRIEF AND DEATH

Loss, Grief, Dying

Class Objectives

The nursing student  Engles stages of

will learn: grief
 nurses role in loss,  Kubler-Ross Grief
grief, death and and Death Reactions
dying  legal and ethic
 emotional reactions dilemmas with death
to loss and dying
 to create a nursing
care plan for a death
and dying patient.
Loss
 Occurs when a • Physical loss
valued person,
object, or
• Psychological
loss
situation is
changed
• Actual Loss
• Perceived loss
• Anticipated loss
Grief or Grieving-Grief is the
Emotional Reaction to Loss
 Bereavement- state  Mourning-period of
of grieving during acceptance of loss
which a person goes and grief during
through grief which the person
reaction. learns to deal with
the loss.
Engels 6 Stages of Grief
Reaction
 Shock and disbelief
 Developing
awareness
 Restitution
 Resolving the loss
 Idealization
 Outcome
Kubler-Ross Grief and Death
Reactions

 Denial and isolation

 Anger
 Bargaining
 Depression
 Acceptance
Five Principles of Palliative Care-
(Hospice care)
 Respects the goals,  Supports the needs
likes and choices of of the family
the dying pt. members
 Looks after medical,  Helps pt gain access
emotional, social, to needed healthcare
and spiritual needs of providers and
the dying person appropriate settings
 Builds ways to
provide excellent end
of life care
Ethical and Legal Dimensions
 Managed death,  Patients look to
 Legalized physician nursing for
assisted suicide, information, advice
 Physician and support.
administered lethal
injections (aid in
dying) – create
ethical dilemmas.
The nurse patient relationship is
key to helping patient’s grieve
Advanced Directives

 Living wills- provide  Durable power of

specific instructions attorney- appoints
about the kinds of and agent the person
health care that trusts to make
should be provided decisions in the
or foregone in a event of the
particular situation appointing person’s
subsequent
incapacity.
Do not resuscitate or No code
orders

What is the difference between a

DNR or a No code order
and
Comfort measures only order?
Factors that influence Grief and
Dying
 Developmental
 Family
 Socioeconomic
 Cultural
 Religious
 Cause of Death
Nursing Process

 Questions to ask
 Assessing-
determine the • What have you been told
about your condition?
adequacy of the pt’s
• Have you had any previous
and families, experience with this condition
knowledge, or death of a loved one?
perceptions, coping • Tell me a little bit about how
strategies and you are coping
resources. • What is helping you get
through this?
Nursing Diagnoses
 Impaired adjustment  Anticipatory grieving
 Caregiver role strain  Dysfunctional
 Decisional conflict grieving
 Ineffective coping  Hopelessness
 Ineffective denial  Ineffective
management of
therapeutic regimem
Planning expected outcomes

 The pt and family will achieve:

• Demonstrate freedom in expressing
feelings
• Identify and use effective coping
strategies.
• Accept need for help as appropriate
• Make healthcare decisions reflecting
personal values and goals.
Implementing

 The nurses aim is to  Nursing Diagnosis

care for the dying pts • Impaired adjustment
and their families r/t newly diagnosed
and promote health terminal illness
and preventing • Caregiver role strain r/t
hospital discharged
illness of the family dying pt because of
inadequate insurance.
• Dysfunctional grieving
r/t inability to accept
death of infant no grief
resolution.
Nursing interventions

 Monitor patient for  Monitor pain

anxiety  Facilitate obtaining
 Monitor mood spiritual support for
changes pt and family
 Communicate  Include the family in
willingness to care decisions and
discuss death activities as desired.
 Encourage pt and
family to share
feelings about death
Evaluating

 The plan of nursing care for dying pts. meets

the outcome of a comfortable, dignified death
and family members resolve their grief after
a suitable time of mourning and resume
meaningful life roles and activities.
Nurses grieve too.
Clinical Signs of Impending
Death
 Muscle weakness
 Respiratory changes
• Cheyne-Stokes
• Death Rattle
 Sensory changes
 Circulatory changes
Postmortem Care
 Nursing prepares the body for viewing
 Identification
 Who to notify
 Jewelry and valuables
 Dentures, glasses, prosthetics