Chapter 42 Loss, Grief, and Dying

1. Chapter 42Loss, Grief, and Dying

2. Types of Loss • Actual loss: can be recognized by others • Perceived loss: is felt by person but intangible to others • Physical loss versus psychological loss • Maturational loss:experienced as a result of natural developmental process • Situational loss: experienced as a result of an unpredictable event • Anticipatory loss: loss has not yet taken place

3. Definitions • Grief: internal emotional reaction to loss • Bereavement: state of grieving from loss of a loved one • Mourning: actions and expressions of grief that make up outward expression of grief

4. Engel’s Six Stages of Grief • Shock and disbelief • Developing awareness • Restitution • Resolving the loss • Idealization • Outcome

5. Definition of Death • Uniform Definition of Death Act: An individual who has sustained either (1) irreversible cessation of all functions of circulatory and respiratory functions or (2) irreversible cessation of all functions of the entire brain, including the brainstem, is dead. • Medical criteria used to certify a death: cessation of breathing, no response to deep painful stimuli, and lack of reflexes (such as the gag or corneal reflex) and spontaneous movement

6. Components of a Good Death • Control of symptoms • Preparation for death • Opportunity to have a sense of completion of one’s life • Good relationship with health care professionals

7. Clinical Signs of Impending Death • Difficulty talking or swallowing • Nausea, flatus, abdominal distention • Urinary and/or bowel incontinence or constipation • Loss of movement, sensation, and reflexes • Decreasing body temperature, with cold or clammy skin • Weak, slow, or irregular pulse • Decreasing blood pressure • Noisy, irregular, or Cheyne-Stokes respirations • Restlessness and/or agitation • Cooling, mottling, and cyanosis of the extremities and dependent areas

8. Kübler-Ross’s Five Stages of Grief • Denial and isolation • Anger • Bargaining • Depression • Acceptance

9. The Husband of a Terminally Ill Patient Begins the Grieving Process

10. Advance Directives • Indicate who will make decisions for the patient in case the patient is unable. • Indicate the kind of medical treatment the patient wants or doesn’t want. • Indicate how comfortable the patient wants to be. • Indicate how the patient wants to be treated by others. • Indicate what the patient wants loved ones to know.

11. Special Orders • Allow natural death, do-not-resuscitate, or no-code Orders • Terminal weaning • Voluntary cessation of eating and drinking • Active and passive euthanasia • Palliative sedation

12. Factors Affecting Grief and Dying • Developmental considerations • Family • Socioeconomic factors • Cultural, gender, and religious influences • Cause of death

13. Needs of Dying Patients • Physiologic needs: physical needs, such as hygiene, pain control, nutritional needs • Psychological needs: patient needs control over fear of the unknown, pain, separation, leaving loved ones, loss of dignity, loss of control, unfinished business, isolation • Needs for intimacy: patient needs ways to be physically intimate that meets needs of both partners • Spiritual needs: patient needs meaning and purpose, love and relatedness, forgiveness and hope

14. Developing a Trusting Nurse–Patient Relationship • Explain the patient’s condition and treatment. • Teach self-care and promoting self-esteem. • Teach family members to assist in care. • Meet the needs of the dying patient. • Meet family needs.

15. The Nurse Offers Support to a Patient’s Grieving Spouse

16. Providing Postmortem Care • Care of the body • Care of the family • Discharging legal responsibilities • Death certificate issued and signed • Labeling body • Reviewing organ donation arrangements, if any • Care of other patients

17. Postmortem Care of the Body • Prepare the body for discharge. • Place the body in anatomic position, replace dressings, and remove tubes (unless there is an autopsy scheduled). • Place identification tags on the body. • Follow local law if patient died of communicable disease.

18. Postmortem Care of the Family • Listen to family’s expressions of grief, loss, and helplessness. • Offer solace and support by being an attentive listener. • Arrange for family members to view the body. • In the case of sudden death, provide a private place for family to begin grieving. • It is appropriate for the nurse to attend the funeral and make a follow-up visit to the family.