[PPT]Loss, Death, and Grieving - Bakersfield Collegedeath,grieving.ppt · Web viewLoss, Death, and Grieving Nursing Fundamentals NURS B20 Loss, Death, Grieving Nursing by its nature

Loss, Death, and Grieving

Nursing FundamentalsNURS B20

Loss, Death, Grieving

Nursing by its nature is involved in all processes of life from birth to death. Nurses interact daily with clients and families experiencing loss and grief.

Loss

Loss of external objects Loss of known environment Loss of a significant other Loss of an aspect of self Loss of life

Concepts and Theories of the Grieving Process

Engle’s Theory (1964)– Shock and Disbelief– Developing Awareness– Reorganization and Restitution

Concepts and Theories of the Grieving Process

Kubler-Ross Stages of Dying (1969)– Denial– Anger– Bargaining– Depression– Acceptance

Concepts and Theories of the Grieving Process

Rando– Avoidance– Confrontation– Accommodation

Hope

Hope is not a single act but a complex series of thoughts, feelings, and actions that change often. Clients and families facing terminal illness or serious loss experience different dimensions of hope.

– Generalized hope- “I hope all is well”– Particular hope- A particular outcome

Assessment of the Grieving Client

Age– Toddler– Preschooler– School-age– Young adult– Middle age– Elderly

Nature of relationship Nature of the loss Cultural and spiritual beliefs Gender roles Socioeconomic status/ social support system

Nursing Diagnoses

Anticipatory Grieving Dysfunctional Grieving

Implementation

Therapeutic communication Maintenance of self-esteem Promotion of return-to-life activities

The Dying Client

When does death occur?– Traditionally

– Since the 1st transplantation

– Who can pronounce a person dead?

Coroner’s Case

Request family member consent and signature for autopsy. Several reasons for a death becoming a case for the coroner:– Death by suspicious means or not under a

doctor’s care– Death resulting from an accident– Client has been hospitalized for less than 24

hours

Death with Dignity

Dying Persons’ Bill of Rights (page Passive euthanasia California Law (1976)- “Right to Die” bill California Natural Death Act Promotion of comfort

Death with Dignity

Maintenance of independence Prevention of loneliness and isolation Promotion of spiritual comfort Support for the grieving family Hospice Care

Physical Changes Indicating Approaching Death

Temperature usually elevates to 104+ Pulse= fast, irregular, weak, difficult to find Respirations= rapid, shallow, noisy,

Cheyne-Stokes BP= decreased Peripheral circulation

Physical Changes Indicating Approaching Death

Thirst= dry mouth Sight fails Aphagia Mental alertness varies Hearing- supposed to be last sense to be

lost Relaxation of muscles

After Death

Physical Changes After Death– Pupils- Fixed and dilated– Algor Mortis- Rapid cooling of the body– Rigor Mortis- Stiffening of the body, develops

2-4 hours after death– Livor Mortis- Purple discoloration of skin in

dependent areas

Care After Death

Certification of death Time of death Notification nursing and admissions office Client’s belongings Removal of therapies Dentures Raise head of bed

Care After Death

Clean body Remove valuables Positioning After the family views the body