Grief and End-of-Life Care Quiz

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Questions and Answers

What does Pattison's Living-Dying Interval refer to?

The planning period before a planned death

The time from learning one is terminally ill to death (correct)

The period of bereavement after death

A psychological response to anticipated loss

Which behavior is associated with anticipatory grief?

Immediate expression of anger toward others

Complete withdrawal from social interactions

Total denial of the impending loss

Detailed planning for the loss (correct)

What characterizes acute grief?

A prolonged period of emotional calmness

Unwavering feelings of joy and acceptance

A smooth and consistent emotional recovery

Crisis symptoms that manifest as waves of distress (correct)

What distinguishes persistent or pathological grief from other types of grief?

Adjustment to the loss remains blocked Signup and view all the answers

Which of the following is not typically a symptom of acute grief?

Total emotional numbness Signup and view all the answers

What is the role of a Power of Attorney (POA)?

To make legal decisions for the incapable person. Signup and view all the answers

What happens if multiple Substitute Decision Makers (SDMs) are assigned?

The POA becomes the ultimate decision maker in conflicts. Signup and view all the answers

What requires discussion with a physician during the voluntary process?

Wishes and plans regarding medical care. Signup and view all the answers

When was Medical Assistance in Dying (MAiD) first legalized in Canada?

June 17, 2016 Signup and view all the answers

What is true about the assignment of a Substitute Decision Maker (SDM)?

The law defines a hierarchy for assigning an SDM. Signup and view all the answers

What sign may indicate recurrent acute grief?

Irrational and excessive anger Signup and view all the answers

What best describes disenfranchised grief?

Losses not acknowledged or publically mourned Signup and view all the answers

Which of the following is NOT a component of a good death?

Avoidable distress and suffering Signup and view all the answers

What is one of the 6 C's identified by Weisman for caring at the end of life?

Consistency Signup and view all the answers

Which type of care may be needed by dying persons and their families?

End of life care Signup and view all the answers

What emotional state may indicate a need for professional intervention in grief?

Overwhelming depression Signup and view all the answers

Which of the following best represents a hidden loss in disenfranchised grief?

Loss of a pet Signup and view all the answers

What is a key responsibility of nurses when providing care to dying patients and their families?

To work with the interprofessional team for a good death Signup and view all the answers

What is the primary focus of palliative care?

Comfort and quality of life Signup and view all the answers

Which of the following is NOT a goal of the Canadian Hospice Palliative Care Association (CHPCA)?

Cure the underlying disease Signup and view all the answers

Which nursing responsibility is essential in palliative care?

Support for the patient and family Signup and view all the answers

What approach is taken as the possibility of cure decreases in palliative care?

An increased emphasis on comfort Signup and view all the answers

In providing palliative care, which aspect is NOT addressed according to CHPCA's guidelines?

Financial planning Signup and view all the answers

How long can nursing care for dying patients last?

Days to months Signup and view all the answers

What is the primary responsibility of Nurse Practitioners or Physicians regarding MAiD?

To ensure patients are not pressured into choosing MAiD Signup and view all the answers

What does palliative care aim to promote for patients?

Meaningful experiences and personal growth Signup and view all the answers

Which approach includes the family in the palliative care process?

Including families in bereavement support Signup and view all the answers

If a nurse conscientiously objects to participating in MAiD, what is one of their responsibilities?

To hand over care to another nurse who will meet the patient's needs Signup and view all the answers

Which of the following is NOT a component of end of life care?

Patient emancipation from family responsibilities Signup and view all the answers

What percentage of Canadians prefer to die at home?

More than 50% Signup and view all the answers

In which of the following settings can a patient choose to die?

Home Signup and view all the answers

What is a significant aspect of hospice palliative care?

It integrates psychosocial, spiritual, and physical aspects of care Signup and view all the answers

What should be done if there is a delay in transferring care due to conscientious objection?

The nurse must continue to provide all care except for MAiD procedures Signup and view all the answers

Which of the following statements best describes the philosophy of hospice palliative care?

It is both an approach and a philosophy of care Signup and view all the answers

What should be used to ensure a patient remains comfortable instead of a heating pad?

A mohair or light weight blanket Signup and view all the answers

Which of the following is a common symptom management intervention for shortness of breath?

Using a combination of pharmacological and non-pharmacological interventions Signup and view all the answers

What is a necessary care step for patients experiencing dry eyes?

Using artificial tears Signup and view all the answers

What should caregivers avoid when patients have swallowing difficulties?

Encouraging forced eating or drinking Signup and view all the answers

How should pain management be approached for patients with malignancies?

Assess and treat pain frequently with appropriate narcotics Signup and view all the answers

What is a sign that may indicate reduced vision in patients at end of life?

Vision is often reduced Signup and view all the answers

What indicator suggests a patient may not need routine oxygen use?

They do not show signs of breathing difficulty Signup and view all the answers

What type of lighting should be used to support a patient’s eye care needs?

Soft indirect lights Signup and view all the answers

What is the primary reason for using a combination of treatments for respiratory secretions?

To effectively manage distressing noise and maintain comfort Signup and view all the answers

Why is it important to titrate narcotic doses in pain management?

To match the intensity and duration of pain Signup and view all the answers

Study Notes

Grief, Loss, and End of Life

Grief is an individual's emotional response to a loss.
There is no one way to respond to grief; everyone's experience varies.
Mourning and bereavement are often used synonymously.
Both are active processes of incorporating loss into one's life.
Rituals and behaviours may assist with this process.
Cultural and social norms influence mourning and bereavement.

Learning Objectives

Define loss, bereavement, and grief, and explore their associated theories.
List strategies to support families, friends, and caregivers of a dying patient.
Explore legal issues related to dying, including MAID, informed consent, competency, advance directives, and substitute decision-making.
Describe physiological changes during imminent death and nursing interventions for end-of-life care.

Activity

Write down one question or concern about caring for someone who is dying.
Example concern: Worrying about supporting a patient and family if the caregiver is also experiencing sadness and upset.

Loss

Loss is an experience of losing someone or something.
Loss can occur throughout life, or at the end of life.
Persons may lose health, a valued possession, a significant relationship, or their lives.
One person's loss of life is another person's loss of a significant relationship.
Nurses play a vital role in supporting patients and families through loss and grief.

Grief

Grief is an individual's emotional response to a loss.
Mourning and bereavement are often used synonymously.
Both are ongoing, active processes of incorporating loss into one's life.
Processes may include rituals and behaviors to assist.
Cultural and social norms significantly influence the experience of grief.

Factors Influencing Grief and Loss

Human development (age and life stage) shape the experience.
Psychosocial perspectives and personal experiences influence coping mechanisms.
Socioeconomic status can increase the burden of loss when resources are limited.
Personal relationships, especially loss of loved ones, deeply impact the experience of grief.
The nature of the loss (e.g. sudden or expected) impacts the grieving process.
Culture and ethnicity affect grief responses due to the multicultural nature of Canada.

Models of Grief

Grief models acknowledge common physical and psychological manifestations and phases across individuals.
Acute Grief: Experienced when the loss first occurs, focusing on initial emotions.
Despair Grief: Often presented as sadness or depression, affecting daily functioning and interactions.
Adjustment Grief: The stage where an individual learns to adapt to change and rebuild their life without the lost person or object.
Grief processes are not fixed; the experience is not always linear and predictable.

Kubler-Ross Model

Stages of grief experienced by individuals dealing with loss: denial, anger, bargaining, depression, and acceptance.
The stages are not rigid. Some people may not experience all the stages.
The timeline for the stages is not set in stone.

Pattison's Living-Dying Interval

The time between the initial "crisis knowledge" of impending death and the point of death.

Types of Grief

Anticipatory Grief: Grief experienced before the loss occurs, characterized by worry and pre-occupation with the loss.
Sociological Death: Premature withdrawal from the dying person by others.
Psychological Death: Withdrawal of the dying person from others.
Acute Grief: A crisis presenting somatic and psychological symptoms fluctuating over time, that includes negativity, hostility, and or difficulty doing daily activities.
Persistent Grief: Recurring grief responses that do not diminish with time.
Disenfranchised Grief: When a loss cannot be outwardly acknowledged or publicly mourned, such as hidden relationships or losses deemed unimportant.

Needs of the Dying Patient and Family

End-of-life care encompasses services for the last year of a patients life and bereavement services following the patients death.

A Good Death

Nurses work with the interprofessional team to support patients and their families through end-of-life.
A "good death" is free of avoidable distress.
A "good death" is consistent with patient and family's wishes.
A "good death" is consistent with clinical, cultural, and ethical standards.

Weisman's 6Cs

Individuals at the end of life require specialized care addressing their physical, emotional, and spiritual needs.
Six areas considered to care for the needs of the dying that include: Care, Control, Composure, Communication, Continuity, and Closure.

Care

People who are dying need the best symptom management.
Medical needs must be addressed to provide comfort to patients.
Treatment of symptoms and conserving energy are crucial elements of good care.
Pain needs treatment that addresses all emotional and psychological elements of pain, not only physical elements.

Control

Patients at the end of their lives may lose control.
Nurses should facilitate as much control as possible in their care. This includes providing care to support symptom control and total care for patients as directed by the palliative team.

Composure

Many cultures incorporate emotional expression and support during periods of illness and death.
Tools can be utilized to support clients having emotional extremes.

Communication

Nurses have the responsibility to encourage communication with the dying person.
Different types exist (closed awareness, suspected awareness, mutual pretense, and open awareness).

Continuity

Maintaining a sense of continuity for dying persons is important, preserving an awareness of legacy and memory of the life they have lived.
Leaving a legacy or establishing rituals or memories can offer a sense of continuity.

Closure

Closure provides opportunities for reconciliation and transcendence that can allow for the process of acceptance and closure.
Reminiscence can be helpful in putting a life in order.

Supporting Families

Families and friends are often present during a person's last days and moments.
Nurses provide emotional support to ensure patient's loved ones are met with comfort.

Legal Concepts at End of Life

Advanced Care Planning: The process of planning ahead for decisions and care that might need to occur when the individual is unable to decide for themselves.
- Choosing a Substitute Decision Maker (SDM) and communicating wishes.
- SDM role is to act in the best interest of the incapable person based on the incapable person's wishes.
Advanced Directive: A legal document containing written instructions to direct healthcare if the individual is unable to make choices.
- Discussing advance directives and wishes with a physician. This could be a helpful option.
- Having written instructions can ease pressure at crucial times.
POA/SDM: An assigned decision maker granted the legal ability in Canada to make decisions on the incapable person's behalf. The law provides a hierarchy of who can be assigned as a SDM should the incapable person not have chosen a SDM.
- Determining the appropriate assigned SDM.
- Determining the individuals in the hierarchy in case the incapable person doesn't choose.
MAID (Medical Assistance in Dying): A legal process for individuals in Canada.
- Two types of MAID: Practitioner-Assisted and Patient Self-Administered.
  - Requirements include: eligibility criteria (18+, grievous, etc.); specific written requests; waiting periods; withdrawing options; ensuring the patient is informed of other options; and other safeguards.
  - RN/RPN role is limited; safeguarding that they are not administering the potentially fatal medication.
Conscientious Objection: The right to refuse to participate in any medical procedures with which a nurse has a belief conflict with their values or conscience. If refusing, the nurse must transfer care to another nurse qualified to handle the care in question.

End-of-Life Care

Various settings for end-of-life care: Hospice, hospital, home, and long-term care.
Patients require quality care that addresses pain, symptoms, and other practical and psychosocial, spiritual needs, including the family.
Canada's preference for end-of-life care at home, though not always possible.
Hospice palliative care is an approach to care and a philosophy of care that aims to improve the quality of patient and family's life during a patient's illness, death, and bereavement.

Nursing Implications

Nursing care for dying patients may last days or months.
Nurses need competency for dying patients and their families.
Review of resources, including the Canadian Fundamentals of Nursing, are vital.

Advice for Families and Caregivers

Provides specific signs or symptoms related to end-of-life and support options.

Reflection

Reflect on personal values and beliefs related to death and dying.
Consider how you would prefer to receive care during your own death and the death of a loved one, including the needs of your loved ones and expectations surrounding death.
Determine how you will treat others during similar personal or family experiences.

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Description

Test your knowledge on the concepts of grief, anticipatory grief, and end-of-life care practices. This quiz covers various aspects such as Medical Assistance in Dying (MAiD), substitute decision makers, and the emotional states associated with grief. Perfect for those interested in healthcare, psychology, and palliative care.