Podcast
Questions and Answers
A client states, 'I am looking forward to our family reunion next year,' when discussing their terminal illness. Which stage of the Kübler-Ross model of grief is the client most likely experiencing?
A client states, 'I am looking forward to our family reunion next year,' when discussing their terminal illness. Which stage of the Kübler-Ross model of grief is the client most likely experiencing?
- Depression
- Denial (correct)
- Acceptance
- Bargaining
A client's family lost their home during a tornado. What type of loss should the nurse recognize the family is experiencing?
A client's family lost their home during a tornado. What type of loss should the nurse recognize the family is experiencing?
- Anticipatory loss
- Necessary loss
- Maturational loss
- Situational loss (correct)
Which action should the nurse take to uphold the client's dignity and self-esteem during palliative care?
Which action should the nurse take to uphold the client's dignity and self-esteem during palliative care?
- Encouraging the client to relinquish control over daily decisions to conserve energy.
- Allowing the client to make choices regarding their daily activities and care. (correct)
- Limiting the client's interactions with family to avoid emotional distress.
- Making all care decisions to minimize stress for the client.
A client with a terminal illness states, 'I promise to go to church every day if I can live through this.' According to the Kübler-Ross model of grief, which stage is the client in?
A client with a terminal illness states, 'I promise to go to church every day if I can live through this.' According to the Kübler-Ross model of grief, which stage is the client in?
A client is diagnosed with a terminal illness and expresses feelings of sadness and hopelessness. Which statement by the nurse demonstrates therapeutic communication related to the client's emotional state?
A client is diagnosed with a terminal illness and expresses feelings of sadness and hopelessness. Which statement by the nurse demonstrates therapeutic communication related to the client's emotional state?
Which situation exemplifies disenfranchised grief?
Which situation exemplifies disenfranchised grief?
A client is nearing the end of life. Which physical change should the nurse anticipate?
A client is nearing the end of life. Which physical change should the nurse anticipate?
What is the primary focus of palliative care?
What is the primary focus of palliative care?
What should the nurse recognize as the key purpose of advance directives?
What should the nurse recognize as the key purpose of advance directives?
A nurse is caring for a client experiencing anticipatory grief. Which statement describes this type of grief?
A nurse is caring for a client experiencing anticipatory grief. Which statement describes this type of grief?
A client is in the anger stage of grief according to the Kübler-Ross model. Which behavior is most likely exhibited by the client?
A client is in the anger stage of grief according to the Kübler-Ross model. Which behavior is most likely exhibited by the client?
What is the primary role of the nurse when a client is considering organ and/or tissue donation?
What is the primary role of the nurse when a client is considering organ and/or tissue donation?
A client has a document in which they have appointed someone to make medical decisions on their behalf when they are no longer able to do so. Which document should the nurse recognize?
A client has a document in which they have appointed someone to make medical decisions on their behalf when they are no longer able to do so. Which document should the nurse recognize?
A client is in the depression stage of grief. Which statement describes the client's likely emotional state during this stage?
A client is in the depression stage of grief. Which statement describes the client's likely emotional state during this stage?
Which nursing action is most appropriate when providing postmortem care?
Which nursing action is most appropriate when providing postmortem care?
A nurse is caring for a client whose family is providing all of the client's ADLs. What rationale for client self-care should the nurse communicate to the family?
A nurse is caring for a client whose family is providing all of the client's ADLs. What rationale for client self-care should the nurse communicate to the family?
What should the nurse do to prevent facial discoloration after a client's death?
What should the nurse do to prevent facial discoloration after a client's death?
Which factor increases an individual's risk for dysfunctional grieving?
Which factor increases an individual's risk for dysfunctional grieving?
Which action should the nurse avoid when interacting with a client who is bereaved?
Which action should the nurse avoid when interacting with a client who is bereaved?
Which intervention is most appropriate for the nurse to implement for a client experiencing complicated grief?
Which intervention is most appropriate for the nurse to implement for a client experiencing complicated grief?
A client nearing the end of life is experiencing increased anxiety. Which nursing intervention is most appropriate to manage this symptom?
A client nearing the end of life is experiencing increased anxiety. Which nursing intervention is most appropriate to manage this symptom?
A client's family is struggling with the client's impending death. How should the nurse support the grieving family?
A client's family is struggling with the client's impending death. How should the nurse support the grieving family?
A nurse is caring for a client who has a living will. Which statement best describes the purpose of a living will?
A nurse is caring for a client who has a living will. Which statement best describes the purpose of a living will?
A nurse is providing postmortem care. Which action maintains respect for the client and family?
A nurse is providing postmortem care. Which action maintains respect for the client and family?
What is the focus of hospice care?
What is the focus of hospice care?
A client is experiencing a 'necessary loss'. Which situation should the nurse recognize as an example?
A client is experiencing a 'necessary loss'. Which situation should the nurse recognize as an example?
Which of the following is considered an actual loss?
Which of the following is considered an actual loss?
A nurse is caring for other nurses who are grieving after the loss of a long-term client. Which strategy can they use to cope?
A nurse is caring for other nurses who are grieving after the loss of a long-term client. Which strategy can they use to cope?
Why is it important for nurses to be sensitive to comments made in the presence of clients who are unconscious?
Why is it important for nurses to be sensitive to comments made in the presence of clients who are unconscious?
Flashcards
Advance Directives
Advance Directives
Legal documents that direct end-of-life issues, such as living wills and health care proxies.
Living Will
Living Will
Directive document for medical treatment per the client's wishes.
Health Care Proxy
Health Care Proxy
Document that appoints someone to make medical decisions when the client is unable to do so.
Necessary Loss
Necessary Loss
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Actual Loss
Actual Loss
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Perceived Loss
Perceived Loss
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Maturational/Developmental Loss
Maturational/Developmental Loss
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Situational Loss
Situational Loss
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Anticipatory Loss
Anticipatory Loss
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Denial
Denial
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Anger
Anger
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Bargaining
Bargaining
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Depression
Depression
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Acceptance
Acceptance
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Disenfranchised Grief
Disenfranchised Grief
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Palliative Care
Palliative Care
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Hospice Care
Hospice Care
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Postmortem Care
Postmortem Care
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Study Notes
Grief, Loss, and Palliative Care
- Clients experience loss across life aspects, with grief manifesting in thoughts, feelings, and behaviors.
- Bereavement encompasses grief and mourning as an individual processes a significant person's death.
- Palliative care addresses clients' physical, spiritual, and psychosocial needs.
- Healthcare staff aid in end-of-life decisions to ease stress, grief, and bereavement.
Advance Directives
- Advance directives are legal documents guiding end-of-life care.
- Living wills direct medical treatment according to the client's wishes.
- A healthcare proxy, or durable power of attorney, allows someone to make medical decisions for incapacitated clients.
Types of Loss
- Necessary loss is related to life changes, anticipated yet intensely felt, and replaceable.
- Actual loss involves a valued person, item, or status recognized by others, like losing a job.
- Perceived loss is defined by the client.
- Maturational or developmental loss is normally expected in life, helping people develop coping skills, e.g., child leaving for college.
- Situational loss is unanticipated due to external events, for example, losing a home during a tornado.
- Anticipatory loss is experienced before the loss happens.
Kübler-Ross Model of Grief
- Denial involves disbelief in an expected or actual loss.
- Anger is directing anger towards the self, others, a deity, objects, or the current circumstances.
- Bargaining is negotiating for more time or a cure.
- Depression is overwhelming sadness due to the inability to change the situation.
- Acceptance is acknowledging the reality of the situation and planning for the future.
- Clients might not move through the stages in order or experience each stage for the same amount of time.
Factors Influencing Loss, Grief, and Coping
- Important factors include current age, stage of development, interpersonal relationships, and social support.
- The type and significance of the loss, cultural and ethnic background and spiritual/religious beliefs and practices, prior experience with loss, socioeconomic status and coping strategies all affect the grieving process.
- Dysfunctional grieving is more likely with dependency on the deceased or unexpected death at a young age.
- Inadequate coping skills and lack of hope or pre-existing mental health can also increase risk.
Manifestations of Grief Reactions
- Normal grief is considered uncomplicated.
- Emotions can be negative but should shift to acceptance over time, usually evident by 6 months.
- Somatic symptoms include chest pain, palpitations, headaches, nausea, and disrupted sleep.
- Anticipatory grief involves "letting go" before a loss, as in terminal illness.
- Complicated grief includes chronic, exaggerated, masked, and delayed types.
- Complicated grief has difficult progression, prolonged grief work, severe manifestations, and potential depression.
- Suicidal ideation, intense guilt, lowered self-esteem, and persistent somatic complaints can occur with complicated grief.
- Disenfranchised grief cannot be shared publicly or is culturally unacceptable.
Nursing Interventions
- Allowing time, identifying expected behaviors, and therapeutic communication.
- Active listening, open-ended questions, and silence can facilitate mourning.
- Nurses should avoid inhibiting expression of feelings.
- Assisting with accepting reality, encouraging "moving on," new relationships, and assessing ineffective coping.
- Sharing grief stages is important.
- Avoid clichés and share community resources.
Interprofessional Collaboration
- Bereavement or grief support groups and individual psychotherapy can help.
- Spiritual advisors and mental health counselors can be beneficial.
Palliative Care
- Nurses advocate for client dignity and self-esteem with palliative care.
- Palliative care aims for a client to live fully with incurable conditions.
- Palliative care improves life quality for clients and families facing end-of-life issues.
- Interventions relieve physical, spiritual, emotional, and psychosocial suffering.
Hospice Care
- Hospice provides comprehensive care for clients and their families.
- Provided in various settings for clients expected to live under 6 months.
- Medical care shifts from a cure to enhancing life quality and peaceful death.
End-of-Life Assessment
- Identify client's sources of strength and hope.
- Determine desires/expectations of the client and family.
- Characteristics of Discomfort: Pain, anxiety, restlessness and dyspnea.
- Nausea, vomiting, dehydration, bowel issues, incontinence, and inability to perform ADLs.
Manifestations of Approaching Death
- Decreased consciousness and muscle tone, labored breathing, and Cheyne-Stokes respiration.
- Diminished touch sense, mucus, incontinence, mottling, nonreactive pupils, weak pulse, dropping blood pressure, cool extremities, perspiration, and dark urine output are all signs.
- The client may experience an inability to swallow.
Nursing Interventions
- Promoting continuity, prioritizing end-of-life care, and comfort through symptom management.
- Administering medications like morphine, assess treatment effectiveness, and manage adverse effects.
- Repositioning the client for airway patency, maintaining skin integrity, and providing caring touch.
- Environment should promote dignity, eliminating odors, providing comfortable clothing, grooming, and encouraging comforting possessions.
- Relaxation techniques, promoting decision-making, and encouraging ADLs.
Psychosocial Care
- Interprofessional approach, providing care, and fostering support.
- Utilize volunteers provide nonmedical care.
- Encourage religious practices, facilitate communication, assist with clarifying values, and use past coping mechanisms.
- Care should be sensitive to comments made and that hearing is the last sensation lost.
Prevention of Abandonment and Isolation
- Reduce fear of dying alone.
- Answer call lights, maintain contact, and provide procedure updates.
- Allow family overnight stays.
- Prioritize client comfort, either in a room near the nurses' station or a central home location.
Support for the Grieving Family
- Suggest visit schedules, ensure appropriate information, and provide privacy.
- Evaluate family's ability to provide care and educate.
- Allows families to express feelings.
Postmortem Care
- Adhere to laws regarding organ/tissue donation, autopsy permission, documenting death, and administering postmortem care.
- Nurses should be the primary focus.
Postmortem: Care of the Body
- Nurses should provide respectful care, respecting cultural, religious, and social practices.
- Providers should certify death by pronounces time, documenting therapies
- The head should be elevated putting the head on a pillow to avoid discolouration
Preparing the Body for Viewing
- Ask family about their inclusion, providing privacy, removing tubes and belongings, cleansing/aligning the body, and applying fresh linens
- Excess supplies should be removed, dim lights, and minimize noise.
- Ask about family visits and clarify belongings.
- In the case of infants, swaddle and transport according to protocol.
Post Viewing and Organ/Tissue Donation
- Postviewing involves applying identification tags, completing paperwork, and respecting sensibilities.
- Coordinate requests for donation and support family decisions.
- Be sensitive about cultural and religious influences and maintain ventilation for organ retrieval.
Autopsy Considerations
- Discussed with the family by the provider.
- The nurse supports family questions/choices.
- Used to advance scientific knowledge.
- Legal requirements in cases of homicide or death within 24 hours of admission.
- All tubes are to remain in place.
- Documentation includes time of death, who pronounced it, organ donation, tubes, personal items, notifications, tag locations, and departure time.
Care of Nurses who are Grieving
- Acknowledge attachments to clients.
- Employ coping mechanisms with professional boundaries (funerals, communication, debriefing, stress management, counselling).
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