Podcast
Questions and Answers
Which of the following best describes a situational loss?
Which of the following best describes a situational loss?
- Loss that is only emotionally experienced.
- Loss that occurs as a person transitions between developmental stages.
- Loss that is deliberately planned for in advance.
- Loss caused by factors outside of a person’s control. (correct)
A person who has just received news of a terminal illness may initially exhibit which of the following stages of grief, according to Kübler-Ross?
A person who has just received news of a terminal illness may initially exhibit which of the following stages of grief, according to Kübler-Ross?
- Denial (correct)
- Bargaining
- Anger
- Depression
Which statement best reflects the nature of grief?
Which statement best reflects the nature of grief?
- Grief is an abnormal response to loss that must be treated with medication.
- Grief is experienced in the same ways for every individual.
- Grief is an expected and individual response without a specific order or timeline. (correct)
- Grief always progresses in a linear fashion through defined stages.
Which nursing intervention is most appropriate to support a client experiencing grief?
Which nursing intervention is most appropriate to support a client experiencing grief?
Which of the following is NOT considered a major category of loss?
Which of the following is NOT considered a major category of loss?
Which of the following is a characteristic of the 'bargaining' stage of grief?
Which of the following is a characteristic of the 'bargaining' stage of grief?
A client consistently demonstrates intense and persistent patterns of grief that do not lead toward resolution, which type of grief is the client experiencing?
A client consistently demonstrates intense and persistent patterns of grief that do not lead toward resolution, which type of grief is the client experiencing?
What is the primary focus of palliative care?
What is the primary focus of palliative care?
What role does the Patient Self-Determination Act (PSDA) play in end-of-life care?
What role does the Patient Self-Determination Act (PSDA) play in end-of-life care?
During what stage of grief might a person express emotional numbness?
During what stage of grief might a person express emotional numbness?
What is a key nursing intervention for a client experiencing the fear of dying?
What is a key nursing intervention for a client experiencing the fear of dying?
What distinguishes disenfranchised grief from other forms of grief?
What distinguishes disenfranchised grief from other forms of grief?
A durable power of attorney takes effect when the client is?
A durable power of attorney takes effect when the client is?
Which of these is an ethical dilemma surrounding the end-of-life?
Which of these is an ethical dilemma surrounding the end-of-life?
Which of the following is an expected goal for a person experiencing grief?
Which of the following is an expected goal for a person experiencing grief?
Which of the following is a common physiological need addressed in the care of a dying client?
Which of the following is a common physiological need addressed in the care of a dying client?
What is the primary focus of nursing care during the 'Planning and Outcome Identification' phase for a dying client?
What is the primary focus of nursing care during the 'Planning and Outcome Identification' phase for a dying client?
Which action by a nurse demonstrates a powerful way of showing care to a dying client or their family?
Which action by a nurse demonstrates a powerful way of showing care to a dying client or their family?
What is a key aspect of providing spiritual care to a dying client?
What is a key aspect of providing spiritual care to a dying client?
Which of the following is a NOT a typical physical sign of death?
Which of the following is a NOT a typical physical sign of death?
What is a nursing intervention to support a dying client's family?
What is a nursing intervention to support a dying client's family?
Which of these is considered a symptom of shadow grief experienced by nurses?
Which of these is considered a symptom of shadow grief experienced by nurses?
According to the content, what is a common anxiety experienced by people who are dying?
According to the content, what is a common anxiety experienced by people who are dying?
When providing care after death (post-mortem), and the client is NOT a coroner's case, what is a typical action for a nurse?
When providing care after death (post-mortem), and the client is NOT a coroner's case, what is a typical action for a nurse?
What is a common learning need for a family of a client that is dying?
What is a common learning need for a family of a client that is dying?
What is the legal responsibility of a physician when a patient dies?
What is the legal responsibility of a physician when a patient dies?
In the final stages of dying, what is a common respiratory pattern that might occur?
In the final stages of dying, what is a common respiratory pattern that might occur?
Which of these is a recommended way for a nurse to cope with grief after caring for a dying client?
Which of these is a recommended way for a nurse to cope with grief after caring for a dying client?
What is a physiological change happening in the body of a dying person, just prior to death?
What is a physiological change happening in the body of a dying person, just prior to death?
What is a key goal when purchasing clothing for a client who is dying?
What is a key goal when purchasing clothing for a client who is dying?
Flashcards
Loss
Loss
Any situation where a valued person or object is changed or becomes inaccessible.
Maturational Loss
Maturational Loss
Loss that occurs as a person progresses through developmental stages. For example, a child losing their first tooth or graduating high school.
Situational Loss
Situational Loss
Loss that occurs due to external events beyond the person's control. Examples include accidents, natural disasters, or sudden job loss.
Grief
Grief
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Stages of Grief (Kubler-Ross)
Stages of Grief (Kubler-Ross)
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Shock (Grief)
Shock (Grief)
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Reality (Grief)
Reality (Grief)
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Uncomplicated Grief
Uncomplicated Grief
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Anticipatory Grief
Anticipatory Grief
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Dysfunctional Grief
Dysfunctional Grief
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Disenfranchised Grief
Disenfranchised Grief
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Advance Directive
Advance Directive
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Durable Power of Attorney
Durable Power of Attorney
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Palliative Care
Palliative Care
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Hospice Care
Hospice Care
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Pain
Pain
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Dyspnea
Dyspnea
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Anorexia
Anorexia
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Weakness/Fatigue
Weakness/Fatigue
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Constipation
Constipation
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Nausea & Vomiting
Nausea & Vomiting
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Delirium
Delirium
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Client and family goals and expectations
Client and family goals and expectations
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Client’s awareness that illness is terminal
Client’s awareness that illness is terminal
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Identification of support systems
Identification of support systems
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Client’s stage of dying
Client’s stage of dying
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History of positive coping skills
History of positive coping skills
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Client perception of unfinished business to be completed
Client perception of unfinished business to be completed
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Powerlessness
Powerlessness
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Hopelessness
Hopelessness
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Death anxiety
Death anxiety
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Study Notes
Chapter 13: End of Life Care
- Objectives include identifying stages of grief, ways nurses can support dying patients/families through the grief process, hospice program objectives, and local resources.
Group Questions
- What is Loss? Any potential, actual, or perceived situation when a valued object or person is changed or is inaccessible to the individual.
- Examples of Loss: Loss of a significant other, a part of oneself, an external object, or a familiar environment.
- Maturational loss occurs as a person moves between developmental stages.
- Situational loss occurs due to external events, often beyond a person's control
- What is Grief? A highly individualized experience, influenced by life experiences, support systems, and resources. It's a series of intense psychological responses occurring after loss; an emotional response to loss, exhibited in many ways. Grief responses are vital, normal, natural, and adaptive.
- What are the 5 Stages of Grief (Kubler-Ross)?
- Denial
- Anger
- Bargaining
- Depression
- Acceptance -Important to note that each person experiences grief differently and these stages may not be linear.
- What are Advance Directives? Written instructions of client wishes
- What is a Living Will? Specifies circumstances under which life-sustaining measures should or should not be rendered. This is part of Patient Self-Determination Act (PSDA).
- What is Power of Attorney? Competent adults have the right to direct their own medical health. If a client becomes incapable of making decisions, a Durable Power of Attorney is established.
- What is Palliative Care? Focus on meeting physical and psychosocial needs of the client and family, including symptom control, identifying needs, and promoting interaction to facilitate a peaceful death.
Major Categories of Loss
- Loss of significant other
- Loss of an aspect of self
- Loss of an external object
- Loss of a familiar environment
Stages of Grief (Detailed)
- Shock: May last from days to one month or more. Often described as emotional numbness.
- Reality: A painful experience that occurs when a person consciously realizes the full meaning of their loss.
Types of Grief
- Uncomplicated Grief: Normally follows predictable significant loss.
- Anticipatory Grief: Occurs before an expected loss.
- Dysfunctional Grief: Intense, persistent pattern that does not result in reconciliation of feelings.
- Disenfranchised Grief: Not openly acknowledged, socially sanctioned, or publicly shared.
Factors Affecting Loss and Grief
- Developmental stage
- Religious and cultural beliefs
- Relationship with lost object
- Cause of death
Nursing Care of Grieving Clients
- Assessment: Determine personal meaning of loss, encourage clients to express feelings, and assess progress through grieving.
- Diagnosis: Potential diagnoses include dysfunctional grieving and anticipatory grieving.
- Planning & Outcome Identification: Expected goals for those experiencing grief – accepting loss, verbalizing feelings, sharing with others, and renewing activities/relationships
Nursing Care of Dying Clients - Assessment:
- Client and family goals
- Awareness of terminal illness
- Identifying support systems
- Client's stage of dying
- Coping skills history
- Unfinished business perception
Dying Person
- A YouTube video might be relevant to the topic.
Diagnosis of Dying Clients
- Possible diagnoses include powerlessness, hopelessness, and death anxiety.
Planning and Outcome Identification (cont'd)
- Treat each dying individual as unique and worthy of respect
- Many dying do not fear death but are anxious about painful deaths or dying alone
- Schedule time to spend with clients
- Identify areas of concern and make appropriate referrals
- Protect & promote self-esteem
- Balance client independence with assistance needs.
Planning and Outcome Identification (cont'd)
- Meet physical needs
- Respect confidentiality
- Provide factual information
- Offer to contact clergy or spiritual leader
Implementation
- Communicate caring to clients & family
- Physical touch & reassurance are important
Physiological Needs
- Respirations
- Fluids & nutrition
- Mouth, Eyes, Nose
- Mobility
- Skin care
- Elimination
- Comfort
- Physical environment
- Humanizing the environment, especially clothing choices
- Essential to maintain well-groomed appearance.
Spiritual Needs
- Using touch
- Music
- Praying with clients
- Communicating empathy
- Contacting clergy (if desired)
- Reading religious materials (if desired)
Support for the Family
- Family rules & coping mechanisms may differ from staff values
- Respect client's and family's wishes
- Remember the relationship with family may continue beyond the client's death
Learning Needs
- Understanding treatment regimens & physical condition
- Anticipating medical crises
- Inexperience with personal threat of death
- Unfamiliarity with emergency situations outside the hospital
Impending Death
- Lungs cannot adequately diffuse gases
- Heart and blood vessels cannot maintain adequate tissue perfusion
- Brain ceases vital center regulation
- Cheyne-Stokes respirations & 'death rattles' occur
Physical Signs of Death (cont'd)
- Absence of heartbeat
- Cessation of respirations
- Skin mottling
- Eyelids remaining slightly open
- Jaw relaxation
- No response to stimuli
- Fixed eyes
- No eye blinking
- Release of bowel/bladder contents
Care After Death
- Treat the body with respect
- Practical Post-Mortem Care: Bathing, removing dressings/tubes (unless coroner's case), placing body with head elevated, denture care, and combing hair.
Legal Aspects
- Physician certifies death (in most states)
- Autopsy to determine cause of death
- Organ donation requires sensitivity & compassion
Care of the Family
- Offer info on viewing body
- Help with transportation, funeral home, & belongings
- Provide support items (coffee, tissues, light snacks).
Nurse's Self-Care
- Nurses confront death/loss daily; at particular risk
- Shadow grief (unresolved sadness)
- Risk of burnout
Symptoms of Shadow Grief (cont'd)
- Loss of energy
- Detachment, feeling powerless
- Increased smoking/drinking
- Unusual forgetfulness
- Constant criticism
- Inability to get work done
- Uncontrolled outburst of anger
- Treating clients/families as objects
- Surrendering hobbies
Ways to Cope with Grief
- Take time to cry for clients/with clients
- Exercise/Physical activity
- Seeking colleague support
- Connecting with a place of worship/prayer
- Finding joy & laughter
- Forming a caring circle of friends
- Listening to music
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