CHANGES IN HEALTH CARE RELATED TO DYING AND DEATH:

Enabling Learning Objective for Nursing Process in Loss

• Action: Explain the nursing process in loss.
• Condition: Classroom environment, appropriate materials, scenarios of end-of-life care.
• Standard: Explain the nursing process in loss, grief, and special supportive care without error.

Changes in Healthcare Related to Dying and Death

• Before the 1950s, patients often died at home.
• From the 1950s-1980s, institutional care and life-prolonging equipment became common.
• Diagnosis-related groups (DRGs) led to shifts in hospitalizations.
• Today, hospitalizations are focused on medical risk and post-procedure recovery. Home care, convalescent centers, and nursing homes are more frequently used.

Historical Overview of Dying, Death, and Grief

• Theories on death and dying, like Kübler-Ross's stages, have influenced healthcare.
• Hospices gained recognition in the 1970s.
• "Death with Dignity Acts" allow terminally ill individuals to choose assisted suicide in some states.
• The National Consensus Project for Quality Palliative Care (2013) established eight domains of care.

Types of Loss

• Actual loss: Easily identified, like a mastectomy.
• Perceived loss: Less obvious, like loss of confidence or a desired outcome.
• Maturational loss: From normal life transitions—childhood dreams, adolescent breakups.
• Situational loss: Sudden, external events like job loss or death.
• Personal loss: Any significant loss requiring adaptation via the grieving process.

Grief: The Subjective Response to Loss

• Grief is a process leading to resolution of hurt and reestablishment of life.
• Grief is not an episode, it is a continual process.
• Grief attacks: Involuntary and unexpected reappearance of grief.
• Grief is influenced by the individual's culture, ethnicity, and family practices; its expression also varies.

Tasks in the Grief Process

• Accepting loss.
• Experiencing pain of loss.
• Adjusting to the new environment.
• Reinvesting emotional energy.

Nurses' Grief and Bereavement Overload

• Nurses can develop heightened empathy for patients.
• Nurse's grief can complicate care if unresolved.
• Bereavement overload: Multiple losses without adequate coping.

Stages of Grief and Dying (Kübler-Ross)

• No one way to grieve; theories are tools for anticipation and intervention.
• Kübler-Ross stages help nurses understand patient responses.

Complicated Grief

• Complicated grieving: Delayed or exaggerated responses to loss.
• Unresolved grief can lead to various issues.

Supportive Care During Dying and Grieving

• Assessment: Evaluate physical, emotional, intellectual, sociocultural, and spiritual domains.
• Physical assessment: Focuses on pain management, comfort, and basic needs.
• Emotional assessment: Addresses anxiety, fears, and acceptance.
• Intellectual assessment: Evaluates patient/family education and expectations.
• Sociocultural assessment: Identifies support systems and social needs.
• Spiritual assessment: Considers a patient's beliefs and values.

Nursing Process in Loss and Grief

• LPN/LVN role involves care planning, reviewing the plan, following prioritization, and using clinical guidelines.
• Assessment: Collect subjective and objective data on the meaning of loss.
• Identify patient problems related to clinical situation, and consider the context of loss.
• Develop expected outcomes and comprehensive care plans.
• Implement the plan of care, considering older adult needs, and prioritize care.

Evaluation of Care

• Evaluate achievement of established goals, asking the patient or their family regarding satisfaction.
• Incorporate goals relating to the grief process and personal growth, including spiritual, physical, and social well-being.

Special Supportive Care

• Perinatal death: Offer support for grieving parents, including their need to view and hold the baby, and maintain cultural rituals.
• Pediatric death: Understand children's perspectives and offer honest communication. Address parents' guilt, and involvement of other family members and support systems.
• Suicide: Recognize the grief and support needs of survivors.
• Gerontologic death: Address individual needs and acceptance, and address concerns associated with age-related changes and possible losses.
• Sudden or unexpected death: Provide support for families dealing with shock, guilt, and trauma.

Issues Related to Dying and Death

• Euthanasia: Active or passive, raising moral and ethical questions.
• DNR orders: Patient, family, and provider decisions regarding life-sustaining measures.
• Advance directives: Living wills and durable powers of attorney.
• Organ donations: Brain death criteria, living and non-heart-beating donors. Consent processes.
• Fraudulent treatments: Be wary of unproven or misrepresented therapies.

Dying Patient Communication

• Communicating with the dying patient, using open, caring language, nonjudgmentally.
• Assisting the dying patient in saying goodbye. Create a comfortable environment, discuss desired wishes from the patient.
• Delivering palliative care: An approach to relief of symptoms related to a terminal illness without affecting a cure.

Postmortem Care and Documentation

• Postmortem care protocol: Prepare the deceased's body, following agency guidelines, and maintain dignity.
• Documentation: Detail the care provided and transfer of the body, including valuables transferred.

Grieving Family Support

• Provide support to the family with empathy, sympathy, and understanding. Encourage family coping mechanisms, and provide access to referral options.
• Ongoing support can promote grief resolution: Help process the tasks involved in adapting to a significant loss, and involve all relevant parties in the discussion, particularly if the loss involves special challenges as part of the process involved with grieving.

Inquests and Postmortem Considerations

• Importance of accurate and complete documentation, legal procedures, and consent processes.

This quiz explores the nursing process involved in loss and grief, covering historical changes in healthcare practices related to death and dying. It also delves into significant theories and legislation that have shaped modern end-of-life care. Test your knowledge on these critical aspects of nursing and patient support.