CHANGES IN HEALTH CARE RELATED TO DYING AND DEATH:

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Questions and Answers

Which state does not officially have an act supporting physician-assisted suicide but does not restrict physicians from prescribing lethal medications?

Vermont

California

Washington

Montana (correct)

What type of loss occurs suddenly in response to a specific external event?

Situational loss (correct)

Maturational loss

Actual loss

Perceived loss

Which of the following is NOT one of the eight domains established for quality palliative care?

Cultural aspects of care

Spiritual aspects of care

Personal aspects of care (correct)

Psychological aspects of care

What is an example of an 'actual loss'?

Loss of a pet due to illness Signup and view all the answers

How can grief best be described?

A subjective response involving thoughts, feelings, and behaviors Signup and view all the answers

What major change in the healthcare system occurred from the 1950s to the 1980s regarding the dying process?

Dying usually occurred in institutions with advanced medical equipment. Signup and view all the answers

Which historical figure is recognized for influencing discussions on death and dying in the 1960s?

Elizabeth Kübler-Ross Signup and view all the answers

What was a key factor that led to changes in how terminally ill patients receive care today?

Shifts in healthcare policies promoting home care. Signup and view all the answers

What therapy aims to assist individuals coping with the pain of loss?

Grief therapy Signup and view all the answers

Which aspect is emphasized regarding care for terminally ill patients in the home health care setting?

They receive technical and mechanical assistance. Signup and view all the answers

Which task is NOT part of the process to facilitate passage from grief to closure?

Avoiding the pain of grief Signup and view all the answers

What is a grief attack typically triggered by?

Unexpected reminders of the deceased Signup and view all the answers

Which statement about nurses experiencing grief is accurate?

Nurses can develop empathy for patients but should not let personal grief interfere with care. Signup and view all the answers

What occurs in the case of complicated grief?

Individuals become 'stuck' in the grief process and struggle to seek support. Signup and view all the answers

Which aspect is NOT part of the comprehensive assessment for supportive care during the grieving process?

Financial assessment Signup and view all the answers

What is the primary goal of the intellectual assessment in a dying patient?

To understand the educational level and expectations of the patient and family. Signup and view all the answers

Which statement is true regarding the sociocultural assessment during end-of-life care?

Family support systems need to be identified and understood. Signup and view all the answers

How should a nurse approach the spiritual assessment of a dying patient?

By discovering the patient's life philosophy without judgment. Signup and view all the answers

Which of the following best reflects the nurse’s role in supporting patients experiencing shock and denial?

They should offer guidance and understanding during this emotional state. Signup and view all the answers

What is a key responsibility of licensed practical nurses (LPNs) in the nursing process related to loss and grief?

To participate in planning care based on individual patient needs. Signup and view all the answers

Why is it important to consider multiple defining characteristics when identifying patient problems?

Multiple characteristics can suggest different underlying issues. Signup and view all the answers

What factor must be considered for appropriate interventions in grieving patients?

The nature of the patient's loss. Signup and view all the answers

What is an expected goal for a patient engaging in grief work?

The patient will actively participate in grief work. Signup and view all the answers

How should a nurse prioritize care for a patient with multiple complex problems?

Reevaluate and restate priorities based on the patient's condition. Signup and view all the answers

Which intervention best supports a patient experiencing both grief and nutrient deficiency due to anxiousness?

Promoting discussions about their grief first. Signup and view all the answers

Study Notes

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.

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.

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.

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Description

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.