Week 6: Grief and End of Life Concepts
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Questions and Answers

What is anticipatory grief?

  • Grief that lasts for an extended period without resolution
  • A response to a loss before it occurs (correct)
  • A response to a loss after it has occurred
  • A type of grief characterized by recurrent waves of distress

    • What is a common emotional response during anticipatory grief?

  • Irritability and impatience (correct)
  • Indifference towards others
  • Calmness and acceptance
  • Elation and happiness

    • Which of the following best describes acute grief?

  • A mild and short-lived reaction to loss
  • A stable, manageable form of grief
  • A crisis with fluctuating emotional and somatic symptoms (correct)
  • A prolonged state of emotional numbness

    • What distinguishes persistent grief from acute grief?

    <p>Persistent grief does not occur in waves</p> Signup and view all the answers

    What is meant by 'pathological grief'?

    <p>Grief that prevents normal adjustment and persists over time</p> Signup and view all the answers

    During which types of events might a person experience persistent grief?

    <p>Significant dates such as anniversaries or birthdays</p> Signup and view all the answers

    What are common manifestations of acute grief?

    <p>Feelings of self-blame, guilt, and hostility</p> Signup and view all the answers

    Which strategy can help individuals experiencing anticipatory grief?

    <p>Facilitating open communication</p> Signup and view all the answers

    What is the primary role of a nurse in supporting patients experiencing loss and grief?

    <p>Support patients and families through the bereavement period</p> Signup and view all the answers

    Which term is often used synonymously with grief?

    <p>Mourning</p> Signup and view all the answers

    What is an essential component of grief as described in the content?

    <p>Grief is an individual's emotional response to a loss</p> Signup and view all the answers

    Which of the following factors can influence the process of mourning?

    <p>Culture and social norms</p> Signup and view all the answers

    What can be described as loss in the context of death and grief?

    <p>The loss of a significant relationship</p> Signup and view all the answers

    How do loss and grief manifest throughout a person's life?

    <p>Through various forms of loss, such as dreams or health</p> Signup and view all the answers

    Which of the following best defines bereavement?

    <p>The process of coping with grief and loss</p> Signup and view all the answers

    What are some strategies to support families and caregivers of dying patients?

    <p>Communicate effectively and provide emotional support</p> Signup and view all the answers

    Which healthcare professionals are allowed to administer a medication intended to cause the death of a patient?

    <p>Nurse Practitioner or Physician</p> Signup and view all the answers

    What must a nurse do if they conscientiously object to participating in a MAiD procedure?

    <p>Provide care for the patient until another nurse can be found</p> Signup and view all the answers

    In which of the following locations can a patient choose to receive end-of-life care?

    <p>Long Term Care Facility</p> Signup and view all the answers

    What is the primary focus of care when a patient is nearing death?

    <p>Reducing pain and managing symptoms</p> Signup and view all the answers

    What is a potential consequence of a nurse encouraging a patient to choose MAiD?

    <p>It is considered a criminal offence</p> Signup and view all the answers

    Which of the following statements about conscientious objection is true?

    <p>Nurses have the right to refuse involvement based on their conscience</p> Signup and view all the answers

    When a nurse identifies the need for conscientious objection, what should they do in the interim?

    <p>Provide all necessary care except related to MAiD</p> Signup and view all the answers

    What type of care is emphasized in settings where patients can choose to die?

    <p>High quality care focusing on comfort</p> Signup and view all the answers

    What is the role of a Substitute Decision Maker (SDM)?

    <p>To make health care decisions on your behalf if you cannot</p> Signup and view all the answers

    Which of the following is NOT a requirement for eligibility for Medical Assistance in Dying (MAiD)?

    <p>Must have a terminal illness expected to result in death within six months</p> Signup and view all the answers

    Which safeguard is NOT included in the MAiD process?

    <p>Patient is required to choose a SDM</p> Signup and view all the answers

    In the context of MAiD, what does 'Practitioner-Assisted MAiD' entail?

    <p>A healthcare practitioner administers medication at the patient's request</p> Signup and view all the answers

    What happens if two Substitute Decision Makers disagree on healthcare decisions?

    <p>The Office of the Public Guardian &amp; Trustee will intervene</p> Signup and view all the answers

    Which aspect of Medical Assistance in Dying requires the patient's understanding of their choices?

    <p>Informed consent</p> Signup and view all the answers

    What is a primary responsibility of nurses in the context of MAiD?

    <p>Support the patient and interprofessional team</p> Signup and view all the answers

    Which of the following factors is excluded from the eligibility criteria for MAiD?

    <p>Mental illness as the only condition</p> Signup and view all the answers

    What must occur before a patient's request for MAiD is fulfilled?

    <p>A waiting period must be observed</p> Signup and view all the answers

    What does patient self-administered MAiD involve?

    <p>The patient administers prescribed medication themselves</p> Signup and view all the answers

    What is considered a fundamental component of hospice palliative care?

    <p>Universal access to psychosocial, spiritual, and physical care</p> Signup and view all the answers

    Which statement best describes the philosophy of hospice palliative care?

    <p>It shifts the focus from cure to comfort and quality of life.</p> Signup and view all the answers

    What role does a care coordinator or case manager play in end-of-life care?

    <p>They coordinate and facilitate care for the dying person.</p> Signup and view all the answers

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

    <p>Foster dependence on medical interventions.</p> Signup and view all the answers

    How does a palliative care approach adapt as the possibility of cure decreases?

    <p>It increases in intensity and scope.</p> Signup and view all the answers

    In hospice palliative care, which aspect is primarily addressed alongside physical care?

    <p>Coping with psychological and social issues.</p> Signup and view all the answers

    What is one of the aims of hospice palliative care when addressing a dying person's needs?

    <p>To prevent new physical issues from arising.</p> Signup and view all the answers

    What does the World Health Organization define as a key aspect of palliative care?

    <p>The prevention and relief of suffering.</p> Signup and view all the answers

    What should never be used for a client with a cool skin temperature?

    <p>Heating pad</p> Signup and view all the answers

    What is a common sign of respiratory distress in patients?

    <p>Noisy breathing and gurgling</p> Signup and view all the answers

    What is recommended for managing dry eyes in patients nearing the end of life?

    <p>Turning the patient's head towards light</p> Signup and view all the answers

    How should caregivers respond to difficulty swallowing in patients?

    <p>Permit small amounts of food if the patient shows interest</p> Signup and view all the answers

    What is the approach to pain management in patients with malignancies?

    <p>Assess &amp; treat pain frequently using narcotics as needed</p> Signup and view all the answers

    What is a common misconception about oxygen use in patients experiencing shortness of breath?

    <p>Oxygen is used primarily for patient comfort, not routinely required</p> Signup and view all the answers

    What type of interventions are effective for managing respiratory secretions?

    <p>Both pharmacological and non-pharmacological interventions</p> Signup and view all the answers

    When should muscle weakness be assessed for its impact on swallowing?

    <p>Throughout the progression of the illness</p> Signup and view all the answers

    What should caregivers prioritize to avoid aspiration pneumonia during mealtime?

    <p>Do not force the client to eat or drink</p> Signup and view all the answers

    What is the importance of titrating narcotic doses?

    <p>To ensure the doses fit the intensity and duration of pain</p> Signup and view all the answers

    Study Notes

    Week 6: Grief, Loss, and End of Life

    • Grief is an individual's emotional response to a loss. No single way to grieve exists.
    • Mourning and bereavement are often used interchangeably.
    • These processes involve incorporating loss into one's life and often involve rituals and behaviors.
    • Cultural and social norms significantly influence mourning and bereavement.
    • Loss, death, dying, and grief are integral and universal aspects of life.
    • Loss and grief can affect both the patient and their loved ones.
    • Nurses play a crucial role in supporting patients and families during loss and bereavement.

    Learning Objectives

    • Define concepts of loss, bereavement, and grief, exploring associated theories.
    • Describe strategies to support families, friends, and caregivers of a dying patient.
    • Explore legal issues surrounding end-of-life care, including MAID, informed consent, competency, advanced directives, and substitute decision-making.
    • Explain physiological changes that occur when death is imminent and discuss nursing interventions when providing care and comfort at end-of-life.

    Activity

    • Students should write down one question or concern regarding caring for someone who is dying.

    Week 6.2: Grief & Loss

    • Loss is an experience of losing someone or something.
    • Loss can occur throughout life, not just at the end of life, and includes health, possessions, relationships, or life itself.
    • One person's loss is another's significant loss.
    • Grief is an individual's emotional response to loss, with varied responses.

    Loss, Grief, & Death

    • Loss, death, dying, and grief are inevitable and universal aspects of human life.
    • These are experienced throughout life through loss of dreams, positions, relationships, health, or death
    • Nurses play a critical role in helping patients and loved ones cope with loss and grief.

    Loss

    • Loss is an experience of losing someone or something.
    • Throughout life and particularly at the end of life, loss is experienced in many forms.
    • One person's loss can be considered a significant loss for another.

    Grief

    • Grief is an individual's emotional response to a loss.
    • Everyone grieves differently.
    • Mourning and bereavement are terms often used synonymously. Both are active evolving processes of incorporating the loss into one's life.

    Factors Influencing Grief & Loss

    • Human development influences how individuals cope with grief.
    • Socioeconomic status and financial limitations can impact grief.
    • Psychosocial perspectives – Personal experiences shape each individual’s coping.
    • Quality and meaning of relationships with loved ones influence how significant grieving is.
    • Nature of loss, its meaning, and circumstances surrounding it influence the process.
    • Culture and ethnic background influence responses to loss.

    Models of Grief

    • Many grief models have been developed since the 1970s.
    • These models influence how healthcare providers and society understand and respond to grief.
    • Most focus on describing the grieving process related to death; however, the models can also be applied to other kinds of significant losses.

    The Grieving Process

    • Models of grief acknowledge similar physical and psychological manifestations and phases.
    • Stages include acute, despair, and adjustment. Individuals experience these phases differently.
    • Processes are not always rigid or predictable, meaning one phase does not always follow another.

    Kubler-Ross

    • Denial: The individual acts as though nothing has happened.
    • Anger: The individual resists the loss and often lashes out at others.
    • Bargaining: Attempts to postpone the awareness of the new reality.
    • Depression: An individual is hit with the full impact of the loss and significance. Potential withdrawal from community.
    • Acceptance: The individual accepts the loss and begins to look forward.

    Pattison's Living-Dying Interval

    • The living-dying interval is the transition period between learning of a terminal illness and death.
    • Stages include peak anxiety, crisis, knowledge of death, integrated dying, and terminal phase.
    • Phases—acute crisis, chronic living-dying, or disintegration—may overlap, and individual experiences differ.

    Types of Grief

    • Anticipatory grief is a response to a loss before its occurrence.
    • Anticipatory grief may involve preoccupation with the loss, detailed planning, or a change in attitude towards the future.
    • Anticipatory grief can present in withdrawal of the person and environment for the dying.

    Types of Grief

    • Acute Grief: A crisis with somatic and psychological symptoms that manifest in waves.
    • Persistent Grief: Lingering grief that resurfaces from time to time. Grief that may be maladaptive or dysfunctional
    • Complicated Grief: A normal grieving trajectory that is overwhelmed by loss. Symptoms may include preoccupation with the loss, avoidance of reminders, feelings of mistrust.
    • Disenfranchised Grief: An experience where loss is not socially recognized or openly acknowledged. Example: Loss of a secret lover, hidden relationship, or loss of a pet.

    Needs of the Dying Patient and Family

    • End-of-life care includes services needed and support for the patient, family, or friends in the last year of life.
    • A good death is free from suffering, consistent with patient and family wishes, and aligns with ethical standards.

    Weisman's 6 C's

    • Individuals facing end-of-life require specialized care addressing physical, emotional, and spiritual needs.
    • These needs are approached with the six elements of care, control, composure, communication, continuity, and closure.

    Care

    • Provides comprehensive care management of physical symptoms and needs.
    • Addresses the importance of spiritual, emotional, and psychological needs.
    • Considers the conservation of patient energy as part of treatment.

    Control

    • Patients experience control loss.
    • Returning control in the form of control over bodily functions, identity, and choices is essential.
    • Effective symptom management and care continuity are essential.

    Composure

    • Supports the client and those around them during stressful periods.
    • Counter-coping techniques are used by the nurse.

    Communication

    • Open communication between and among persons is encouraged.
    • Nurses have a responsibility to ensure the dying person has an opportunity for desired communication
    • This can involve acknowledging awareness of a terminal illness.
    • Different ways to communicate with the dying patient and their family are often presented.

    Continuity

    • Maintain a sense of normalcy and continuity; establish routines to ease transition.
    • Establish legacies, create rituals to remember the living person.
    • The client must have an opportunity to say goodbye and make final arrangements.

    Closure

    • Reconciliation and transcendence
    • Opportunity for reconciliation, emotional processing, and reminiscence.
    • Spiritual reconciliation with higher power or other. Completion of important tasks.

    Supporting Families

    • Families and friends are often with the patient during the last moments.
    • Nurses provide support to family and friends, including emotional support.
    • Helpful strategies include being informed, physically present, knowing names, offering comfort, and showing empathy.
    • Advanced care planning
    • Advanced directives
    • Substitute decision-makers
    • Key legal documents (e.g., advance directives, POA/SDM).
    • The roles and responsibilities of these parties

    MAID

    • Two ways for performing Medical Assistance in Dying: Practitioner-Assisted or Patient Self-Administered
    • Requirements for eligibility, safeguards, and nurse's role, for example patient age and health condition, written consent, and time-related elements.
    • Conscientious objection for nurses.

    The Canadian Hospice Palliative Care Association Goals

    • Relieve suffering and improve quality when dying.
    • Support for psychological, social, spiritual and practical needs.
    • Support families, grief processing and managing loss
    • Support end-of-life care in all settings.

    Nursing Implications

    • The care of the terminally ill requires competency in several tasks.
    • Understanding care preferences and managing symptoms
    • Signs of approaching death.
    • Addressing needs in several settings
    • Offering support and expertise to patients, families, and other healthcare providers.

    Hospices

    • Hospice Palliative care is both an approach and philosophy of care.
    • Hospice approaches address quality of life by managing pain, suffering, and other symptoms.
    • Focuses on the individual and family experience with life-threatening illness and loss.

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    Related Documents

    Grief, Loss, and End of Life (UTD) PDF

    Description

    This quiz covers the essential concepts of grief, loss, and end-of-life care as discussed in Week 6. It explores the emotional responses to loss, the roles of cultural norms in mourning, and the critical support provided by healthcare professionals. Engage with key theories and legal aspects surrounding bereavement and patient care.

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