Grief, Loss, Death Lecture Notes PDF

8/15/2021 Loss, Grief and Dying Paula Wyman MSN, RN, CNL, CMSRN College of Nursing and Health Innovations University of Texas at Arlington 1  Actual loss  Perceived...

8/15/2021 Loss, Grief and Dying Paula Wyman MSN, RN, CNL, CMSRN College of Nursing and Health Innovations University of Texas at Arlington 1  Actual loss  Perceived loss Concepts of  Physical loss loss and  Psychological loss grieving  Maturational loss  Situational loss  Anticipatory loss Taylor, Lynn and Bartlett. 2019 2 1. Shock and Disbelief 2. Developing awareness Engel (1964) 3. Restitution Stages of Grief 4. Resolving the loss 5. Idealization 6. Outcome Taylor, Lynn and Bartlett. 2019 3 1  8/15/2021 1‐ denial and isolation 2‐ anger Kubler‐Ross 3‐bargaining Five emotional 4‐depression stages of 5‐acceptance death Taylor, Lynn and Bartlett. 2019 4  Death‐  Clinical signs of impending death 1. Weakness 2. Changes in body temperature, vital signs Signs of 3. Confusion Impending 4. Less socialization, more sleep Death 5. Changing toilet habits 6. Changes in skin Taylor, Lynn and Bartlett. 2019 5  Guided by the preferences (values) of the individual  Interdisciplinary coordinated care that addresses the patient and their loved ones What is a  Symptom relief (all kinds, not just pain) “good” death?  Evolving needs are met (physical, emotional, social and spiritual)  The Dying Person’s Bill of Rights  The involvement in care and planning of care by patient and with their permission, their loved ones. Taylor, Lynn and Bartlett. 2019 6 2  8/15/2021  Can vary from person to person 1. Resolved Grief reaction 2. Unresolved 3. Inhibited (Suppressed) Taylor, Lynn and Bartlett. 2019 7  Advance directives Ethical and  Physician orders legal issues in  Assisted suicide end of life care  Euthenasia  Palliative care Taylor, Lynn and Bartlett. 2019 8 Dying Person’s  Patients are legally and morally protected in their right to refuse and treatment Bill of Rights Taylor, Lynn and Bartlett. 2019 9 3  8/15/2021 Terminal Illness’ Impact Taylor, Lynn and Bartlett. 2019 10  Body, mind, spirit, heart and soul  Dying is natural and personal  Goal is best quality of life possible by the AGGRESSIVE management of symptoms Palliative Care  ANA position statement 2017‐The Ethical responsibility to Manage Pain and Suffering  Hospice Care‐would I be surprised if this person died within the next 6 months? Taylor, Lynn and Bartlett. 2019 11  Do‐ not‐resuscitate order Advance  Comfort measures only Directives  Do not hospitalize Taylor, Lynn and Bartlett. 2019 12 4  8/15/2021  Death Certificate End of Life  Organ donation Issues  Autopsy  Funeral Arrangements Taylor, Lynn and Bartlett. 2019 13  Age  Family Relationships Factors that  Socioeconomic Position Affect Loss,  Cultural Grief and  Gender Dying  Religious Influences  Cause of Death Taylor, Lynn and Bartlett. 2019 14  Personal Hygiene Physiological  Pain control Care of a  Nutritional and Fluid needs Dying Patient  Movement and their  Elimination  Respiratory Care Family  Teaching Family to Provide Care Taylor, Lynn and Bartlett. 2019 15 5  8/15/2021  Teach family how to provide care  Teach patient and family what to expect  Help patient establish and achieve goals Psychological  Nonjudgmental listening and support Care of a  Discuss work and hobbies Dying Patient  Friends and their  Family Activities Family  Fear  Isolation  Intimacy Taylor, Lynn and Bartlett. 2019 16 Spiritual Care  Religion of a Dying  Faith Patient and  Feel lives have meaning  What is next? their Family Taylor, Lynn and Bartlett. 2019 17  Assessment  Diagnosis Nursing  Outcomes Process  Interventions  Evaluation Taylor, Lynn and Bartlett. 2019 18 6  8/15/2021  Patient and Family 1. Knowledge 2. Perceptions Nursing 3. Coping Strategies Process 4. Resources Assessment Taylor, Lynn and Bartlett. 2019 19  INEFFECTIVE COPING  ANTICIPATORY GRIEVING  DENIAL  AVOIDANCE  SURVIVOR’S GUILT Nursing  HOPELESSNESS Process  SELF NEGLECT  PROLONGED BEREAVEMENT Diagnosis  SPIRITUAL DISTRESS  COMPROMISED FAMILY COPING  INSUFFICIENT SUPPORT SYSTEM  COMPLICATED GRIEF Taylor, Lynn and Bartlett. 2019 20  Quality Care at the end of life 1. hope 2. control Nursing 3. recognition Process 4. supported Outcomes 5. comfortable 6. prepared 7. Accepting Taylor, Lynn and Bartlett. 2019 21 7  8/15/2021  Offer information  Offer support  Referrals Nursing  Mediate conflict Process  Ask questions Interventions  Share  Explain condition and the treatment  Encourage self care, independence and promote self esteem  Open comunication Taylor, Lynn and Bartlett. 2019 22  Normal anatomic position  Tubes, lines removed (if no autopsy ordered)  Soiled dressings replaced Post Mortem  Sometimes bathing (sometimes this must be done by a specific person) Care  Identification tags placed  Dentures, prosthetics labeled and sent with patient  Bag Taylor, Lynn and Bartlett. 2019 23 Support in following patient will Listening to expressions of grief, loss and helplessness The Nurse’s Solace and support‐not trite reassurances Role in Family Assist in contacting other family members Care Post Contact coroner and Funeral Home Morten Encourage reflections and honoring of the deceased Offer clergy if desired and available Taylor, Lynn and Bartlett. 2019 24 8  8/15/2021  Safe place  Guided Imagery  Exercise  Sleep Self Care  Hobbies  Family  Pets  Happiness Taylor, Lynn and Bartlett. 2019 25  Taylor, C., Pamela Lynn, Jennifer L. Bartlett. Lippincott CoursePoint for Taylor: Fundamentals of Nursing. [CoursePoint]. Retrieved from https://coursepoint.vitalsource.com/#/books/9781975101336/ Taylor, Lynn and Bartlett. 2019 26 9