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FONDATION OF NURSING
FINAL CHAPT 43
| Question | Answer |
|---|---|
| Loss & Grief-RESPECT CULTURE AND BELIEF | Actual or potential situation in which something valued is changed or no longer available OCCURS AT DIFFERENT STAGES |
| Types of Loss | Actual Recognized by others I.E MASECTOMY Perceived Experienced by one person but cannot be verified by others I.E LOSS JOB THAT MADE MORE MONEY Anticipatory Experienced before loss occurs, A SICK PERSON Can be actual or perceived |
| TYPE OF LOSS | Situational -UNPREDICATED Loss of job ,Death of child MaturationaL Departure of children from homeRetirement |
| Grief, Bereavement, Mourning INDIVIDUALIZE, CULTURE AND SPIRITUAL BASED | Grief Total response to emotional experience of loss BereavemenT Subjective response by surviving loved ones Mourning-EXPRESSING LOSS(WEAR BLACK) Behavioral process through which grief is resolved or altered |
| Stages of Grief & Dying STAGES MAY OVERLAP | Shock & disbelief Refuses to accept or intellectually accepts loss Developing awareness Reality sets in with psychological pain, crying, anger Restitution Noted by the work of the mourning process- |
| LOSS= Resolving the loss-Energy focused on thoughts of the deceased IDEALIZATION=GOOD FEELINGS-REMEBER GOOD TIME | Idealization Negative feelings toward deceased are repressedThen, griever able to incorporate characteristics of deceased into own personality Outcome Dependence on deceased decreases; griever able to move on with own life |
| Dysfunctional Grief=DO NOT MOVE ALONG | Abnormal or distorted Person may have difficulty expressing feelings of loss or may deny themGrief period may be extended for long period of timePerson may suppress grief feelings; may have physical symptoms instead of expressing feelings |
| Definition of Death | CESSATION OF BREATHING, NOT RESPONDING TO PAINFUL STIMULI Lack of reflexes (such as the gag or corneal reflex) and spontaneous movement Flat encephalogram (brain waves) |
| DEATH-PATIENT IN SUPINE POSITION-MAKE THEM LOOKING GOOD | An individual who has sustained either (1) irreversible ces sation of all functions of circulatory and respiratory functions or (2) irreversible cessation of all functions of the entire brain, including the brainstem, is dead |
| Clinical Signs of Impending Death THIS WILL HELP FAMILY MEMBER TO PROGRESS-HELP PATIENTS COPE AND NURSSES NEEDS COUNSELING, SUPPORT | STILL PROVIDE CARE-CLEANING, COMBING HAIR, Weak, slow, or irregular pulse Loss of movement, sensation, and reflexe Noisy, irregular, or Cheyne-Stokes respirationsRestlessness and/or agitation Urinary and/or bowel incontinence or constipation Dec BP |
| Components of a Good Death-EDUCATE THE FAMILIES MEMBERS Relatively free of pain, and with dignity | KEEP PATIENT COMFORTABLE Control of symptoms Preparation for death Opportunity to have a sense of completion of one’s life Good relationship with health care professionals |
| Kübler-Ross’ Stages of Grief & Dying EVERY DEATH MUST BE REPORTED MOTICIAN HAS TO SIGN DEATH CERTIFICATED LINK HEALTH-HARVEST ORGANS | Denial Cannot belief that loss is true Anger Angry at others (including God) & at self Bargaining Try to exchange promises for longer life Depression Reality of loss becomes realAcceptanceDeals with reality of loss & ready to move on |
| Terminal Illness-BE FACTUAL-Cultural influences may dictate how much information is desired and which family members are to be informed | TELL WHATS GOING ON-EVERYONE HAS TO BE ON THE SAME PAGE FAMILY MUSTBE INCLUDED IN EVERYTHING-PROVIDE SUPPORT Allows them to work through grief processAllows them to make informed decisions about what treatment to have or to choose not to have treatment |
| PALLATIVE CARE | RELIEVE SYMPTOMS-INTENTED TO CURE |
| HOSPICE CARE | RELIEVING SYMPTOMS - AND SUPPORTING CLIENT with limitedlife expectancy of months & their familieS NO INTENTION TO CURE-EN OF LIFE |
| Ethical & Legal Dimensions | Need for self-reflection |
| Advance Care Planning 18 AND OLDER WHO CAN SEE YOUR PHI OR NOT Does not guide Emergency Medical Personnel Guides inpatient treatment decisions when made available | LIVING WILLS-WISHED FOR TREATMENT , WHAT YOU WANT OR DONT WANT-SPECIFIC INSTRUCTION Durable power of attorney-PERSON MAKES DECISON WHILE ALIVE, CANT MAKE DECISON ENT WHILE SICK(WHAT YOU WANT DONE) |
| WHAT IS Physician Order for Life-Sustaining Treatment (POLST)? | Medical order indicating patient’s wishes regarding treatments commonly used in medical crisis Must be signed by healthcare professional Can go wherever patient goes |
| Special Orders HELP EVERYONE TO BE ON THE SAME PAG | Allow natural death, do-not-resuscitate, or SHOW no-code orders Active euthanasia Comfort measures only orders -GOAL OF TREATMENT Terminal weaning Voluntary cessation of eating and drinking Active and passive euthanasia-WITHDRAW TREATEMENT |
| Factors Affecting Grief & Dying | Developmental considerations ChildhoodChildren grieve Developmental delaysEarly and middle adulthood Death of parentsLoss from impaired health, functionLate adulthoodLoss of friends, longtime mate |
| Factors Affecting Grief & Dying Family/support systemPeople closest to grieving individual | First to provide supportNeed for ongoing support may be unmetRoles of family membersSocioeconomic statusEffects available support system; available resources such as life insurancePossible lack of finances |
| Factors Affecting Grief & Dying | Spiritual beliefsMost religious groups have practices related to dying Cause of loss or deathSome diseases considered "clean," engender compassion Preventable death may be viewed as less acceptable-UNEXPECTED-SEAT BELT |
| Suicide Prevention | ADDRESS SUICIDE Rise in suicide rates-IN COVID Do nurses have responsibility to prevent suicide? Suicide prevention in inpatient facilities |
| SUICIDE PREVENTIONQUESTIONAIRE-ALGEE | Assess for risk of suicide or harm Listen nonjudgmentallyGive reassurance & information Encourage appropriate professional help Encourage self-help & other support strategies |
| Nurse as Role Model | PROVIDING COMPASSIONATE CARE TO DYING AND NON-DYING, FAMILIES Existence of an advance directive (It is critical that the authorized decision maker be known to all members of the health care team.) |
| Assessing- Where are they in the grief process?Use of non-judgmental approach | What are patient’s & family’s knowledge & perception of situation and the illness?What are patient’s personal resources & personal stressors?What are patient’s social supports? Patient’s coping skills? |
| Nursing Actions Provide comfort, maintain dignity, and promote independence | Use therapeutic communicationProvide emotional supportAcknowledge grief of significant othersOffer choicesProvide information on how to access community resourcesSuggest additional sources of information |
| Nursing Actions Develop trusting nurse-patient relationship Explain patient’s condition & treatment Teach self-care & promoting self-esteemMeet needs of the dying patient | Physiologic needs: physical needs, such as hygiene, pain control, nutritional needsPsychological needs: patient needs control over fear of the unknown, pain, separation, leaving loved ones, loss of dignity, loss of control, unfinished business, isolation |
| NURSING ACTION | Spiritual needs: patient needs meaning and purpose, love and relatedness, forgiveness and hope Needs for intimacy: patient needs ways to be physically intimate that meets needs of both partners |
| ACTION | Support those who feel unable to care for or be with the dying Show an appropriate waiting area if they wish to remain nearbyMeet family needsHow do you feel about patients talking to you about their dying? About their fear of dying? |
| Providing Postmortem Care | Encourage family to view the body if they wantIf family or friends wish to view the bodyMake environment as clean and as pleasant as possibleMake body appear natural and comfortable |
| Providing Postmortem Care | Place one pillow under the head and shoulders Close eyelids Insert dentures Close mouth Wash soiled areas of the body Place absorbent pads under the buttocks Place a clean gown on the clientBrush and comb the hair |
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