Loss and Grieving
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| Loss | The experience of parting with an object, person, belief, or relationship that one values. Requires reorganization of one or more aspects of the person's life. Can be major or minor. Expected/unexpected. Normal part of life
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| Actual Loss | Recognized by the individual and others: loss of a spouse. Loss of a job.
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| Perceived Loss | Recognized by the individual but not by others: Loss of youth. Loss of dreams and hopes.
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| Grief | An emotional reaction. Pain caused by loss. Occurs with all loss, actual and perceived, temporary and permanent. The loss of: things, people, dreams, hopes, situations
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| Bereavement | State of desolation that occurs as the result of a loss, particularly the death of a significant other
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| Mourning | Socially prescribed behaviors after death
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| Anticipatory grief | Response to impending loss, real or imagined, such as hearing a loved one has a terminal diagnosis
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| Newborn/Infant | Separation, "peek a boo". No concept of life and death. Learning to deal with presence and absence.
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| Toddlers/Preschool | Death is reversible
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| School-Age/Adolescent | Realizes death is inevitable
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| Adult/Older Adult | Usually has support system, can have numerous losses
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| Normal Grief | Feelings of resentment, sorrow, anger, crying, loneliness, and temporary withdraw from activities
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| Anticipatory Grief | Feelings and behaviors of grief experienced prior to experiencing the actual loss
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| Chronic Grief | lasts for an extended period of time
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| Disenfranchised Grief | When loss is experienced but can not be openly acknowledged, socially sanctioned or publicly shared.
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| Delayed Grief | Grief reaction is postponed until trigger by something, may be completely unrelated to what grief is about.
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| Exaggerated Grief | Exaggerated response to grief, often with psychiatric manifestations such as severe depression or psychosis
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| Masked Grief | Symptoms seem unrelated to grief such as physical illness
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| Factors Affecting Grief | Developmental stage, cultural influences, religious beliefs, circumstances of death: sudden, accidental, violent, impending. Personal resources and stressors. Meaning of the loss to the person: major or minor? How does it impact their day to day life.
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| Four Tasks of Mourning | Accept the reality of the loss. Work through the pain of grief. Adjust to the environment in which the deceased is missing. Emotionally relocate the deceased: learning to love them in a new way.
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| Care of the dying Client | Treat the client like any other client: bath, clean linens, mouth care, assess for pain, chaplain. Care for family and friends: Kleenex, water/coffee, bedding if they are spending the night, chaplain
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| Death | The point at which there is complete cessation of: respiration, heartbeat (usually the last vital sign to stop-verify by checking apical pulse). Blood pressure.
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| Physical Signs of Dying | Failure to swallow, loss of motion and sensation and reflexes, pitting edema, decreased GI and urinary tract activity: absence of bowel sounds, oliguria, anuria. Bowel and bladder incontinence, cyanosis, decrease HR/BP. Cheyne-Stokes resp. Decrease LOC
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| Changes in the Body after Death | Rigor Mortis-stiffening of the body. Algor mortis-cooling of the body. Livor Mortis- skin discoloration.
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| Rigor Mortis | Caused by chemical changes in the muscles after death. Begins 3-4 hours after death. At its maximum at 12 hours. Dissipates at 24 hrs.
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| Nursing responsibilities | Checking resuscitation status. Notification of various persons. Facilitation of legal requirements. Securing and the transfer of valuables. Care of the deceased. Care of the family members. Documentation.
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| Full Code | Everything is done to save a person's life, including CPR and advanced life support.
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| DNR | Do not resuscitate
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| DNR-CCA | Do not resuscitate-Comfort Care Arrest: Everything is done to save someone's life up to the point of cardiac or respiratory arrest, then care switches to comfort care only. All medical treatments continue.
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| DNR-CCO | Do not resuscitate-Comfort Care Only: Care changes from curing/making the pt better to comfort measures only. No medications or medical interventions unless their purpose is to make the pt more comfortable. Only meds: pain, anxiety, secretions.
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| Notification | Notify family: significant other, guardian. Clergy: chaplain or personal spiritual guide. Physician: pronounce client, talk with family.
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| Autopsy | Notify coroner if appropriate. Autopsy must be done in: accident, suicide, homicide, surgery, illegal therapeutic practice, suspected drug abuse, pt dies within 24 hrs of admission or 24 hrs postop. May be done when: stillbirth, questionable death.
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| Autopsy Guidelines | May be ordered by coroner even if family refuses Consent for autopsy is a legal requirement when it is not coroner's case May be prohibited by some religious groups except in coroner's cases Generally the responsibility of the physician to obtain consent.
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| Legal requirements | Completion of death certificate: must be signed by the pronouncing physician. Release body to the funeral home. Authorization of tissue or organ donation. Authorization for autopsy
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| Ohio Legal Requirements | LifeBank (organ procurement group) is notified of all deaths whether or not the pt is eligible for organ donation. LifeBank then makes the decision about eligibility and contacts the family to discuss the possibility of donation.
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| Securing and Transferring of Valuables | Secure valuables in a locked safe. Give them to the power of attorney or family members. Document distribution in nurses' notes and death report. Include glasses, rings, watches, personal effects
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| Caring for the Deceased | Obtain a morgue pack. Place a "no visitors" sign on the door. Prepare the deceased's body
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| How to prepare the deceased's body | Close eyes; place dentures in mouth. Place in a supine position with arms at their sides. Remove tubes if autopsy not ordered. Wash soiled body parts. Observe religious rituals of cleansing depending on faith. Replace soiled linens with clean ones.
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| How to identify the deceased body, dentures, prostheses | Leave agency ID bracelet on. Tag on shroud or garment the body is clothed in. Tag on the toe or ankle. Tag on morgue drawer.
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| If the body is going to be viewed by family prior to transfer: | Remove unnecessary or soiled equipment from room: IV polls, O2 equipment, supplies. Keep arms & hands outside the sheets. Put side rails down. Have extra chairs in room for family to sit on. Have Kleenex available. Provide privacy & time to say goodbye.
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| Once family has said their goodbyes to deceased | Wrap body in a shroud. Transfer to morgue refrigerator per agency policy or prepare body for transport by funeral home. Body may require special handling with certain communicable diseases.
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| Care of the Family | Use a conference room to gather family. Provide access to phones for family to call others. Offer to call the funeral home and clergy. Refer to agency's bereavement resources and make them available to family
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| Documentation | Time of death, persons notified, time of notification, list and disposition of valuables and personal effects, time body removed from unit, destination, by whom. ANy additional info required by agency.
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| Advanced directives | A written expression of what the client wants to happen or not happen to their body prior, during, and after death. Address "extraordinary measures". Prepared prior to client becoming incapacitated: living wills, Power of attorney. DNR order.
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| Palliative Care | The prevention, relief, reduction, or soothing of symptoms of disease or disorders without effecting a cure. For any age person. Any diagnosis. At any time, not just the last few months of life.
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| Hospice and Palliative Care | An alternative way of delivering care to the terminally ill. Have less than 6 months to live. Client and family directed care. Care for the client and family prior to death and care of the family following death.
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| How to care for Yourself | Clarify your own feelings. Take time to grieve: With your friend, staff, or chaplain. It is okay to let the deceased's family know that you care and miss deceased but never so far as to have them comforting you.
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| Nursing Diagnosis | Anticipatory grieving. Dysfunctional grieving. Hopelessness. Powerlessness. Spiritual Distress
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