Chapter 21 Loss and Grief Fundamentals of Nursing: Standards & Practices, 2E.

Chapter 21

Loss and Grief

Fundamentals of Nursing: Standards & Practices, 2E

Copyright 2002 by Delmar, a division of Thomson Learning 21-2

Loss

Loss is any situation (actual, potential, or perceived) in which a valued object is changed or is no longer accessible to the individual.

A maturational loss occurs as a result of moving from one developmental stage to another.

A situational loss occurs in response to external events.


Types of loss• Actual loss• Perceived loss• Physical loss• Psychological loss


Categories of loss• Loss of an external object• Loss of a familiar environment• Loss of aspect of self• Loss of significant other


Grief

Grief is a series of intense physical and psychological responses that occur following a loss.

Loss leads to mourning - the period of time during which the grief is expressed, and resolution and integration of the loss occurs.

Bereavement is the period of grief following the death of a loved one.


Theories of the grieving process• Lindemann• Engle• Bowlby• Worden


Types of grief• Uncomplicated grief• Dysfunctional grief• Anticipatory grief


Factors affecting grief• Developmental level• Religious and cultural beliefs• Relationship to the lost object• Cause of death


Nursing Care of theGrieving Person

Assessment• Begins with a determination of the

personal meaning of the loss• Assess the stage of grief the client is

experiencing


Diagnosis• NANDA-approved diagnoses

Dysfunctional grieving Anticipatory grieving


Outcome identification and planning• Expected outcome criteria include

Verbalize feelings of grief Share grief with significant others Accept the loss Renew activities and relationships


Implementation• The nurse must spend time listening.• The nurse’s nonjudgmental, accepting

attitude is essential while the bereaved expresses anger.

• The nurse should provide appropriate referrals to community support groups.


Evaluation• Nurses usually do not have an

opportunity to be with the bereaved when grief work is completed.

• Important to teach grieving individuals that resolution of the loss is generally a process of life-long adjustment.


Death

Stages of death and dying (Elizabeth Kubler-Ross)• Denial• Anger• Bargaining• Depression• Acceptance


Nursing assessment of the dying client• Client’s awareness of the terminal

nature of illness• Availability of support systems• Physical condition• Emotional status


• Presence of advance directives for health care decisions

• History of previous positive coping skills

• Unfinished business expressed by client or family


Diagnosis• NANDA-approved diagnoses

Powerlessness Hopelessness


Outcome identification and planning• Planning focuses on meeting the

holistic needs of the client and family.• A goal of nursing care is to promote an

optimal quality of life by treating the client and family in a respectful manner and providing a safe environment for the expression of feelings.


Implementation• Physiological needs• Psychosocial needs• Spiritual needs• Support for the family


• Hospice care Allows individuals to die with dignity and

surrounded by those who love them Palliative care

• Home care


Learning Needs of Client and Family

Client and family knowledge deficits can be related to• Insufficient information about physical

condition• Information about the treatment regime• Inability to anticipate medical crises


Inexperience with personal threat of death

Unfamiliarity with protocol to follow in case of need for emergency care when not in the hospital


Care After Death

Physiological changes• Algor mortis• Liver mortis• Rigor mortis

Legal aspects• Autopsy• Organ donation


Nursing care of the family may include• Informing the family of the type and

circumstances surrounding the death• Providing information about viewing

the body


• Asking the family about organ donation• Offering to contact support people• Helping the family with decision

making regarding a funeral home, transportation, and removal of the deceased belongings


Nurse’s self-care• Nurses need to talk about the intense

emotions associated with caregiving.• Use support from within the health care

agency - counselors, clergy, support groups.

• Find a way to say goodbye to the deceased client.

Chapter 21 Loss and Grief Fundamentals of Nursing: Standards & Practices, 2E.

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Transcript of Chapter 21 Loss and Grief Fundamentals of Nursing: Standards & Practices, 2E.