Understanding Death Loss Grief and Bereavement

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    Definition of ICN

    Nursing encompasses autonomous and collaborativecare of individuals of all ages, families, groups andcommunities, sick or well and in all settings. Nursingincludes the promotion of health, prevention ofillness, and the care of ill, disabled and dying people.

    Advocacy, promotion of a safe environment,research, participation in shaping health policy and inpatient and health systems management, andeducation are also key nursing roles.

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    Terminal Illness

    Any disease that cannot be cured and will result in death.

    Everyone reacts differently to news of a terminal illness.

    Some react with fear and anxiety.

    Many fear pain, abandonment, loneliness, and the unknown.

    They may become anxious about their loved ones, unfinishedwork, or dreams.

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    1.Unable to oxygenate the body enough for adequate gas

    diffusion

    2.Respirations become stridorous or noisy, leading to

    death rattle

    3. Cheyne-Stokes respiration sign of pulmonary systemfailure

    Consists of alternate hyperpneic and apneic

    phases

    Respiratory System

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    Cardiovascular System

    Heart unable to pump strongly enough to keep blood movingDecreased blood causes decreased circulation to the body

    Skin becomes cool to the touch, pale

    Person appears cyanotic, possibly mottled

    Failure of peripheral circulation frequently results in a drenching

    sweat cooling the body surface.

    Pulse becomes weak and thready, ultimately irregularA stronger pulse typically means death is hours away

    A weak, irregular pulse typically means that death is imminent in the

    next couple of hours.

    An apical pulse might be required.

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    Metabolism rates decrease.The person might retain feces or become incontinent.

    Urinary output decreases.

    Dying person may turn toward light as sight

    diminishes.Dying person may hear only what is distinctly spoken.

    Dying person may remain consciousness or become

    unconscious/comatose

    Other Changes

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    Some dying people rally in clarity and consciousnessjust prior to their death

    A persons eyes might be open even if unconscious

    Dying people might turn toward or speak to someone

    who is not visible to anyone else in roomPain might be present

    Pain medication should not be withheld as person

    nears death.

    Other Changes

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    Right to Die

    Most people with terminal illness believe that someonewith a terminal illness should be allowed to refusemeasures that would prolong their life.

    This is the right to die.

    Respirators, pacemakers, and other medical devices canbe withheld and the person can die with dignity.

    DNRDo Not Resuscitate Order

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    Emotional and Physical Reasons

    People May Fear Death.

    Helplessness

    Dependence on others

    Physical faculties

    Mutilation by surgery or disease

    Uncontrollable pain

    Being unprepared for death

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    Social Reasons People May Fear Death

    Fear of separation from family or home

    Fear of leaving behind unfinished tasks or

    responsibilities

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    Loss

    Occurs when avalued person,object, or situationis changed

    Actual Loss

    Perceived loss

    Anticipated loss

    Physical lossPsychological

    loss

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    Grief or Grieving-Grief is the Emotional

    Reaction to Loss

    Bereavement- stateof grieving during

    which a person goes

    through grief

    reaction.

    Mourning-period ofacceptance of loss

    and grief during

    which the person

    learns to deal withthe loss.

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    Engels 6 Stages of GriefReaction

    Shock and disbelief

    Developing awareness

    Restitution

    Resolving the loss

    Idealization

    Outcome

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    5 Stages of Grief

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    Kubler-Ross Model

    (Five Stages of Grief)

    a process by which people deal with grief andtragedy, especially when diagnosed with a terminal

    illness or catastrophic loss.

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    Elisabeth-Kbler Ross

    -Swiss-born psychiatrist andthe author of the

    groundbreaking book On

    Death and Dying.

    - Discussed the Kbler-

    Ross Model

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    Denial

    People refuse to accept that the diagnosis of death isreal

    Temporary defense

    Replaced with heightened awareness of situationsand individuals that will be left behind after death

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    Denial

    Usually occurs when the person is first told of the illness.

    Individuals may say,

    The tests are wrong.

    This cant be happening to me.

    I dont believe it.

    Others dont talk about it.

    Health care workers should listen without confirming or denying it.

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    Anger

    Anger at death itself and the feelings of helplessness to change

    things

    Misplaced feelings of rage and envy

    Any individual that symbolizes life or energy is subject to projected

    resentment and jealous

    This stage occurs when the patient can no longer deny death.

    The patient may blame themselves, their loved ones, or health care

    workers for their illness.

    Health care workers must understand this is not a personal attack.

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    Bargaining

    A dying person tries to make a deal with doctors or even with God

    Hope that death can be postponed or delayed

    Extended life in exchange for reformed lifestyle

    Patients turn to religion and spiritual beliefs during this period.

    They want to see their child gradate, get married, or hold a grandchild.

    Making promises to God to try and obtain more time sometimes occurs.

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    Depression

    Sadness from losses already experienced and those yet to come

    Begins to understand the certainty of death

    Disconnect oneself from things of love and affection

    This stage occurs when the patient realizes that death will come soon

    and they wont be with their families any longer.

    They realize that some goals they set will not be met.

    Health care workers need to let the patient know that depression isOK.

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    Acceptance

    The patient understands that they are going to die.

    Feelings and physical pain may be non-existent

    End of the dying struggle

    This is normally the final stage.

    May complete unfinished business and try to help those around them dealwith death.

    Patients will slowly get farther away from the world and other people.

    They need emotional support during this stage.

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    Five Principles of Palliative Care (Hospice

    care)

    Respects the goals,likes and choices ofthe dying pt.

    Looks after medical,emotional, social,and spiritual needs ofthe dying person

    Supports the needs ofthe family members

    Helps pt gain access toneeded healthcareproviders and

    appropriate settingsBuilds ways to provideexcellent end of lifecare

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    Ethical and LegalDimensions

    Managed death,

    Legalized physicianassisted suicide,

    Physicianadministered lethalinjections (aid in dying)create ethicaldilemmas.

    Patients look tonursing for

    information, advice

    and support.

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    The nurse patient relationship is key to

    helping patients grieve

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    Next Meeting

    End-of Life Care Nursing

    Palliative Care Nursing

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