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Loss, Death, Grieving
Nursing by its nature is involved in all processes of life from birth to death. Nurses interact daily with clients and families experiencing loss and grief.
Loss
Loss of external objects Loss of known environment Loss of a significant other Loss of an aspect of self Loss of life
Concepts and Theories of the Grieving Process
Engle’s Theory (1964)– Shock and Disbelief– Developing Awareness– Reorganization and Restitution
Concepts and Theories of the Grieving Process
Kubler-Ross Stages of Dying (1969)– Denial– Anger– Bargaining– Depression– Acceptance
Hope
Hope is not a single act but a complex series of thoughts, feelings, and actions that change often. Clients and families facing terminal illness or serious loss experience different dimensions of hope.
– Generalized hope- “I hope all is well”– Particular hope- A particular outcome
Assessment of the Grieving Client
Age– Toddler– Preschooler– School-age– Young adult– Middle age– Elderly
Nature of relationship Nature of the loss Cultural and spiritual beliefs Gender roles Socioeconomic status/ social support system
Implementation
Therapeutic communication Maintenance of self-esteem Promotion of return-to-life activities
The Dying Client
When does death occur?– Traditionally
– Since the 1st transplantation
– Who can pronounce a person dead?
Coroner’s Case
Request family member consent and signature for autopsy. Several reasons for a death becoming a case for the coroner:– Death by suspicious means or not under a
doctor’s care– Death resulting from an accident– Client has been hospitalized for less than 24
hours
Death with Dignity
Dying Persons’ Bill of Rights (page Passive euthanasia California Law (1976)- “Right to Die” bill California Natural Death Act Promotion of comfort
Death with Dignity
Maintenance of independence Prevention of loneliness and isolation Promotion of spiritual comfort Support for the grieving family Hospice Care
Physical Changes Indicating Approaching Death
Temperature usually elevates to 104+ Pulse= fast, irregular, weak, difficult to find Respirations= rapid, shallow, noisy,
Cheyne-Stokes BP= decreased Peripheral circulation
Physical Changes Indicating Approaching Death
Thirst= dry mouth Sight fails Aphagia Mental alertness varies Hearing- supposed to be last sense to be
lost Relaxation of muscles
After Death
Physical Changes After Death– Pupils- Fixed and dilated– Algor Mortis- Rapid cooling of the body– Rigor Mortis- Stiffening of the body, develops
2-4 hours after death– Livor Mortis- Purple discoloration of skin in
dependent areas
Care After Death
Certification of death Time of death Notification nursing and admissions office Client’s belongings Removal of therapies Dentures Raise head of bed