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NUR 141 > 2.11 Psychological Wellbeing, Death and Dying > Flashcards

2.11 Psychological Wellbeing, Death and Dying Flashcards

1
Q

Spirituality In Nursing

A

Spirituality of the nurse

Spirituality of the patient and family

The effects of Nursing and spirituality

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2
Q

Scientific Knowledge Base

A

Mind, body and spirits are interrelated

Physical and psychological well being results from beliefs and expectations

Beliefs and convictions are powerful resources for healing

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3
Q

Current Concepts in Spiritual Health

A

see slide

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4
Q

Difference Between Religion and Spirituality

A

Religion (The Map)

Spirituality (The Journey)

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5
Q

Patients benefit from both types of care

Religious care?

A

Religious care:

helping patients maintain faithfulness to their belief system and worship practices

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6
Q

Patients benefit from both types of care

Spiritual care?

A

Spiritual care:
helping people identify meaning and purpose in life, look beyond the present, and maintain personal relations as well as a relationship with a higher being or life force

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7
Q

Cultural and Spiritual Practices

A

Countless ethno cultural religious differences

Traditions in mourning and end of life rituals

Religious traditions

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8
Q

Faith

A

Ongoing effort to make sense of our lives and purpose of being

Represents a set of beliefs developed over time

Faith struggles

Common among people who experience illness and loss

These people may feel anger, guilt, self judgement, worthlessness

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9
Q

Hope

A

Basic human need to achieve, create, shape something of our life that will endure

Rooted in purpose

A spiritual person’s faith brings hope.

People who are confronting a debilitating or terminal illness often loose hope.

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10
Q

Love

A

Willing the good of another

Many people think of love as a trade

Extend love in hopes that love will be return in some way

Relationship is a source of pain. Even when love is shared

Illness and sudden injury commonly prompt such struggles with love

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11
Q

Nursing Assessments of Spiritual Health

HOPE

A

Hope
Screening Tools and method used to assess your patient spiritual health

Identifies meaning of comfort, strength , peace, love and connection, identifies organized religion, Personal practices and effects of medical care and end of life decisions

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12
Q

Nursing Assessments of Spiritual Health

SPIRIT

A

Spirit

Spiritual assessment comprehensive method involving six key areas of focus assessment

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13
Q

Nursing Process (Assessment)

A

Assessment expresses a level of caring and support

Taking a faith history reveals patient’s beliefs about life, health, and a Supreme Being

Through the patient’s eyes

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14
Q 
Nursing Process (Assessment)
Assessment tools
A 
Assessment tools
Listening
Ask direct questions
FICA (Faith, Importance, Community, Address)
Spiritual well-being (SWB) scale
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15
Q

Nursing Process (Assessment)
Faith/Belief
Life and self-responsibility
Connectedness

A

Faith/Belief
Ask about a religious source of guidance
Understand the patient’s philosophy of life

Life and self-responsibility: ask about a patient’s understanding of illness limitations or threats and how the patient will adjust

Connectedness: ask about the patient’s ability to express a sense of relatedness to something greater than self
Life satisfaction

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16
Q 
Nursing Process (Assessment)
Culture
Fellowship and community:
Ritual and practice
Vocation
A

Culture: ask about faith and belief systems to understand culture and spirituality relationships

Fellowship and community: ask about support networks

Ritual and practice: ask about life practices used to assist in structure and support during difficult times

Vocation: ask whether illness or hospitalization has altered spiritual expression

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17
Q

Nursing Process (Planning)

A

Goals and outcomes

A spiritual care plan includes
realistic and individualized goals
with relevant outcomes.

Setting priorities

The patient identifies what is most important.
Teamwork and collaboration

In a hospital setting, the pastoral care department is a valuable resource.

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18
Q

Nursing Process (Diagnosis)

A 
Anxiety
Ineffective Coping
Complicated Grieving
Hopelessness
Powerlessness
Readiness for Enhanced Spiritual Well-Being
Spiritual Distress
Risk for Spiritual Distress
Risk for Impaired Religiosity
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19
Q

Nursing Process (Diagnosis) Grieving or Complicated Grieving

A 
Grieving or Complicated Grieving 
Ineffective denial 
Hopelessness 
powerlessness 
chronic sorrow
 spiritual distress 
self care deficit
Constipation and other physiological responses
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20
Q

Nursing Process (Implementation)

A

Health promotion
Establishing presence—involves giving attention, answering questions, having an encouraging attitude, and expressing a sense of trust; “being with” rather than “doing for”
Supportive healing relationship
Mobilize hope.
Provide interpretation of suffering that is acceptable to patient.
Help patient use resources.

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21
Q

Nursing Process (Implementation)
Acute care
Restorative

A

Acute care
Support systems
Diet therapies
Supporting rituals

Restorative and continuing care
Prayer
Meditation
Supporting grief work

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22
Q

Nursing Process (Evaluation)

A

Through the patient’s eyes
Include the patient in your evaluation of care.
Outcomes established during the planning phase serve as the standards to evaluate the patient’s progress.
Patient outcomes

23
Q

To assess, evaluate, and support a patient’s spirituality, the best action a nurse can take is to:
A. assist the patient to use faith to get well.
B. refer the patient to the health care facility chaplain.
C. provide the patient with a variety of religious literature.
D. determine the patient’s perceptions and belief system.

A

???

24
Q

Hospice care

A

Hospice- A model of care for patients and their family when faced with limited life expectancy. Based on a philosophy of death with comfort and dignity. Palliative care is the focus of Hospice care

25
Q

Palliative care

A

Palliative- Care that is given to improve quality of life when a patient is facing a life-threatening illness. The relief of physical, mental and spiritual distress for people with an incurable illness. Pain control is an essential part of palliative care.

26
Q

Physiological changes near death Sensory

A

Sensory
Hearing is usually the sense to disappear
Touch decrease in sensation with decrease perception of pain
Taste and smell will decrease with the disease progression
Blurring of vision, sinking and gazing of eyes
Blink reflex absent
Eyelids remain half open

27
Q

Physiological changes near death Gastrointestinal

A

Gastrointestinal System
Slowing of GI tract and possible cessation of function
Accumulation of gas
Abdominal distention and Nausea
Loss of Sphincter control
Bowel movement may occur before imminent death or at time of death

28
Q

Physiological changes near death Musculoskeletal

A

Musculoskeletal System
Gradual loss of the ability to move
Sagging of jaw resulting from loss of muscle tone
Difficulty speaking
Difficulty maintaining body alignment
Loss of gag reflex
Jerking or twitching from large doses of opioids

29
Q

Physiological changes near death Cardiovascular

A

Cardiovascular System
Increased heart rate: later slowing and weakening of pulse
Irregular rhythm
Decrease in blood pressure
Delayed absorption of drugs administered IM or SC

30
Q

Physiological changes near death Respiratory

A

Respiratory System
Cheyne- stokes Respiration
Inability to cough or clear respiratory secretions
Grunting, gurgling or “death rattle”
Irregular breathing, gradually slowing down to terminal gasps
Coolness and Mottling
Absence of respiration

31
Q

Physiological changes near death Integumentary

A 
Integumentary System
Mottling of hands, feet, arms and legs
Cold clammy skin
Cyanosis on nose, nail beds and knees
Waxen color (pallor)  as blood settles to dependent areas
32
Q

Physiological changes near death Urinary

A

Urinary System
Gradual decrease in urinary output
Incontinent of Urine
Unable to urinate

33
Q

Phases of Death One to three months

A 
One to three months
Withdrawal from the world and people
Decrease food intake
Increase in sleep
Going inside self 
less communication
34
Q

Phases of Death One to two weeks

A 
One to two weeks 
Disorientation
Agitation
Talking with the unseen
Confusion
Picking at clothes
35
Q

Phases of Death Days or hours

A 
Days or hours
Intensification of 1–2-week signs
Surge of energy
Decrease in blood pressure
Eye glassy, tearing, half open
Irregular breathing, stop/start
Restlessness or no activity
Purplish knees, feet hands blotchy
Pulse weak and hard to find
Decrease urine output
May be incontinent
36
Q

Phases of Death Minutes

A

Minutes
Fish out of water breathing
Cannot be awakened

37
Q

Loss

A

An actual or potential situation in which a valued object, person, body part or emotion is loss or changes and can no longer be seen. Temporary or permanent.

38
Q

Theories of Loss

A

Kubler-Ross (Stages of Coping )

Caplan (Stress and Loss)

Lindermann : (Categories and Symptoms)

39
Q

Theories of Loss

Kubler-Ross

A

?

40
Q

Theories of Loss

Caplan

A

?

41
Q

Theories of Loss

Lindermann

A

?

42
Q

Factors affecting Loss*

A

Age- individuals response to loss is influence by age

Social support ( e.g. partners of people who die with AIDS feel excluded by the deceased families

Culture and spiritual practices

Spiritual beliefs

43
Q

Grief

A

Grieving sets in when there is a loss
Takes up energy and can interfere with health and delayed healing
However, it is needed for the psychological well being during the healing process of death

44
Q

There are three stages of grief

A
  1. Shock and disbelief
  2. Developing awareness of the loss ( painful, sad, guilt shame, helplessness, emptiness)
  3. Restitution and Recovery (prolong and gradual)
45
Q

Grief

Normal Responses to grief

A

Normal Responses to grief
Dynamic
Individual moves through a series of stages towards resolving emotions.

Individualized
Each loss is different, so is the individuals response

Pervasive
Encompass all aspects of person

Normative
Will follow a set of expected steps

Adaptive grief
Healthy response that is helpful in assisting the person to accept the reality of death

46
Q

Pathologic Grief

A

Chronic Grief
When intensity does not diminish after the first year

Conflicted Grief
Unresolved issues, ambivalent feelings toward deceased

Absent Grief
Carrying on as though nothing has happened

Maladaptive or dysfunctional grief
Delayed or exaggerated, may relate to real or perceived loss
1. may occur when grief not resolved from prior experience
2. Grief may have been blocked in some way
3. Feelings and behaviors become exaggerated /disruptive to persons lifestyle

47
Q

Maladaptive or dysfunctional Grief

A 
Person cannot resume normal activities or behavior
(ADL, Work, Social Life)
Severe & Continued 
Profound distress
Increase in intensity
Continues for a long time
Psychotic, depression, suicide risk
Needs professional help
48
Q

Normal vs. Dysfunctional Grief

A 
Normal grief
Natural response to a loss. 
Expected feelings and behaviors 
Emotions intense but gradual. 
Several months to several years
Dysfunctional grief 
Difference is related to the length of time
Intensity of the emotion
Maladaptive dysfunction
Prolonged and overwhelming.
49
Q

Bereavement

A

Individual emotional response to the loss of a significant person
May occur before actual death
Unique to the individual

When you are confronted with the death of a patient or loved one, we are forced to deal with our own mortality
Anxiety may cause us to focus on your end of life

50
Q

How to communicate with grieving families

A

Perfect your listening skills
Be alert for and respond to nonverbal cues with appropriate touch and eye contact
Encourage and except expression of feelings
Reassure the person is not wrong for feelings of anger, guilt, relief other feelings that may feel unacceptable
Increase self awareness ( conscious of own attitudes regarding death)
Continue to communicate with dying patients even in coma state
Encourage family to do the same

51
Q

Care and Comfort for Family members

A

Family need to know their loved one is receiving both emotional and physical care.
Be kind and considerate of family
Order Meals, sleeping arrangements, suggest calling a friend or pastor
Allow them to participate in their love one care
Therapeutic communication
Listening more than talking. Allow them to express their feelings

52
Q

Providing Comfort to The Dying Patient*

A 
Provide clean bed linen, 
Change incontinent patient
Use draw sheet when turning the patient
Reposition the patient q 2hrs. to make sure they are comfortable
Protect bony prominences and elevate HOB if fluid accumulates in the throat
Low lighting
Gentle massage  to improve circulation
Ice chips and sips of water 
Oral care (soft brush or sponge)
Clean eyes and nose of secretions
Oxygen as prescribed for dyspnea
53
Q

Postmortem Care in the hospital

A 
Nurse document time of death 
Notifies physician on call
Call the family if not there already (give them time with the body)
Be mindful of rituals and mourning practices
Permission for autopsy or organ donation
Care of possessions
Transport to the morgue
Then document
54
Q

Care of the nurse who Grieve

A

Nurses need to take time for self reflection and emotional well-being
Nurses must analyze their own feelings and values related to loss and the expression of grief
Being a professional is knowing when to get away from the situation to care for yourself

NUR 141 (48 decks)

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