2.11 Psychological Wellbeing, Death and Dying Flashcards
Spirituality In Nursing
Spirituality of the nurse
Spirituality of the patient and family
The effects of Nursing and spirituality
Scientific Knowledge Base
Mind, body and spirits are interrelated
Physical and psychological well being results from beliefs and expectations
Beliefs and convictions are powerful resources for healing
Current Concepts in Spiritual Health
see slide
Difference Between Religion and Spirituality
Religion (The Map)
Spirituality (The Journey)
Patients benefit from both types of care
Religious care?
Religious care:
helping patients maintain faithfulness to their belief system and worship practices
Patients benefit from both types of care
Spiritual care?
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
Cultural and Spiritual Practices
Countless ethno cultural religious differences
Traditions in mourning and end of life rituals
Religious traditions
Faith
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
Hope
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.
Love
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
Nursing Assessments of Spiritual Health
HOPE
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
Nursing Assessments of Spiritual Health
SPIRIT
Spirit
Spiritual assessment comprehensive method involving six key areas of focus assessment
Nursing Process (Assessment)
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
Nursing Process (Assessment) Assessment tools
Assessment tools Listening Ask direct questions FICA (Faith, Importance, Community, Address) Spiritual well-being (SWB) scale
Nursing Process (Assessment)
Faith/Belief
Life and self-responsibility
Connectedness
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
Nursing Process (Assessment) Culture Fellowship and community: Ritual and practice Vocation
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
Nursing Process (Planning)
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.
Nursing Process (Diagnosis)
Anxiety Ineffective Coping Complicated Grieving Hopelessness Powerlessness Readiness for Enhanced Spiritual Well-Being Spiritual Distress Risk for Spiritual Distress Risk for Impaired Religiosity
Nursing Process (Diagnosis) Grieving or Complicated Grieving
Grieving or Complicated Grieving Ineffective denial Hopelessness powerlessness chronic sorrow spiritual distress self care deficit Constipation and other physiological responses
Nursing Process (Implementation)
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.
Nursing Process (Implementation)
Acute care
Restorative
Acute care
Support systems
Diet therapies
Supporting rituals
Restorative and continuing care
Prayer
Meditation
Supporting grief work
Nursing Process (Evaluation)
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
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.
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Hospice care
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
Palliative care
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.
Physiological changes near death Sensory
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
Physiological changes near death Gastrointestinal
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
Physiological changes near death Musculoskeletal
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
Physiological changes near death Cardiovascular
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
Physiological changes near death Respiratory
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
Physiological changes near death Integumentary
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
Physiological changes near death Urinary
Urinary System
Gradual decrease in urinary output
Incontinent of Urine
Unable to urinate
Phases of Death One to three months
One to three months Withdrawal from the world and people Decrease food intake Increase in sleep Going inside self less communication
Phases of Death One to two weeks
One to two weeks Disorientation Agitation Talking with the unseen Confusion Picking at clothes
Phases of Death Days or hours
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
Phases of Death Minutes
Minutes
Fish out of water breathing
Cannot be awakened
Loss
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.
Theories of Loss
Kubler-Ross (Stages of Coping )
Caplan (Stress and Loss)
Lindermann : (Categories and Symptoms)
Theories of Loss
Kubler-Ross
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Theories of Loss
Caplan
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Theories of Loss
Lindermann
?
Factors affecting Loss*
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
Grief
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
There are three stages of grief
- Shock and disbelief
- Developing awareness of the loss ( painful, sad, guilt shame, helplessness, emptiness)
- Restitution and Recovery (prolong and gradual)
Grief
Normal Responses to grief
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
Pathologic Grief
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
Maladaptive or dysfunctional Grief
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
Normal vs. Dysfunctional Grief
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.
Bereavement
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
How to communicate with grieving families
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
Care and Comfort for Family members
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
Providing Comfort to The Dying Patient*
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
Postmortem Care in the hospital
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
Care of the nurse who Grieve
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
