Ch 25. Loss and Grief

Question 1

Kübler-Ross’s Stages of Grief

Answer 1

Behaviour-oriented

Denial: acting like nothing happened
Anger: resistance to the loss
Bargaining: postponing of reality to postpone the loss from happening
Depression: finally realizing the loss and feeling overwhelming emotion about it
Acceptance: accepts the loss

Question 2

Bowlby’s Phases of Mourning

Answer 2

Based on attachment theory (affectionate bonds between children and caregiver)
• Numbing: Protection from the full effect of loss
• Yearning and seeking: Tearful sobbing and acute distress
• Disorganization and despair: Examining loss and expressing anger
• Reorganization: Beginning to accept change, new role, or skills

Question 3

Worden’s Four Tasks of Mourning

Answer 3

Task 1: Accepting the reality of the loss
Task 2: Working through the pain of grief
Task 3: Adjusting to the environment in which the deceased is missing
Task 4: Emotionally relocating the deceased and moving on with life

Question 4

What are a dying person’s bill of rights

Answer 4

Right to control, 
to be treated with dignity, 
to not die alone, 
to express feeling about death, 
to laugh, to have questions answered honestly, 
to be comforted, 
to not be deceived, 
to have spirituality respected. 
NODA = no one dies alone program

Question 5

Assessment of Grief

Answer 5

• Type and stage of grief
• How a patient is reacting versus should be reacting
• Grief reactions
• Factors that affect grief
• End-of-life decisions (Health care proxy, Substitute decision maker, Advance care directive)
• Nurses’ experiences with grief
• Patients’ expectations

Question 6

3 Code of ethics:

Answer 6

1) promoting health/wellbeing, carrying out wishes of patient
2) promoting/respecting informed decision making
3) preserving dignity

Question 7

Support for the grieving family

Answer 7

• Provide information about care options (hospice, palliative, community, home care).
• Keep the family informed about the patient’s condition.
• Communicate news of impending death when family is together.
• Provide education regarding signs of impending death (e.g., Cheyne-Stokes respirations).
• Provide for flexible visitation schedule

Question 8

Hospice care

Answer 8

• A concept for family-centred care designed to assist the patient in being comfortable and maintaining a satisfactory lifestyle until death
• Services available in the home, hospital, stand-alone facilities, and long-term care settings
• Nurses supportive of a patient’s choice in maintaining comfort and dignity

Question 9

Care after death (post-mortem care)

Answer 9

• Be familiar with institutional policies and procedures.
• Practices may also depend on the individual’s unique experiences and preferences.
• Care for the patient’s body with dignity, with sensitivity, and in accordance with the patient’s beliefs.
• After death, the body undergoes many physical changes, so care must be provided as soon as possible.
• Documentation of End of Life Care