Chapter 43 Loss, Grieving, and Death Flashcards
What are the two types of loss?
Actual and perceived loss
Actual loss
Can be recognized by others
Perceived loss
Is experienced by one person but cannot be verified by others.
Anticipatory Loss
Is experienced before the actual loss occurs.
Example: A woman whose husband is dying may experience actual loss in anticipation of his death.
The loss of an aspect of self changes a persons body image even though the loss?
May not be obvious
Examples of Aspect of self:
Loss of part of the stomach or loss of ability to feel emotion may not be as obvious.
Loss of external objects includes:
- Loss of intimate objects that have importance to the person, such as the loss of money or the burning down of a families house.
- Loss of animate (live) objects such as pets that provide love and companionship.
What is grief? What is grief manifested in?
The total response to the emotional experience related to loss. It is manifested in thoughts, feelings, and behaviors associated with overwhelming distress or sorrow.
What is bereavement?
Is the subjective response experience by the surviving loved ones.
What is mourning? What is it influenced by?
The behavioral process through which grief is eventually resolved or altered; it is often influenced by culture, spiritual beliefs, and custom.
What kind of grief is experienced in advance of the event such as the wife who grieves before her husband dies?
Anticipatory grief
What kind of grief is unhealthy and exists when the strategies to cope with the loss are maladaptive?
Complicated grief
What are the behavioral responses and nursing implications for the stage of denial? (Kubler-Ross’s)
Behavioral Responses: Refuses to believe that loss is happening. Is unready to deal with practical problems, such as prosthesis after the loss of a leg. May assume the artificial cheerfulness to prolong denial.
Nursing implications: Verbally support client but do not reinforce denial. Examine your own behavior to ensure that you do not share in clients denial.
What are the behavioral responses and nursing implications for the stage of Anger? (Kubler-Ross’s)
Behavioral Responses: Client or family may direct anger at nurse or staff about matters that normally would not bother them.
Nursing Implications: Help client understand that anger is a normal response to feelings of loss and powerlessness. Avoid withdrawal or retaliation; do not take anger personally. Deal with needs underlying any anger reaction. Provide structure and continuity to promote feelings of security. Allow clients as much control as possible over their lives.
What are the behavioral responses and nursing implications for the stage of Bargaining? (Kubler-Ross’s)
Behavioral Responses: Seeks to bargain to avoid loss (Ex. let me just live until __ and then I will be ready to die)
Nursing Implications: Listen attentively, and encourage client to talk to relieve guilt and irrational fear. If appropriate, offer spiritual support.
What are the behavioral responses and nursing implications for the stage of Depression? (Kubler-Ross’s)
Behavioral Responses: Grieves over what has happened and what cannot be. May talk freely (Ex. reviewing past losses such as money or job), or may withdraw.
Nursing Implications: Allow client to express sadness. Communicate nonverbally by sitting quietly without expecting conversation. Convey caring by touch.
What are the behavioral responses and nursing implications for the stage of Acceptance? (Kubler-Ross’s)
Behavioral Responses: Comes to terms with loss. May have decreased interest in surroundings and support people. May wish to begin making plans (Ex. Will, prosthesis, altered living arrangements.).
Nursing Implications: Help family and friends understand clients decreased need to socialize. Encourage client to participate as much as possible in the treatment program.
Loss of a job, or death of a child are examples of?
Situational Loss
Departure of children from home, retirement, health and physical vitality are examples of what kind of loss?
Developmental Loss
What if abbreviated grief?
Brief but genuinely felt
List 8 Factors affecting Grief Response?
Age, significance of the loss, culture, spiritual beliefs, gender, socioeconomic status, support systems, and cause of death
What age group experiences the same emotions of grief as adults. Often pushed aside and protected; can lead to feelings of fear and abandonment.
Children
What age group expects to lose a parent?
Middle aged adults
What age group experiences many losses. Health problems of widows/widowers often increase following the death of a spouse
Late adulthood
What age group may no longer have living peers, nurse may need to provide that support.
Older adult
Diagnosis of grieving include:
Grieving, fear, hopelessness, and powerlessness
What are 4 guidelines for physicians as indicators of death:
Total lack of response to external stimuli, no muscular movement especially breathing, no refluxes*, and flat encephalogram (brain waves)
3 death related religious and cultural practices
Autopsy, organ donations ( Buddhists encourage it, Jehovah don’t believe in it), and cremation (no for Catholics, Hindus prefer it and cast ashes in a holy river)
Hospice Care
Care focuses on support care of the dying.
Palliative Care
Is specialized medical care for people with serious illnesses. It focuses on providing patients with relief from the symptoms and stress of a serious illness. The goal is to improve quality of life for both the patient and the family.
End of life Care
Care provided in the final weeks of death.
