Chpater 15 Death and Dying Flashcards
What types of losses commonly occur in our lives?
Losses occur whenever there is change or growth. Some examples include developmental changes, moving, marriage, divorce, surgery, death of significant others, job loss, and retirement. Losses are actual, perceived, physical, and psychological.
What are the main tasks of the grieving process?
According to Worden, there are four stages of the grieving process:
● Acknowledging the loss
● Feeling the emotions and pain
● Adjusting to the environment without the loved one
● Investing emotional energy into something or someone else
What factors affect the grieving process?
The meaning of the loss is the most significant factor indicating the way a person will grieve. Some other factors include the following:
● Number of previous losses ● Person’s coping mechanisms ● Circumstances of the loss ● Developmental stage of the grieving person ● Person’s spiritual/cultural supports
What are advance directives?
Advance directives are a group of instructions (oral or written) stating what a person would want or not want relative to his health care in the event that he is incapacitated or unable to make that decision.
What is the ANA position on assisted suicide?
The ANA position is that the nurse should not participate in assisted suicide because such an act is a violation of the Code for Nurses and the ethical traditions of the profession.
What assessments should you make for your terminally ill patient and her family?
When a patient is dying or has experienced a loss, you must carefully assess the patient and significant others for common grief reactions. Other important areas to assess include knowledge base, history of loss, coping patterns and abilities, meaning of the loss/illness, support systems, cultural and spiritual needs, and physical status.
List three nursing diagnosis labels you might consider when dying or grieving is the primary problem.
Any of the following labels would be appropriate answers:
● Grieving ● Complicated Grieving ● Ineffective Denial ● Hopelessness ● Powerlessness ● Caregiver Role Strain ● Chronic Sorrow ● Spiritual Distress
List three nursing diagnoses labels that might occur as a result of dying or grieving.
Any of the following labels would be appropriate answers:
● Acute or Chronic Low Self-Esteem ● Anxiety ● Altered Comfort (not a NANDA diagnosis) ● Death Anxiety (or Fear) ● Decisional Conflict ● Deficient Knowledge ● Disturbed Sensory Perception ● Fatigue ● Imbalanced Nutrition: Less Than Body Requirements ● Spiritual Distress ● Self-Care Deficit
Describe four ways to facilitate the grief work of a grieving or dying person.
Any four of the following ways are appropriate answers for facilitating grief work of patients:
- Help grieving and dying persons express feelings by:
● Encouraging questions and responding to them within a reasonable time.
● Sitting by the head of the bed and not appearing rushed.
● When you observe the patient or family member expressing feelings either verbally or nonverbally, encouraging them to continue.
● Expecting and accepting a wide range of feelings, including anger, fear, and loneliness.
● Asking, “How can I help?” “What do you need?” “What would you like for me to do?”
● Making sure that everyone on the healthcare team understands and follows the care plan.
● Asking yourself what you would do if this were your family member.
● Not comparing another person’s loss to your own experience (e.g., avoid comments such as “I know how you feel.” Instead, try “Tell me how you feel.”). - Assist them in recalling memories. For example, by going through photo albums with them and asking questions about the people in the pictures. Also look for objects of sentiment (e.g., a family heirloom) in the environment and have the dying or bereaved person share their significance.
- Assist them finding meaning in their lives or their past by helping them talk about it. Facilitating life review is one technique to help the patient and family recognize the unique contributions this person has made to family, friends, and society. You can begin by asking about the various aspects of the patient’s life, commenting on pictures in the room, or picking up on verbal cues that are expressed.
- Suggest bibliotherapy and counseling.
- Provide grief education. Explain the stages of grief and point out that it takes months or even years to resolve. Explain that grief may become more intense on the anniversary of the death (or other loss) and on significant dates (e.g., birthdays). After the death of a loved one, family members may need support for several months. Direct them to educational resources on Web sites, in printed material, and at community forums (e.g., many churches and hospices have groups that meet regularly). Become informed about counseling services and support groups in your community, and refer families to them as needed.
- Help them to normalize their grief. Recall that once the bereaved person accepts that the loss is real, their feelings may be so intense that they may wonder if they are losing their sanity. The grieving person may be fatigued from not sleeping, may be disoriented or unable to concentrate, and may be concerned about what such symptoms mean. Reassure the person that such responses are expected and that there is no single “right” way to grieve (Egan, 2003). Also assure them that although the grief process takes time, their symptoms won’t last forever.
- Increase your self-awareness: your attitudes and feelings regarding death and dying
List two specific interventions for helping grieving families.
In addition to interventions for facilitating grief work (preceding), any two of the following interventions are appropriate answers:
● Encourage family members to help care for the patient, if they are able. This helps meet their need to be useful, as well as promoting family ties and making the patient more comfortable. If they are not physically or emotionally able to provide care, accept that. For family members who are able to help with care, provide instruction and supervision.
● Encourage family members to ask questions, listen actively to client and family concerns, and help them problem solve when needed.
● Follow up with other healthcare team members promptly when the family has questions that are outside your scope of practice.
● Encourage the family to visit the hospital chapel and talk with a chaplain or to speak with their own spiritual adviser.
● Provide anticipatory guidance to the family regarding the stages of loss and grief, so that they will know what to expect after their loved one dies.
● Acknowledge feeling of the family and the loss they are experiencing. (Many times family members begin the grieving process before the loved one dies.)
● Help the family members to explore past coping mechanisms and reinforce successful past coping mechanisms.
● Remind family members and significant others to take care of themselves. Many times they need “permission” to go eat or to go home and rest. If the patient is near death and family and friends do not want to leave the patient’s side, make them as comfortable as possible. Provide comfortable chairs, coffee, and snacks (according to organizational policy), and be alert for other needs they may have. Watching a loved one die is a very difficult experience. A sensitive, caring nurse can make it a little easier.
● Teach the family what to expect with regard to medications, treatments, and signs of approaching death. If family members know what is normal, they will be less likely to panic or fear the inevitable. As physical signs of death become apparent, keep the family informed. You may say something like, “Her blood pressure is becoming difficult to hear. That is one of the signs that she is closer to death.”
● Reassure families of patients who become withdrawn near the time of death that this does not mean the patient is rejecting them, but only that his body is conserving energy and that he has come to terms with dying.
● When approaching death is apparent, ask family members directly, “Do you want to be present while he is dying?” Tell them what to expect, if they do not know.
● At the moment of death, do not interrupt or intrude upon the family. Wait quietly and observe. Give them as much time as they need. When they move away from the body or have said last goodbyes, then it is time to assess and report the lack of vital signs. Be accepting of their behavior at this time, no matter how strange it may seem to you. A family might want to take a picture, or the spouse may lie down beside the deceased person.
How have the common causes of death changed over the past several decades?
Reasons and reactions to death vary from culture to culture. Diet and economic standing remain huge in a culture’s overall health. Each culture treats death and dying differently
What are the 3 physiological phases of death, and how do they differ?
Agonal Death-Gasps, muscle spasms
Clinical Death-Heart circulation, breathing, brain function cease, resuscitation is still possible
Morality-Permanent death
What are the Kubler-Ross stages of dying?
Terminally ill patients experience five stages of dying:
- denial
- anger
- bargaining
- depression
- acceptance
What characterizes each stage of death?
Denial-
not accepting death
Anger-
Anger about dying
Bargaining-
Making pleas/praying for more time
Depression-
Being unequivocally sad about the fact of death.
Acceptance-
Accepting their fate and deathWhat are some critiques to Kubler-Ross’ model?
Not every terminally ill person wants to discuss it, cultures and families vary in beliefs of discussing it, not everyone passes through distinctive stages
What factors tend to predict whether people have high anxiety about death?
Minimize physical distress, maximize psychological security (no fear), enhance personal relationships, foster spirituality, feel you have fulfilled life’s purpose and properly said goodbye
What are some of the common psychological experiences survivors experience?
If the person was in pain-relief.
If it was unexpected-grief
If the process was longer-should have done more to save them
What is grief?
An intense psychological response that accompanies bereavement.
What is bereavement?
The experience of losing a loved one. It is characterized by feeling the loss, sorrow, and grief.
How do grief and bereavement differ?
Grief is the response/reaction to loss. Bereavement refers to the state of the loss.
What types of death generally cause the highest levels of grief?
Pathway 1- Death occurs suddenly
Pathway 2- Death occurs after steady decline
Pathway 3- Dying is a long and erratic process
Pathway 4- proves to cause the highest levels of grief
What are some things that help families cope with the death of a child (textbook only)?
If parents discus death with their child, if they feel they were able to say goodbye, continuation of bonds, and continue to care/love the child
What are the 5 factors children must master before fully understanding death?
Reduce fear and anxiety, it’s okay to feel sad, be honest, explain its a thing that happens, provide comfort (can be based on ideologic beliefs)
What is the best way to explain death to young children?
Be honest, don’t say “they went to sleep,” answer their questions, tell them personal family views may differ, comfort in a healthy manner
Generally, what are some ways that grieving practices vary across cultures?
Dia de los Muertos, wearing black to mourn, not speaking the name of the deceased, other burial practices
What are the 3 different models of caring for the dying?
Hospitals, Palliative Care, and Hospice Care:
- Hospitals
- Palliative Care
- Hospice Care
What are some pros/cons of each way to care for death?
Hospitals:
Life prolonging goals, legally hard to allow death w/o advanced directives
Palliative Care:
Ease pain and easier transition, sometimes in the hospital and not at homes
Hospice Care:
At home more comfortable, stressful for family
How frequent is each type of caring for death across cultures?
Home care is most common, followed by Hospice for WEIRD cultures
What is an Advance Directive?
Any written document spelling out instructions with regard to life-prolonging treatment if individuals become irretrievably ill and cannot communicate their wishes
What are the different types of documents/legal factors associated with advance directives?
Living Wills, DNRs, and and DNH
In a hospital or nursing home, who is designated as the person(s) responsible for pronouncing the death?
A physician is usually designed as the person responsible for pronouncing the death. However in some institutions midlevel providers, such as physician assistants and nurse practitioners, may perform this function.
How does an advance directive differ from durable power of attorney for health care?
Advanced directive spells out “patients wishes” for healthcare at that time when they may be unable to indicate their choice.
Durable Power of Attorney for healthcare is a legal document that appoints a “person” (healthcare proxy) chosen by the patient to carry out his wishes as expressed in an advanced directive.
Why must you be aware of remarks you make to an unresponsive patient?
Because they do hear! Hearing and touch is believed to be one of the last senses to be lost before death.
What are the physical signs of impending death?
Physical weakness, more time sleeping, body functions slow, appetite decreases. Urine output decreases and becomes more concentrated. There may be edema of the extremities or over the sacrum. Incontinence may occur.
Physical weakness, more time sleeping, body functions slow, appetite decreases. Urine output decreases and becomes more concentrated. There may be edema of the extremities or over the sacrum. Incontinence may occur.
What are the physical signs of impending death?
Physical weakness, more time sleeping, body functions slow, appetite decreases. Urine output decreases and becomes more concentrated. There may be edema of the extremities or over the sacrum. Incontinence may occur.
How should the dying patient be treated for dehydration?
As death nears, patients take in fewer and fewer fluids. Research has shown that dehydration results in less distress and pain and that hydration does not improve comfort. Dehydration can be alleviated by small sips of fluid, ice chips and lip lubrication.
Describe the forms and changes of hope as a person declines.
At first, there is hope for a cure. Then, a hope that treatment will be possible. Next, hope for a prolonged life. Finally, hope for a peaceful death.
According to Dr. Elisabeth Kubler-Ross, what are the five stages that a dying person experiences?
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
