Death + Dying Flashcards
Something that you experience, but others can validate. (Loss of leg, loss of job, loss of person)
Actual Loss
A personal loss that can only be validated by the person who is experiencing it. (when you lose yourself, loss of financial independence, loss of personal environment–elderly)
Perceived Loss
Loss of sight, hearing, sense. May combine with Actual Loss.
Physical Loss
Emotional aspect of loss, altered self image, feeling of hopelessness/powerlessness. Mental/emotional loss (injury preventing someone from returning to work) Feeling of worthlessness.
Psychological Loss
Actual loss has not yet occured but we believe it will. (Chronic illness; death will come at some point but we don’t know when. Eventually your parents are going to die. Going in for surgery and having the possibility that you will be losing a bod part.
Anticipatory Loss
The loss of a person, thing, or quality, resulting from alteration of a life situation, including changes related to illness, body image, environment, and death.
Situational Loss
A personal, emotional reaction to a loss
Grief
Period during which mourning for a loss takes place
Bereavement
Actions and expressions of grief, including the symbols and ceremonies that make
up the outward expressions of grief
Mourning
There is no time limit on __________ .
Grieving
Occurs when a valued person, object, or situation is changed or made inaccessible
Loss
The time period of grief depends on…
- The significance of the loss
- The person’s emotional stability and maturity
- The person’s coping abilities
- Preparation of the loss
Normal Grief (2)
Abbreviated
Anticipatory
Short period of grieving; though still genuine.
Abbreviated Grief
We know that death is inevitable, we know a person is going to die in a time frame, we begin to prepare for the loss.
Anticipatory Grief
Dysfunctional grief is _________ or _________ .
Abnormal or distorted grief
Dysfunctional Grief (2)
Unresolved
Inhibited
Extends over a long period of time; years later still trying to come to terms with the loss.
Unresolved Grief
Suppressing grief, may lead to physical manifestations. (Young child dies, mother has physical ailments as milestones pass that the child would have experienced; i.e. graduation, marriage, etc.
Inhibited Grief
Spiritual response to grief
losing faith or looking toward your faith to see why things happened.
Negative ways to bereave
Neglecting own health
Drinking/drugs
Malnutrition or overeating
Positive ways to bereave
Feeling of relief
May get involved in activities
Self-reflection on deceased’s life
Examples of mourning
Funerals, wakes, ceremonies honoring person
Kubler-Ross stages of dying
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
Engel Stages of Grief 6
- Shock and disbelief
- Developing awareness
- Restitution
- Resolving the loss
- Idealization
- Outcome
Refusing to admit that they are dying, may lead to social isolation.
Denial
Why me? What did I do to deserve this? I did everything I was supposed to do, so why am I dying? Upset with God, doctors, family, themselves.
Anger
If you just let me live until next week and let me do this, I will accept my death. Just let me get through my son’s graduation.
Bargaining
Idea of death is starting to set in, individual feels defeated, begins grieving the loss of their own life.
Depression
I am going to die, and it is going to be okay. I am ready to die. There is nothing i can do, I am happy where I am.
Acceptance
Kubler-Ross stages of dying are experienced by…
Actual individual who is dying
Is it possible to previous revert back to stages of dying?
Yes, you may even skip a stage.
Numb, not showing emotions toward loss of loved one. Similar to denial.
Shock + Disbelief
Physical + emotional response. Anger, crying.
Developing Awareness
Compensating for the loss; religious, spiritual, cultural aspect (funeral services)
Restitution
Dealing with the void of loss; tying up financial aspects, sell the house; what am I going to do now that there are no Sunday dinners?
Resolving the Loss
Individual looking back on positives of life; family member reflecting on positives of deceased’s life.
Idealization
Acceptance of loss; move on and get back into day-to-day routines.
Outcome
Developmental factors affecting grief and dying in Children
- May not understand death
- Adults hide the death as a protective mechanism
- May become angry/upset
- May have increased questions, concerns about individual/object
- May affect growth physically + emotionally
Developmental factors affecting grief and dying in Adults
- Can process it better
- Death is a normal part of life
Developmental factors affecting grief and dying in Elderly
- May be scared
- May be able to reflect on life better due to having their spouse for so long
- May help them come to terms with their own death when spouse dies.
- May become hostile if they have not accomplished everything they wanted.
How do family roles change with death?
If one parent dies, the oldest child or other parent will have to step up and take on more responsibilities.
Feeling as though you have to be strong for the kids may impact your own grieving process.
How does the death of a child affect parents?
It can either tear them apart or it can bring them together. May bring a sense of isolation.
Social Interaction
- If parents die, older children may not see each other as much anymore.
- If spouse dies, relationships with spouses friends may not be the same.
- May not go certain places because it was deceased’s favorite place
Economic Loss
- Main bread winner dies, now we have to figure out how to compensate for loss of finances.
- How are we going to get health insurance now?
- College funds when parents die.
Expressions of Grief
- Different cultures express grief differently
- In some cultures, they keep grief to themselves, whereas others will outwardly express their grief.
- May have gender differences between men and women (men are stoic, women are weak)
Beliefs, Views and Rituals
- How do we tell the individual of what is to come?
- Who is the decision maker?
- Do we allow ventilator/feeding tube?
- What is the afterlife going to be like?
Faith and Religious influences on grief
- Can help to provide support as to why something happened
- Why did this happen to them, they were a good person?
- May abandon their religion, or may rely on it
- Individualized
- May request to see a chaplan or spiritual leader
Spirituality in Grief
- To what level do you connect with a religion?
- Connection with higher power
- Will help us accept what is happening/help with grieving process
Cause of Death (3)
Sudden
Accidental
Prolonged
Sudden Death
- Will be harder to go through grieving process
- Have not had time to prepare for death/void
- Reaction will depend on closeness to deceased
Accidental Death
- May feel as though it is their fault
- Feelings of guilt
- What if I had done this instead?
Prolonged Death
- Someone with Chronic Illness
- We know death is coming
- Grieving process may be easier to get through
- Family has time to prepare for death
Nursing interventions help patients/family accomplish major tasks of grieving. What are they? (4)
- Acceptance of loss
- Acknowledgment of pain of the loss
- Adapting to life after the loss
- Cultivation of new relationships + activities
Nursing interventions when caring for the bereaved
- Have contact physically & emotionally with the person
- Listen actively
- Demonstrate genuine compassion and caring
- Give permission to grieve and normalize the grieving process
- Understand that people need to talk about the events and feelings
- Focus them on using coping skills
- Encourage sources of comfort-religion or nature
Palliative care is the care of the whole person, including…
Body, mind, spirit, heart, soul
Palliative care provides aggressive ________ __ ______ .
management of symptoms
Palliative care provides care throughout the…
disease process
Palliative care provides care at the…
end of life
Dying Persons Bill of Rights
- Right to be treated as a living human being
- Right to express feelings and emotions about death in their own way
- Right to participate in all decisions concerning one’s care
- Right to be free of physical pain
- Right to Die
- Right to die in peace and dignity
- Right to expect that the sanctity of the body will be respected after death
Palliative care supports the…
needs of the family
Palliative care provides…
quality of life.
Hospice care is…
end of life care
Philosophy of Hospice Care
Die pain free + with dignity
Hospice care utilizes palliative care to…
manage symptoms
Hospice care incorporates an…
Interdisciplinary Team approach
Hospice care helps patients and families…
understand the dying process
Hospice care is ______ limited.
Time
Advanced directives
Living will, Health Care Proxy, MOLST, Durable Power of Attorney
Appointing someone to make health decisions when you cannot
Healthcare Proxy (Durable Power of Attorney)
Medical Orders for Life Sustaining Treatment
MOLST
The gradual withdrawal of mechanical ventilation from a patient who is not expected to survive without respiratory support.
Terminal Weaning
medical treatment of a dying person where the natural dying process is permitted to occur while assuring maximum comfort. It includes attention to the psychological and spiritual needs of the patient and support for both the dying patient and the patient’s family.
Comfort Measures Only
the suicide of a patient suffering from an incurable disease, effected by the taking of lethal drugs provided by a doctor for this purpose.
Assisted Suicide
Who needs a death certificate?
EVERYBODY
a postmortem examination to discover the cause of death or the extent of disease.
Autopsy
Postmortem Nursing Responsibilities–Care of the Body
- Respectully place body in normal anatomic position
- Wash the body
Nurse is legally responsible for placing tags on body before transporting to morgue
Postmortem Nursing Responsibilities–Care of the family
Bereavement care
Postmortem Nursing Responsibilities–Documentation
- Time patient as pronounced dead
- Postmortem care completed
- Time UNYTS was called, who you spoke with, and there determination
- Time the body was transported to the morgue
