Loss, Grief, and Dying Flashcards
Loss
occurs when a values persoon, object, or situation is changed or becomes inaccessible such as its is diminished or removed
Actual Loss
can be recognized by others as well as the person sustaining the loss
Perceived Loss
is experienced by the person but intangible to others
Anticipatory Loss
occurs when a person displays loss and grief for a loss that has not taken place
Grief
internal emotional reaction to loss
Mourning
outward actions and expressions of grief
(funerals, celebrations of life, writing poem)
Bereavement
state of grieving from loss of a loved one
Dysfunctional grief
abnormal/distorted
- can be either unresolved/inhibited
“Good death”
allows a person to die on their own terms, relatively free of pain, and with dignity
Terminal Illness
illness in which death is expected within a limited period of time
Advanced care planning
planning for future care in the event a person becomes unable to make their own decisions.
Advance directives
legal written documents that allow individuals to state their choices for health care in the future, should they become unable to make those decisions themselves
- Living Will
- Durable Power of Attorney
Physician Order for Life-Sustaining Treatment (POLST) form
medical order indicating a pt’s wishes regarding tx
- commonly used in a medical crisis
Do Not Ressucitate (DNR)
No attempt should be made to resuscitate patient who breathing or heart stops
Comfort measures only
Goal of treatment is a comfortable, dignified death and that further life-sustaining measures are no longer indicated
Terminal Weaning
gradual withdrawal of mechanical ventilation from a patient with a terminal illness with a poor prognosis
Active Euthanasia
taking specific steps to cause a patient’s death
Passive Euthanasia
withdrawing medical treatment with the intention of causing the patient’s death
What are (7) types of losses?
- Actual loss
- Perceived loss
- Physical loss v. psychological loss
- Maturational loss
- Anticipatory loss
- Situational loss
Define actual loss. Provide examples of it.
- can be recognized by others
-> Loss of a limb
-> Loss of child
Define perceived loss. Provide examples of it
- is felt by person but intangible to others
-> Loss of youth
-> Loss of financial independence
Describe physical & psychological loss. Provide examples of it
Both are directly related to actual/perceived loss
- Person who loses an arm in an accident suffers a physical AND psychological loss (bc altered self-image and inability to return to occupation)
- Someone who is scarred, but does not lost a limb by experiences a perceived AND psychological loss
Define maturational loss. Provide examples of it
- experienced during the life cycle
-> First child experiencing loss of status when sibling is born
-> Parent of a single child feels a sense of loss when the child starts school
Define anticipatory loss. Provide examples of it
- loss has not yet taken place
-> Families of patients who have serious/life threatening illness
Define situational loss. Provide examples of it
- experienced as a result of an unpredictable event
-> Natural disaster
-> Disease
-> Death
What are some physical characterisitcs of grief?
- Crying
- Headache
- Difficulty sleeping
What are some emotional characteristics of grief?
- Feelings of sadness/yearning
What are some social cahracteristics of grief?
- Isolate oneself from social contact
What are some spiritual characteristics of grief?
- questioning reason for loss
What is mourning grief? What might it include?
- outward actions and expressions of grief
-> Include symbols/ceremonies: funerals, celebration of life
What is dysfunctional grief? What are the (2) types of grief within dysfunctional grief?
- abnormal/distorted and can either be unresolved or inhibited
-> Unresolved grief
-> Inhibited grief
Dysfunctional Grief
Unresolved Grief
person may have trouble expressing feelings of loss/may deny them; bereavement may extend over lengthy period
Dysfunctional Grief
Inhibited Grief
persons suppresses feelings of grief; may manifest somatic sxs (abdominal pain; heart palpitations)
What are the (5) stages of grief in regard to Kubler-Ross? Describe each stage.
Denial and isolation
- Deny reality of death -> readdress discussions about it
Anger
- Expresses rage & hostility
-> “Why me?” attitude
Bargaining
- Barter for more time (goals they wish to reach before dying)
-> Meeting wishes → help move to later stages
Depression
- Crying and reduced communication
Acceptance
- State of tranquility -> Accepted reality of death
What are the (6) stages of grief in regard to Engel? Describe each stage.
Shock and disbelief
- Refusal to accept the fact of loss
- Stunned/numb response; “no, not me”
Developing awareness
- Physical and emotional response to loss
- Anger, feeling empty; “why me?”
Restitution
- Rituals surrounding the loss
-> expressions of mourning (funeral)
Resolving the loss
- Dealing with the void left by loss
Idealization
- Exaggerate good qualities of person/object lost
-> acceptance of loss & reduced focus to it
Outcome
- Dealing with loss becomes a common occurrence and integrates experience into ones life
Developmental Considerations
How does the death of a parent affect children?
can slow down a child’s development/ cause developmental regression
Developmental Considerations
How does death affect terminally ill children?
talk about and question death to try to understand it
Developmental Considerations
Terminally ill children require ____ ____, ____ and ______ __________ with other children
parental love; support; social interraction
Developmental Considerations
How does the death of a parent affect middle aged adults?
- Helps prepare for loss of spouse or significant other
- Helps accept their own eventual death
Developmental Considerations
How does death affect older adults?
- Reminisce about life
- Put their life and purpose of living in perspective
- Prepare themselves for their inevitable death
Family
How does death/grieving affect the eldest sibling?
feel the need to be “strong” & not grieve openly
Family
How does death/grieving affect someone who lost their spouse?
feel the need to be “strong” & not grieve openly to “protect the children”
Family
How does death/grieving affect the parents of a terminally ill child? Siblings of the child
Parents of terminally ill child
- feeling of guilt as if they were responsible for their death
Siblings:
- suppress feeling of guilt for wishing death of terminally ill sibling
Socioeconomic Factors
How does grief/dying impact socioeconomic factors?
Loss of loved one → economic loss → loss of home, community, and support system
Cultural
How does grief/dying differ in culture?
- Western Culture: grief is a private matter shared only with family.
- Some cultures necessitate public display of emotional distress, loud weeping and moaning
Gender
How does gried/dying affect men? women?
Men:
- expected to be stoic and not cry in public (may internalize feelings)
- Expected to be emotionally supportive
Women:
- judged as “cold” if they do not grieve publically
- Expected to be weak and need support
why would a widow without a job be more emotionally distraught compared to a widow with a job?
the widow without a job was finacially dependent on their spouse
How does religious influences affect grief/dying?
- find comfort and solace in their religion
- blame god for their suffering, death of a loved one, and turn away from god
How is the following type of death perceived as?
Death caused by AIDS diagnosed in homosexuals and drug users
death was punishment
What would be the grief reponse for the following scenario?
when people were reminded of the devestation caused by Covid-19
Terror and panic
How is the following type of death perceived as?
family and/or friends believe they could have prevented the death
guilt
How is the following type of death perceived as?
death while defending the country
honorable
accidental deaths are percieved as ____ luck
bad
Describe the following type of care:
Palliative Care
(Definition, Goal, Timing)
Definition:
- Take care of the whole person, mind, body, spirit, heart, and soul
Goal:
- give patients with life-threatening illnesses the best quality of life they can have by the aggressive management of symptoms
Timing:
- Happens at any stage of disease and illness
Describe the following type of care:
Hospice Care
(Definition, Goal, Timing)
Definition:
- provided for patients with limited life expectancy, usually in the home
Goal:
- focuses on the needs of the dying
Timing:
- Typically <6 month life expectancy
What are some indication that a patient might need to be placed on hospice care?
- Poor performance status
- Declining cognitive status
- Advanced age
- Poor nutritional intake
- Pressure injuries
- Comorbidities
- Previous hospital admissions for acute decompensation
Categorize the following manifestations of approaching death into Physical and Emotional categories:
- Decreased blood pressure
- Fluid and food decrease
- Agitated delirium
- Incontinence or constipation
- Loss of movement, sensation, and reflexes
- Restlessness or agitation
- Nausea, flatus, and abdominal distention
- Depression
- Noisy, irregular, or Cheyne-Stokes respirations
- Coolness or clammy skin
- Weak, slow, or irregular pulse
- Sleeping
- Disorientation
- Congestion
- Difficulty talking or swallowing
- Decreased level of consciousness
Physical Manifestations:
- Difficulty talking or swallowing
- Nausea, Flatus and Abdominal distention
- Incontinence or Constipation
- Loss of movement sensation, and reflexes
- Coolness or clammy skin
- Weak, slow, or irregular pulse
- Decrease blood pressure
- Noisy, irregular or cheyne-stokes respirations
- Sleeping
- Congestion
- Fluid and Food Decrease
Emotional Maniestations
- Deceases level of consciousness
- Agitated delirium
- Depression
- Disorientation
- Restlessness or agitation
Uniform Definition of Death Act
An individual who has sustained either:
- (1) irreversible cessation of all functions of circulatory and respiratory functions
- (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead.
What is the medical criteria used to certify a death?
- cessation of breathing
- no response to deep painful stimuli
- lack of reflexes (such as the gag or corneal reflex) and spontaneous movement.
What are (3) types of Advanced Directives? Describe each one
Living Will
- provides specific instructions about the kinds of healthcare that should be provided in particular situations
Durable Power of Attorney for healthcare
- Appoints an agent the person trusts to make decisions in the event of incapacity
Combination Directive
- combination of a living will and a power of attorney for healthcare
What (5) thngs does advance directives help decide?
- who will make decisions for the patient in case he or she is unable.
- what the patient wants loved ones to know.
- what kind of medical treatment the patient wants or doesn’t want.
- how comfortable the patient wants to be.
- how the patient will be treated by others.
T/F: a POLST form can be filled out by the patiet
False, it must be completed and signed by a healthcare professional and cannot be filled out by a patient
Describe the following medical order:
Do Not Resusictate
(Meaning, Purpose, Nurse’s Role, Misc)
Meaning:
- No attempt should be made to resuscitate patient who breathing or heart stops
Purpose:
- Prevent improper use of CPR & allow natural death
Nurse’s Role:
- Respect pt’s decision
- Clarify pt’s code status
Misc:
- AKA: No Code, Allow Natural Death (AND)
Describe the following medical order:
Slow Code
(Meaning, Purpose, Misc)
Meaning:
- Calling a code and resuscitating the pt are to be delayed until measures will be ineffective
Purpose:
- provider believes pt will not benefit from resuscitation measures
Nurse’s Role:
- X
Misc:
- charged with negligence in the event of a Slow Code resulting patient death
Describe the following medical order:
Comfort Measures Only
(Meaning, Purpose, Nurse’s Role)
Meaning:
- Goal of treatment is a comfortable, dignified death
Purpose:
- focus care on relieving symptoms and ensuring comfort when prolonging life is deemed no longer beneficial by patient
Nurse’s Role:
- focus the health care team’s attention on meeting the needs of dying pt and their families
Misc:
- X
Describe the following medical order:
Do Not Hospitalize
(Meaning, Purpose)
Meaning:
- used for patients in long-term care or residential settings who do not want to be hospitalized
Purpose:
- honor the patient’s wishes to remain in their current setting and avoid burdens of hospitalization
Nurse’s Role:
- X
Misc:
- X
Describe the following medical order:
Terminal Weaning
(Meaning, Purpose, Nurse Role)
Meaning:
- gradual withdrawal of mechanical ventilation from a patient with a terminal illness with a poor prognosis
Purpose:
- allow a patient to die more comfortably when continued ventilatory support is considered futile
Nurse’s Role:
- Offer helpful information about pros & cons of cont. ventaliation
- Expectation of terminal weaning
- Support family decision
- Monitor SXS
- Administer meds to manage SXS
Misc:
- X
Describe the following medical order:
Volutary Stopping of Eating and Drinking (VSED)
(Meaning, Purpose, Nurse’s Role)
Meaning:
- Seriously ill, competent pt chooses to refuse food and liquid with the intention of hastening dying.
Purpose:
- Speed up the dying process
Nurse’s Role:
- ensure that it is an informed and voluntary decision by the pt
Misc:
- X
Describe the following medical order:
Active Euthanasia
(Meaning, Purpose, Nurse’s Role, Misc)
Meaning:
- taking specific steps to cause a patient’s death
Purpose:
- relieve intractable suffering and allow a person to die according to their wishes
Nurse’s Role:
- Obligation to prevent suicide
Misc:
- Deemed immoral & illegal
Describe the following medical order:
Passive Euthanasia
(Meaning, Purpose, Nurse’s Role, Misc)
Meaning:
- withdrawing medical treatment with the intention of causing the patient’s death
Purpose:
- allow the disease to progress naturally to death
Nurse’s Role:
- providing information and support patient or decision makers
Misc:
- Morally and legally justified
According to the ANA code of ethics, nurses “should provide interventions to ____ pain and other symptoms in the dying patient consistent with palliative care practice standards and may not act with the __ ____ to end life”
relieve, sole intent
morticians ____ responsibility for handling and ________ death certificate with proper authorities
assumes; filing
What is the nurses role in regards to the death certificate?
responsible to ensure that the death certificate is signed
(must be signed by clinitian; some cases the pathologist/coroner)
What functional organs are donated if a pt is an organ donor?
K CHLL
Kidney
Heart
Cornea
Liver
Lungs
Who decides if a pt becomes an organ donor?
- pt can fill out organ donor consent card
- family of deceased pt can decide to donate pts organs
Some religions ____ washing the body
forbid
In som ecultures, washing the body is a final act of service. What can the nurse do to facilitate the family’s wished?
Give family supplies and privacy with body
What are the nurses role in postmorem care of the body?
(Hint: 5 things)
- Prepare the body for discharge
- Place the body in anatomical position
- Replace dressings, and remove tubes (unless there is an autopsy scheduled)
- Place identification tags on the body
- Follow local law if patient died of communicable disease
Why is the body placed in anatomical position?
to avoid blood pooling
Being a nurse is an intense and emotionally draining job. Select all the feelings that a nurse may experience after the loss of a patinet?
- Anxiety
- Exuberance
- Helplessness
- Anger
- Contentment
- Depression
- Sadness
- Burnout
- Serenity
- Powerfulness
- Frustration
- Euphoria
- Powerlessness
- Anxiety
- Helplessness
- Anger
- Depression
- Sadness
- Burnout
- Frustration
- Powerlessness
Why should nurses take a “pause” after their patient dies?
To take a break after someone dies to silently reflect and honor their life
T/F: Unrelieved stress allows nurses to have a ton of time to grieve.
False, unrelieved stress makes it difficult for nurses to have time to grieve, since work pressures can make it difficult to create time and space to response to a patients death
A nurse is providing end-of-life care to a family after the sudden death of a patient. Which of the following actions are appropriate to support the grieving family? (Select all that apply.)
- Listen attentively to the family’s expressions of grief, loss, and helplessness.
- Encourage the family to suppress their emotions to maintain composure.
- Arrange for family members to view the body in a private and calm setting.
- Immediately remove the body from the room to reduce the family’s distress.
- Offer solace and support by actively listening to family members’ feelings.
- Avoid attending the funeral to maintain professional boundaries.
- Provide a private place for the family to begin grieving after a sudden death.
- Consider attending the funeral and making a follow-up visit to the family if appropriate.
- Limit contact with the family after the patient’s death to avoid emotional involvement.
- Reassure the family that feeling anger, sadness, and helplessness is normal during grief.
1, 3, 5, 7, 8, 10
A nurse is providing support to a patient’s family following the loss of a loved one. Which of the following interventions demonstrate effective facilitation of mourning? (Select all that apply.)
- Encourage the family to express their feelings and emotions openly.
- Discourage the establishment of new relationships to honor the deceased.
- Interpret signs of guilt, anger, or sadness as normal components of the grieving process.
- Advise the family to move on quickly to minimize emotional pain.
- Be vigilant for signs of ineffective coping, such as denial or prolonged depression.
- Allow the family time to grieve at their own pace without rushing the process.
- Inform the family that feeling detached from others is a normal and permanent response to grief.
- Assist the family in accepting that the loss is real and irreversible.
- Redirect conversations away from the deceased to avoid triggering sadness.
- Encourage the family to focus entirely on positive memories to prevent negative emotions.
1, 3, 5, 6, 8
A nurse is using therapeutic communication techniques to support a grieving patient and their family. Which of the following actions demonstrate appropriate therapeutic communication? (Select all that apply.)
- Establishing a caring presence by sitting at eye level and maintaining gentle eye contact.
- Determining the significance of the loss by asking open-ended questions about the relationship with the deceased.
- Offering personal opinions about how the family should cope with their loss.
- Using active listening techniques to help the patient verbalize their thoughts and feelings.
- Correcting the family’s emotional responses to prevent negative thought patterns.
- Being a nonjudgmental listener who provides space for open expression of emotions.
- Gaining the family’s trust by demonstrating a respectful and reassuring attitude.
- Minimizing the patient’s expressions of grief to maintain a calm environment.
- Using empathetic statements, such as “I am here for you,” to convey support and presence.
- Analyzing the family’s coping strategies and suggesting more practical alternatives.
1, 2, 4, 6, 7, 9
A nurse is working to develop a trusting nurse-patient relationship while caring for a terminally ill patient and their family. Which of the following nursing actions demonstrate trust-building and therapeutic communication? (Select all that apply.)
- Clearly explaining the patient’s condition and the purpose of each treatment.
- Providing vague information to protect the patient from distress.
- Encouraging the patient to practice self-care when possible to enhance self-esteem.
- Involving family members in care by teaching them appropriate techniques to assist.
- Avoiding discussions about prognosis to maintain hope.
- Meeting the patient’s physical and emotional needs with compassion and dignity.
- Ensuring family members’ needs are acknowledged and addressed.
- Discouraging family involvement to maintain professional boundaries.
- Utilizing medical jargon when discussing the patient’s condition to demonstrate knowledge.
- Offering consistent and honest communication to build trust and reduce anxiety.
1, 3, 4, 6, 7, 10
