Loss, Grief and Dying Flashcards
Actual Loss
A loss that can be recognized by others.
Examples:
-Death of a loved one
-Losing a limb due to an accident
-House destroyed by fire
Perceived Loss
Felt by the person but not tangible to others.
Examples:
-Loss of self-confidence after a failed exam.
-Feeling a loss of independence after moving into assisted living.
-A person grieving over a breakup even though their friends don’t see it as a big loss.
Physical Loss
Loss of body part, function, or ability
Examples:
-Loss of sight due to an eye injury.
-Amputation after diabetes complications.
-Losing the ability to walk after a spinal cord injury.
Psychological Loss
Loss of identity, self-esteem, or emotional stability.
Examples:
-Losing trust after a betrayal
-Losing self-esteem after being bullied
-Emotional trauma from an abusive relationship
Maturational Loss
Expected loss due to life transitions.
Examples:
-A child starting school and feeling the loss of staying home.
-Graduating and leaving behind college friends.
-Parents experiencing empty nest syndrome when their child moves out.
Situational Loss
Unpredictable loss caused by sudden events.
Examples:
-A person becoming paralyzed after a car accident.
-Losing a home in a natural disaster.
-Getting fired from a job unexpectedly.
Anticipatory Loss
Loss that has not yet occurred but is expected.
Examples:
-Family members grieving a terminally ill loved one before their passing.
-A person feeling loss before retiring from their lifelong career.
-A soldier preparing for deployment and anticipating separation from family.
Grief
The internal emotional reaction to loss.
Example: Feeling sadness, anger, or loneliness after losing a loved one.
Mourning
The outward expressions of grief through actions, rituals, or traditions.
Example: Wearing black clothing, holding a funeral, or participating in cultural mourning practices.
Bereavement
The state of grieving after the death of a loved one.
Example: A spouse coping with the loss of their partner and adjusting to life without them.
Kubler-Ross’s Five Stages of Grief
1️⃣ Denial & Isolation – Refusing to accept the loss (“This can’t be happening.”).
2️⃣ Anger – Feelings of frustration or blame (“Why me? This isn’t fair!”).
3️⃣ Bargaining – Trying to negotiate or change the outcome (“If only I had…”).
4️⃣ Depression – Deep sadness, withdrawal, and despair.
5️⃣ Acceptance – Coming to terms with the loss and finding a way forward.
Engel’s Six Stages of Grief
1️⃣ Shock & Disbelief – Initial numbness and denial.
2️⃣ Developing Awareness – Emotional pain, crying, anger.
3️⃣ Restitution – Cultural and religious mourning rituals (e.g., funerals).
4️⃣ Resolving the Loss – Gradually integrating the loss into life.
5️⃣ Idealization – Remembering the lost person positively.
6️⃣ Outcome – Adjusting to life without the loved one.
Definition of Death
An individual is legally dead if they have sustained either:
1️⃣ Irreversible cessation of circulatory and respiratory functions (no heartbeat, no breathing).
2️⃣ Irreversible cessation of all brain function, including the brainstem (brain death).
Medical Criteria for Certifying Death
✅ No breathing – Permanent cessation of respiratory function.
✅ No response to deep painful stimuli – Unresponsive to physical touch or pain.
✅ No reflexes or spontaneous movement – Absence of gag reflex, corneal reflex, or any voluntary movement.
What are the physical signs that indicate a patient is approaching death
🧊 Coolness – Skin becomes cool, pale, or mottled, especially on extremities.
😴 Sleeping – Increased fatigue, drowsiness, and unresponsiveness.
🤯 Disorientation – Confusion, hallucinations, or difficulty recognizing people.
🚽 Incontinence – Loss of bladder and bowel control.
💨 Congestion – Gurgling, rattling sounds due to fluid buildup in the throat.
😣 Restlessness – Agitation, repetitive movements, or fidgeting.
💧 Urine Decrease – Reduced kidney function leads to less urine output.
🥄 Fluid & Food Decrease – Loss of appetite and reduced interest in eating/drinking.
🫁 Breathing Pattern Changes – Irregular, shallow, or Cheyne-Stokes respiration (periods of apnea).
Palliative Care
Focuses on caring for the whole person: mind, body, spirit, heart, and soul.
Provides relief from pain, symptoms, and stress of serious illness.
Can be given at any stage of illness, alongside curative treatments.
Offered in hospitals, nursing homes, or outpatient settings.
✅ Example: A patient with cancer receiving pain management, emotional support, and physical therapy while continuing chemotherapy.
✅ Example: A person with Parkinson’s disease receiving palliative care for muscle stiffness, mobility support, and psychological counseling.
✅ Example: A patient with chronic heart failure getting medications to ease symptoms, dietary counseling, and spiritual support.
Hospice Care
Provided for patients with limited life expectancy (typically 6 months or less).
Focuses on comfort care rather than curing illness.
Typically provided at home, hospice facilities, or nursing homes.
Supports patients and their families through end-of-life care.
✅ Example: A patient with terminal lung disease stops aggressive treatments and receives oxygen therapy, pain relief, and end-of-life counseling at home.
✅ Example: A late-stage Alzheimer’s patient in a hospice facility getting assistance with feeding, pain management, and emotional support for family members.
✅ Example: A person with advanced cancer opts for hospice care to manage pain, provide spiritual support, and ensure dignity in their final days.
What are Advance Directives, and what decisions do they cover?
Advance Directives – Legal documents outlining a patient’s healthcare wishes if they become unable to communicate.
✅ Who will make decisions – The patient designates a healthcare proxy (e.g., Power of Attorney for Healthcare).
Example: A patient with advanced dementia assigns their daughter as their healthcare power of attorney to make medical decisions when they can’t.
✅ Medical treatment preferences – Specifies what treatments the patient wants or does not want (e.g., ventilator, feeding tube, resuscitation).
Example: A terminally ill cancer patient refuses CPR and mechanical ventilation in their advance directive.
✅ Level of comfort – States how pain management and palliative care should be provided.
Example: A hospice patient requests strong pain medication and comfort measures to ensure a peaceful passing.
✅ How they will be treated by others – Preferences regarding respect, dignity, and spiritual care.
Example: A patient specifies in their directive that they want spiritual care, family presence, and a peaceful environment at the end of life.
✅ What loved ones should know – Final wishes, personal messages, or instructions for family members.
Example: A patient writes in their directive that they want their family to celebrate their life rather than grieve heavily, specifying no extreme life-prolonging treatments.
Comfort Measures & Special Orders in End-of-Life Care
1️⃣ Do-Not-Resuscitate (DNR) / No-Code.
—>Medical staff will not perform CPR if the patient stops breathing or their heart stops.
✅ Example: An elderly patient with terminal cancer signs a DNR order to avoid aggressive life-saving measures.
2️⃣ Comfort Measures Only (CMO)
—>Focuses on pain relief, symptom control, and emotional support, rather than curative treatment.
✅ Example: A hospice patient chooses morphine for pain relief but declines further medical intervention.
3️⃣ Do-Not-Hospitalize (DNH)
—>Requests that the patient remains in their current care setting (e.g., nursing home) rather than being transferred to a hospital.
✅ Example: A family decides to keep their elderly loved one at home instead of admitting them to the hospital for pneumonia treatment.
4️⃣ Terminal Weaning
—>Gradual withdrawal of life-sustaining support (e.g., ventilators) when recovery is unlikely.
✅ Example: A patient on a ventilator with no chance of recovery is slowly weaned off, with pain management in place.
5️⃣ Active vs. Passive Euthanasia
—>Active Euthanasia – Intentional action to end a life (e.g., lethal injection).
✅ Example: Physician-assisted suicide in states where it is legal.
—>Passive Euthanasia – Withholding or withdrawing life-prolonging treatments, allowing natural death.
✅ Example: A family removes a feeding tube from a terminally ill patient in accordance with their wishes.
What legal and medical documents are required upon death?
1️⃣ Death Certificate
—-Official document certifying the cause, date, and place of death.
Required for legal, burial, and estate purposes.
✅ Example: A hospital issues a death certificate before a funeral home can proceed with burial or cremation.
2️⃣ Organ Donor Card
—-Indicates the deceased’s consent to donate organs/tissues for transplant or medical research.
Can be designated on a driver’s license or an official donor registry.
✅ Example: A person with an Organ Donor Card has their kidneys and heart donated to save other patients’ lives.
What are the key factors that influence grief and the dying process?
📌 1️⃣ Developmental Considerations.
Age and stage of life influence how individuals understand and process death.
✅ Example: A young child may not fully understand the permanence of death, while an elderly person may accept it as a natural part of life.
📌 2️⃣ Family.
Family roles, support systems, and relationships impact grieving.
✅ Example: A close-knit family may provide emotional support, while unresolved family conflicts can complicate grief.
📌 3️⃣ Socioeconomic Factors.
Financial stability can affect access to end-of-life care and funeral arrangements.
✅ Example: A family struggling financially may experience additional stress over funeral costs.
📌 4️⃣ Cultural, Gender, and Religious Influences.
Cultural and religious traditions shape mourning practices and beliefs about the afterlife.
✅ Example: Some cultures emphasize elaborate funeral rituals, while others practice silent grieving.
📌 5️⃣ Cause of Death.
Sudden vs. expected deaths affect the grieving process differently.
✅ Example: A sudden accident may cause shock and prolonged grief, while a terminal illness allows for anticipatory grieving.
What are the key components of building a trusting nurse-patient relationship
📌 1️⃣ Explain the Patient’s Condition & Treatment.
Provide clear, honest, and compassionate communication.
✅ Example: A nurse explains the side effects of chemotherapy in simple terms to reduce patient anxiety.
📌 2️⃣ Teach Self-Care & Promote Self-Esteem.
Encourage patients to participate in their care to maintain dignity and confidence.
✅ Example: Teaching a stroke patient exercises for mobility and self-feeding techniques.
📌 3️⃣ Educate & Support Family Members.
Involve family in caregiving to improve patient support and reduce caregiver stress.
✅ Example: Teaching a family how to turn and reposition a bedridden loved one at home.
📌 4️⃣ Meet the Needs of a Dying Patient.
Provide comfort, emotional support, and pain management in end-of-life care.
✅ Example: Ensuring a hospice patient is pain-free, comfortable, and surrounded by loved ones.
📌 5️⃣ Meet the Needs of the Family
Offer emotional support, bereavement resources, and clear information about the patient’s condition.
✅ Example: Helping family members understand the signs of approaching death and preparing them emotionally.
How can nurses effectively offer support to patients and their families?
📌 1️⃣ Emotional Support
Provide a compassionate presence and actively listen to patient concerns.
✅ Example: Sitting with a grieving family member and allowing them to express their feelings.
📌 2️⃣ Physical Comfort
Ensure pain management, hygiene, and proper positioning for comfort.
✅ Example: Adjusting a terminally ill patient’s bed position to relieve discomfort.
📌 3️⃣ Informational Support
Educate patients and families about conditions, treatments, and what to expect.
✅ Example: Explaining medication side effects in simple terms.
📌 4️⃣ Practical Support
Assist with daily tasks, referrals, and coordination of care.
✅ Example: Connecting a patient with social services for financial or home care assistance.
📌 5️⃣ Spiritual Support
Respect and facilitate religious or spiritual needs.
✅ Example: Arranging a chaplain visit or providing a quiet space for prayer.
📌 6️⃣ Family Support
Offer guidance and involve family members in caregiving when appropriate.
✅ Example: Teaching family members how to assist with feeding and mobility for a bedridden patient.
How can nurses facilitate the mourning process for patients and families?
📌 1️⃣ Help Family Accept That Loss is Real
Encourage open discussion about the death of their loved one.
✅ Example: Gently reinforcing reality by using clear language (e.g., “Your loved one has passed away” instead of “gone” or “lost”).
📌 2️⃣ Encourage Establishment of New Relationships
Support family members in reconnecting with others and finding new sources of support.
✅ Example: Suggesting grief support groups or community involvement.
📌 3️⃣ Allow Time to Grieve
Recognize that grief is a personal journey and varies in duration.
✅ Example: Encouraging patience with the grieving process and avoiding pressure to “move on” too soon.
📌 4️⃣ Interpret “Normal” Grieving Behavior
Educate families that anger, sadness, and guilt are normal grief reactions.
✅ Example: Reassuring a grieving spouse that crying and withdrawing from social activities are common early grief responses.
📌 5️⃣ Provide Continuing Support
Offer follow-up care, bereavement resources, and check-ins with families.
✅ Example: Providing grief counseling referrals or hospice bereavement support services.
📌 6️⃣ Be Alert for Signs of Ineffective Coping
Watch for prolonged or complicated grief that may require intervention.
✅ Example: Noticing a family member who refuses to eat, withdraws completely, or exhibits risky behavior and referring them for counseling.
