Spirituality and End of life Flashcards
Actual Loss
- can be recognized by others as well as the person sustaining the loss
- ex: loss of a limb, child, valued object, or job
Perceived loss
- is felt by the person but intangible to everyone else
- ex: loss of youth, financial independence, valued environment
Maturational loss
- experienced as a result of natural developmental process
- ex: first child may experience a loss of status when a sibling is born
Situational loss
- experienced as a result of an unpredictable event
- ex: traumatic injury, disease, death, natural disaster
Anticipatory loss
- a person displays loss and grief behaviors for a loss that has not taken place yet
- often seen in families of patients with serious and life-threatening illnesses
- may lessen the effect of the actual loss
Bereavement
state of grieving due to the loss of a loved one
Grief
internal emotional response to loss
Dysfunctional grief
- abnormal or distorted, may be either unresolved or inhibited
- person may have trouble expressing feelings of loss or may deny them
Engel’s 6 stages of grief
- shock and disbelief
- developing awareness
- restitution
- resolving the loss
- idealization
- outcome
Clinical signs of impending death
- difficulty talking or swallowing
- nausea/abd distention
- incontinence or constipation
- loss of movement/sensation/reflexes
- decreasing body temp
- weak, slow, irregular pulse
- decreasing BP
- restlessness or agitation
- noisy, irregular respirations
Care to facilitate a “good death”
- providing control
- independence and dignity are central issues
- palliative care
- focus on relief of symptoms
- guided by values and preferences of the individual patient
Kubler Ross 5 stages of grief
- denial and isolation
- anger
- bargaining
- depression
- acceptance
Advance Directives
- living will or durable power or attorney for healthcare
- can minimize difficulties by allowing people to state in advance what their choices would be for healthcare that should be provided or foregone in particular situations
Living will
provide specific instructions about the kinds of health care that should be provided or foregone in specific situations
Power of attorney for healthcare
appoints an agent the person trusts to make decisions in the event of subsequent incapacity
Comfort measures only order
indicates that the goal of treatment is a comfortable, dignified death and that further life -sustaining measures are no longer indicated
Terminal weaning
the gradual withdrawal of mechanical ventilation from a patient with a terminal illness or an irreversible condition with a poor prognosis
Palliative Sedation
the lowering of patient consciousness using medication for the express purpose of limiting patient awareness of suffering that is intractable and intolerable
Factors affecting grief and dying
- developmental considerations
- family
- socioeconomic factors
- culture, sex assigned at birth, religious influence
- cause of death
Suicide Prevention: action plan
A: assess for risk of suicide or harm
L: listen nonjudgementally
G: give reassurance and information
E: encourage appropriate professional help
E: encourage self help and other support strategies
Developing a trusting nurse - patient relationship
- explain patients condition and treatment
- teach self care and promote self esteem
- teach family members to assist in care
- meet the needs of the dying patient
- meet family needs
Postmortem care
- prepare body for discharge
- place in anatomical position, replace dressings, remove tubes
- ## place ID tags on the body
Postmortem care of the family
- listen to family’s expression of grief, loss, helplessness
- offer solace and support by being an attentive listener
- arrange for family members to view the body
- in the case of sudden death, provide a private place for family to grieve
- it is appropriate for the nurse to attend the funeral and make a follow up visit to the family
Universal spiritual needs
- need for meaning and purpose
- need for love and relatedness
- need for forgiveness
