Mental Health: Grief and Loss

Which 3 findings found in the medical record that require immediate reporting to the charge nurse? (Select all that apply) a. Nurse's reference to client's age b. Nurse's reference to euthanasia c. Client sharing what was discussed with their spiritual advisor d. Client's lack of appetite e. Nurse's reference to future pain medication f. Nurse's comment regarding their faith

After collecting data, the charge nurse should immediately follow-up with the nurse's comments to the client regarding their faith, euthanasia, and their age. The nurse should respect the client's right of self-determination and not offer personal advice or judgment about their faith or age. The nurse's use of the term "euthanasia" is inaccurate and needs to be addressed immediately. Medical aid in dying is a process by which a mentally capable adult (as defined by the state), with a medical prognosis of living less than six months, requests a prescribed medication from their provider that the client can self-ingest resulting in their death without pain or suffering. Inaccurately, medical aid in dying has been referred to as 'physician assisted suicide', 'physician aid in dying', 'death with dignity' or 'euthanasia'. Euthanasia, where someone other than the client administers medication that ends the life of the client, is not legal in the United States and is inconsistent with the core values of nursing. In states where medical aid in dying is authorized, nurses will need to consider their core beliefs and values. Recommendations for nurses include becoming knowledgeable about medical aid in dying, protecting the confidentiality and choices of the client, and understanding that the nurse may conscientiously object to being involved in the medical aid in dying process.

A nurse is providing discharge instructions to the caregiver of a client who is dying. Drag words from the choices below to fill in each blank in the following sentence. The nurse should identify that the caregiver is experiencing _______ and _________.

Burnout Compassion fatigue After collecting data, the nurse should identify that the caregiver is experiencing burnout and compassion fatigue. Burnout is caused by emotional exhaustion and feelings of frustration. Compassion fatigue occurs when the caregiver is not able to separate their feelings of anxiety and stress from the care they are giving, therefore, affecting the delivery of empathetic and compassionate care.

A nurse in a mental health clinic is caring for a client who is grieving the loss of a child. Complete the following sentence by using the list of options. The nurse should assist in providing client education about ______ that focuses on ______

Complicated grief therapy Strengthening relationship The nurse should take action by educating the client about complicated grief therapy, an interpersonal treatment, which can strengthen the relationship between the client and their partner. This therapy will support the client in understanding grief, managing the pain of loss, thinking about the future, telling stories of the loss, learning to live with reminders of the loss, and remembering the child who died.

Specify if the finding is consistent with uncomplicated grief or maladaptive grief. Somatic issues noted upon admission. Onset of back pain on day 400. Feeling a sense of loss when thinking about the client. Disheveled and unclean appearance.

Uncomplicated Grief Feeling a sense of loss when thinking about the client. Somatic issues noted upon admission Maladaptive Grief Disheveled and unclean appearance. Onset of back pain on day 400.

A nurse is discussing medical aid in dying with a group of coworkers. Which of the following statements by a coworker indicates an understanding of medical aid in dying? a. "An adult person with proven mental capacity self-ingests the prescribed medication to die." b. "Someone who has more than 12 months to live can be eligible for medical aid in dying." c. "All states permit medical aid in dying for any adult who is considered mentally capable." d. "Another person, a nurse or family member, can administer the medical aid-in-dying prescription to the client."

a. "An adult person with proven mental capacity self-ingests the prescribed medication to die." Medical aid in dying a process by which a mentally capable adult (as defined by the state) with a medical prognosis of living less than 6 months requests a prescription from their provider that they self-ingest to die without pain or suffering.

A nurse is discussing euthanasia with a coworker. Which of the following statements indicates an understanding of the role of nurses and euthanasia? a. "Euthanasia is illegal in the United States, and the core values of nursing do not support it." b. "It is a nurse's personal decision if they want to participate in administering a lethal medication euthanasia." c. "The nurse must put their own beliefs aside and do what is best for the client." d. "Euthanasia is really an act of mercy. That is why it is called mercy killing."

a. "Euthanasia is illegal in the United States, and the core values of nursing do not support it." Euthanasia is the act where a person administers a lethal dose of medication to another person. This is illegal in the United States and is inconsistent with nursing core values as identified in Code of Ethics for Nurses with Interpretive Statements.

A nurse is reinforcing teaching with a client about complicated grief and resilience. Which of the following factors should the nurse identify as reducing the risk for developing complicated grief? (Select all that apply.) a. Regular religious or spiritual practices b. Previous experience with the loss of a loved one c. A sense of personal health and well-being d. A reliable support system e. Being treated for substance use

a. Regular religious or spiritual practices Regular religious or spiritual practices is a protective factor that can reduce a person's risk for developing complicated grief. c. A sense of personal health and well-being A sense of personal health and well-being is a protective factor that can reduce a person's risk for developing complicated grief. d. A reliable support system A reliable social support system enhances resilience after a loss and reduces risk for developing complicated grief.

A unit manager is evaluating the nurses' understanding of occupational stress. Which of the following statements are examples the effects of occupational stress? (Select all that apply.) a. "Everyone is sick sometimes, but lately, with all the client deaths, the number of people calling in sick is increasing." b. "We had three more nurses hurt themselves during work last month." c. "Sometimes, I have to work on other units where everyone feels negative. It is rough just being on a different unit." d. "Many of the nurses on the unit volunteer for the unit self-governance committee." e. "We have had so many of our longtime clients die these last few weeks. It is overwhelming."

a. "Everyone is sick sometimes, but lately, with all the client deaths, the number of people calling in sick is increasing" Frequent or increased absenteeism can be a result of increased or chronic occupational stress. b. "We had three more nurses hurt themselves during work last month" Work-related injuries can be a result of increased or chronic occupational stress. c. "Sometimes, I have to work on other units where everyone feels negative. It is rough just being on a different unit" Low morale can be a result of increased or chronic occupational stress. e. "We have had so many of our longtime clients die these last few weeks. It is overwhelming" Nurses who work in units or situations where they experience frequent loss or exposure to death are often unable to process their own grief. This is an example of occupational stress.

A nurse is reinforcing teaching with a client about the purpose of participating in a therapy group about coping strategies. Which of the following client statements indicates and understanding of the teaching? a. "Learning positive coping strategies can help me adapt to life after the death of my partner." b. "I will learn the purpose of the medications I am prescribed." c. "During the therapy, we will learn how to improve our interpersonal and behavioral skills." d. "This is a social group for people like me. We will plan recreational activities together."

a. "Learning positive coping strategies can help me adapt to life after the death of my partner." Programs that focus on support and active coping strategies, such as venting, positive reframing, humor, and emotional support, assist clients to adapt and navigate the grieving process.

A nurse is caring for a client who has end-stage pancreatic cancer. The client has decided to forgo any additional treatment and be allowed to die. Which of the following responses should the nurse make to honor the client's request? a. "This action is supported by your right of self-determination." b. "This action is beyond my scope of practice." c. "This action goes against the ANA Nursing Code of Ethics." d. "This is an unusual request and not common practice."

a. "This action is supported by your right of self-determination." End-of-life care is within the nursing scope of practice and the role of the nurse is to advocate for the client, provide supportive care by alleviating suffering, and support the client's right of decision.

Which of the following has been identified as a priority outcome of ensuring a nurse's physical and mental well-being? a. A growing and sustainable future nursing workforce b. A decrease in the costs of health care c. An improved public image of nursing d. A reduction of bias surrounding mental health

a. A growing and sustainable future nursing workforce The significance of personal well-being of the nurse has been cleary identified as a priority in order to grow and sustain the future work force. Modeled through self-care, the nurse ensures both personal well-being and on a larger scale adds to the well-being and sustainability of the future nursing workforce.

A nurse is caring for a client who is grieving and states, "No matter what I do, I just can't stop crying. It feels like I am in the grave." Which of the following actions should the nurse take first? a. Ask the client what they mean by "in the grave." b. Explain to the client that crying is a normal response to loss or death. c. Suggest an activity for the client to do when feeling sad. d. Discuss the client's sleep and rest patterns.

a. Ask the client what they mean by "in the grave." This is an example of using therapeutic communication, a clarification strategy to assist the client to express their thoughts and feelings. This is the priority action because it will aid the nurse in understanding what the client is thinking and feeling, including consideration of self-harm and safety.

A nurse is caring for a client who is dying. The client's family is at the bedside and have placed pictures and objects on the bed with the client. Which of the following actions should the nurse take? a. Ask the family about the objects and their meaning. b. Tell the family to remove the objects as they might hinder care. c. Request that a hospital chaplain be called to the room. d. Remove all personal objects for ease in providing client care.

a. Ask the family about the objects and their meaning. Asking about the objects allows the nurse to connect with the client's family and understand cultural or spiritual practices. Encouraging a client's spirituality or religious practices is a significant part of grief-informed and client-centered care.

A nurse is caring for a client who has recently experienced the death of a partner. Based on client findings, which of the following 3 actions should the nurse take? (Select all that apply) a. Encourage the client to discuss their current daily routine. b. Perform an ongoing collection of data of the client's emotional status. c. Share what the client has said with the client's adult child. d. Encourage the client to internalize experiences with their partner. e. Encourage the client to talk about the death of their partner.

a. Encourage the client to discuss their current daily routine. b. Perform an ongoing collection of data of the client's emotional status. e. Encourage the client to talk about the death of their partner. When taking action, the nurse should encourage the client to talk about the death of their partner, perform an ongoing data collection of the client's emotional state, and encourage the client to discuss the current daily routine. Bereavement care focuses on encouraging the grieving client to discuss the relationship they had with their deceased partner and not internalize those feelings. The nurse should monitor the client's emotional status since deep emotional pain can lead to hopelessness and suicidal ideation. The nurse should also encourage the client to discuss their daily routine and what their life is like since the death of their partner.

A client who is experiencing prolonged grief disorder (PGD) is at risk for which of the following? (Select all that apply.) a. Suicide b. Hallucinations c. Binge eating d. Social dysfunction e. Delirium

a. Suicide Clients who have PGD, or complicated grief, are at an increased risk for suicide and might display a general disinterest in living and deficits in work and social functioning. d. Social dysfunction Clients who have PGD are at an increased risk for suicide, increased use of alcohol and tobacco, present a general disinterest in living, and display deficits in work and social functioning.

A nurse is caring for a group of clients. Which of the following clients might be experiencing disenfranchised grief? a. A client whose child was in the military and was killed during combat b. A client whose child was identified as the shooter and killed by police during a school shooting c. A client whose child was diagnosed with stage IV lung cancer but has not yet died d. A client whose child died because of injuries from a motor vehicle crash

b. A client whose child was identified as the shooter and killed by police during a school shooting Disenfranchised grief occurs when the individual finds that it not socially, culturally, or publicly acceptable to grieve. In this case, the client's child was a shooter in a school shooting and the client is finding it difficult to grieve the loss of their child.

A nurse manager is assessing their unit for factors that contribute to the development of compassion fatigue. Which of the following factors should the nurse manager identify as increasing the risk for compassion fatigue? a. Nurse are provided with scheduled breaks every shift. b. A large number of nurses are working extra shift hours. c. Nurse managers offer one-on-one meetings with staff. d. Nurses formed a shared governance group to meet with nursing leadership.

b. A large number of nurses are working extra shift hours. Extra shift hours is a factor that places nurses at risk for compassion fatigue. Additionally, nurses are at risk for compassion fatigue due to repeated exposure to client suffering, deaths, and traumatic experiences.

A nurse is caring for an adolescent client whose parent died 4 years ago. The client's other parent states that the client has been coming home drunk, lost their driver's license due to reckless driving, and has been skipping school. Which of the following actions is the nurse's priority? a. Assist the client to identify feelings. b. Monitor the client for risk of suicide. c. Encourage the client to participate in a support group. d. Educate the client about the importance of adequate nutrition.

b. Monitor the client for risk of suicide. For a client who is experiencing complicated grief, it is the nurse's priority to monitor for safety. The nurse should assist the client with identifying their feelings.

A nurse is assisting with preparing a presentation for newly hired nurses about the role that nursing self-care has on the social determinants of health. Which of the following information should the nurse include in the presentation? a. Nurses lack the leadership skills needed to advocate for their clients in all settings. b. Nurses must lead and model well-being among themselves before they can truly partner with others. c. Nurses have always been focused on clients with a selfless approach modeling empathy. d. Nurses demonstration of self-sacrifices is a positive quality contributing to positive client outcomes.

b. Nurses must lead and model well-being among themselves before they can truly partner with others. The nurse must understand how the social determinants of health apply to them and understand and lead themselves in their own physical and mental well-being. This must be done first before nurses can lead others, clients, families, interdisciplinary teams, or communities.

A nurse is preparing to begin caring for a client and discovers that the client's adult children were recently killed as a result of gun violence. Which of the following actions should the nurse take? a. Review all news accounts of the incident to avoid asking the client any questions. b. Spend time reflecting and planning to avoid imposing any personal bias. c. Discuss any person concerns with a peer. d. Speak with the charge nurse and the nurse manager about plans for client care.

b. Spend time reflecting and planning to avoid imposing any personal bias. The beginning of client-centered care is self-reflection for one's own beliefs or biases, which helps to guide the nurse to be objective in their care of the client.

A nurse is caring for a client who is actively dying. The client's partner is crying and holding the client's hand. Which of the following responses should the nurse make? a. "I see your partner is not responding. I am sure they are not suffering or in pain." b. "Let me call the provider and see if they will order you something to help you." c. "I know this is difficult. Would you like me to sit with you?" d. "Death is a very spiritual time. I will leave you alone."

c. "I know this is difficult. Would you like me to sit with you?" The client's partner is experiencing anticipatory grief. Providing a therapeutic presence will create a safe environment for grieving.

A nurse is caring for a client who recently lost their partner in a motor vehicle crash. Which of the following actions should the nurse take to provide supportive grief-informed care? a. Have the client complete their menu request. b. Place the client's personal items within reach. c. Ask the client how they met their partner. d. Provide the client with a list of local grief support groups.

c. Ask the client how they met their partner. This is an example of reminiscing. Reminiscing allows the client to talk about the person who died and is a way to show compassion and normalize their grief. Grief-informed care normalizes the grieving process and includes therapeutic communication and opportunities to remember the person who died.

A nurse is preparing to reinforce education with a client who is experiencing grief. Which of following information should the nurse include? a. Grief is commonly considered a mental health disorder. b. Grief is experienced in precise steps or stages. c. Feelings of sadness can fluctuate in intensity when a person is grieving. d. The majority of people experience a debilitating form of grief.

c. Feelings of sadness can fluctuate in intensity when a person is grieving. Grief can cause intense emotions, such as sadness or anger, and these feelings can fluctuate. This is a normal occurrence when grieving.

A nurse is caring for a client who has sustained life-threatening injuries. The health care team is discussing withdrawal of life-sustaining treatment. The decision to withdraw treatment is made by which of the following? a. Individual care providers, based on universal ethics protocols b. Independently by the medical staff, based on evidence and best practices c. The health care team and the family d. Rarely done as it violates medical ethics and current standards of practice

c. The health care team and the family The decision to withdraw life-sustaining care is the responsibility of the health care provider and is best done with the health care team and the client's family. The nurse provides a significant role in management of care.

A nurse observes an assistive personnel crying in the nurses' locker room. Which of the following actions should the nurse take first? a. Offer to take the assistive personnel to employee health. b. Suggest that to the assistive personnel they take an extend break. c. Use therapeutic communication to determine why the nurse's aide is crying. d. Provide the assistive personnel with the phone number for the employee counseling services.

c. Use therapeutic communication to determine why the nurse's aide is crying. When using the nursing process, the nurse should first gather data about why the nurse is crying. It appears the nurse has had a difficult or traumatic experience. This response is therapeutic and seeks clarification. Collaborating with the assistive personnel is a leadership skill and is needed to determine underlying factors for why the nurse is experiencing compassion fatigue, burnout, or secondary traumatic stress.

A nurse is caring for a client who reports headache, nausea, and difficulty sleeping. The client states, "My dog died a few weeks ago, and I miss them so much." Which of the following statements by the nurse demonstrates a grief-informed approach? a. "Have you recently changed what you are eating?" b. "What time of the day do the headaches begin?" c. "What activities are you doing before you go to bed?" d. "The loss of your dog must be difficult. Can you share what happened?"

d. "The loss of your dog must be difficult. Can you share what happened?" A grief-informed approach begins with focusing on what occurred. This is done while acknowledging the loss and creating a compassionate, safe environment.

A nurse is reinforcing education with a client who was recently diagnosed with prolonged grief disorder (PGD). Which of the following client statements requires follow-up by the nurse? a. "A professional therapist is specially trained to help with my grief." b. "These feelings of sadness and anger can be very intense for me." c. "During the support group, I will be encouraged to talk about my child." d. "There is nothing to do; I just can't go on living without my child."

d. "There is nothing to do; I just can't go on living without my child." This is a safety concern and should be addressed immediately. Any mention of suicidal thoughts or not wanting to live requires immediate nursing intervention.

A nurse in a high school is caring for an adolescent who has recently suffered the traumatic loss of a classmate and is crying. Which of the following actions should the nurse take first? a. Determine how the student is doing in class. b. Contact the student's guardians. c. Discuss the student with their teachers. d. Create a safe, nonjudgmental environment.

d. Create a safe, nonjudgmental environment. Creating a safe, nonjudgmental environment is vital for establishing trust and developing a therapeutic relationship as a beginning point of client care.

A nurse is caring for a client who was diagnosed with amyotrophic lateral sclerosis (ALS), has been hospitalized for aspiration pneumonia, and has failed a swallow evaluation. The provider determined the need for a feeding tube to be inserted. However, the client is refusing to have the tube inserted. The nurse is experiencing moral distress. Which of the following actions should the nurse take first? a. Determine the nurse's responsibility. b. Address the current situation. c. Request an ethics committee. d. Identify the area of concern.

d. Identify the area of concern. When using the nursing process, the first step is to collect data. This requires the nurse to identify the issue and the ethical concern. This allows the nurse to develop moral courage as a client advocate.

A nurse is participating in a wellness check for an 8-year-old child who was recently in a motor-vehicle crash where both guardians were killed. Which of the following findings should the nurse identify as an indication that the child is experiencing traumatic grief? a. The child is talking excessively and out of turn. b. The child is seen pulling out the hair on their head. c. The child becomes very upset with any slight deviation in their routines. d. The child reports frequent stomachaches.

d. The child reports frequent stomachaches. Children who are experiencing traumatic grief can experience nightmares, a decreased ability to concentrate, and somatic responses, such as stomachaches.