Chapter 39

Kübler-Ross (1969) studied the responses to death and dying. Her findings are as follows:

Sometimes a person returns to a previous stage, the stages of dying may overlap, the duration of any stage may range from as little as a few hours to as long as months, and the process varies from person to person

Crying and having difficulties sleeping

are not unusual and will often accompany healthy grieving.

Reactions to grief and dying

are similar. The stages of these reactions overlap and vary among individuals. One person may skip a reaction stage, whereas another may repeat an earlier stage. Each person is different, and clients and family members may be at different reaction stages. More important than the actual stages of any given grief reaction is the idea that grief is a process that varies from person to person

Bargaining is an

attempt to postpone death.

Shock and disbelief involve the person

being in denial or having a numbed response to the death.

Organs can be obtained from

brain-dead clients and non-heart-beating cadavers

Developing awareness is characterized

by physical and emotional responses such as anger, feeling empty, and crying

Consent for autopsy is

legally required, usually from the closest surviving family member. It is usually the physician's responsibility to obtain permission for an autopsy. If death is caused by accident, suicide, homicide, or illegal therapeutic practice or if it occurs within 24 hours of admission to the hospital, the coroner must be notified.

Perceived loss is what?

loss of youth, of financial independence, and of a valued environment, is experienced by the person but is intangible to others.

Care for dying clients should focus

on the relief of symptoms, not limited to pain, and should use both pharmacologic and nonpharmacologic means

A good death is one that allows a

person to die on his or her own terms, relatively free of pain with dignity. It is free from avoidable distress and suffering for patients, families, and caregivers; in general accord with patients' families wishes; and reasonably consistent with clinical, cultural, and ethical standards

Measures to establish rapport with the client

providing time and physical contact by sitting in a chair next to the client; holding the client's hand should be utilized. The client should be encouraged to express his feelings. The nurse should provide information about the progress of the disease

Denial occurs when the person

refuses to believe certain information.

Palliative care, which is conceptually broader than hospice care,

, is both an approach to care and a structured system for care delivery that aims to "...prevent and relieve suffering and to support the best possible quality of life for clients and their families, regardless of the stage of the disease or the need for other therapies."

Dysfunctional Grieving

An inability to return to normal activities 18 months after a sibling's death is suggestive of Dysfunctional Grieving.

A client states, "My children still need me. Why did I get cancer? I am only 30." This client is exhibiting which stage according to Kübler-Ross?

Anger is the second stage and is exhibited by statement similar to "Why me?"

what are ways to help children deal with loss of a loved one?

Encourage the children to remember their grandfather. • Help make the children feel loved and safe. • Include the children in any rituals...Stoicism should not be praised. The children also should not be compared to the deceased.

resolving the loss

involves dealing with the void left by the loss.

When providing end-of-life care for clients, what will the nurse most often need to prioritize?

Pain control and emotional support Common prioritie, include the need to provide vigilant pain control and emotional support.

shock stage

Participating in mourning rituals would be appropriate for the shock stage. Articulating the stages of grief does not necessarily show that the client has entered the reorganization stage

A terminal illness is a condition

Recovery is beyond reasonable expectation from which recovery is beyond reasonable expectation. Clients with terminal illness do not recover from the illness; they may be treated symptomatically and provided care and comfort.

A nurse is developing a plan of care for a dying client. Which of the following physiologic basic human needs should be addressed?

involves meeting physical needs such as personal hygiene, pain control, nutritional and fluid needs, movement, elimination, and respiratory care

The cardiac nurse, who has been caring for a hospitalized terminally ill client for 3 days, finds that the client has expired. The nurse manager knows that the nurse can legally care for these clients when the nurse states which of the following

The scarcity of organs has resulted in legislation mandating hospitals to notify transplantation programs of potential donors.

Referring the client to self-help groups

is appropriate during the disorganization stage. Referring the client for career counseling is appropriate during the reorganization stage.

Anticipatory loss occurs when

a person displays loss and grief behaviors for a loss that has yet to take place. It is often seen in the families of clients with serious or life-threatening illnesses, and serves to lessen the effect of the actual loss of a family member.

With inhibited grief

a person suppresses feelings of grief and may instead manifest somatic (body) symptoms, such as abdominal pain or heart palpitations.

Unresolved grief is

abnormal or distorted; it may be either unresolved or inhibited. In unresolved grief, a person may have trouble expressing feelings of loss or may deny them; unresolved grief also describes a state of bereavement that extends over a lengthy period.

actual loss and can be

actual loss and can be recognized by others as well as by the person sustaining the loss; for example, loss of a limb, of a child, of a valued object such as money, and of a job

Discussing a search for new meaning would be appropriate during the

disorganization stage.

Palliative care goes beyond

giving traditional medical care. Palliative care is considered a "bridge" not exclusively limited to hospice care,

A feeling of "not doing enough" is common during

grief and would only be considered dysfunctional if this became a long-term and all-encompassing belief

The goal of palliative care is to

improve the client's and the family's quality of life. The support should include the patient's physical, emotional, and spiritual well-being. Each discipline should contribute to a single care plan that addresses the needs of the client and family.

grief resolution

involves dealing with the loss. Listening to the patient's expressions of grief, including significant others in discussions, and communicating acceptance helps the patient deal effectively with the loss. Encouraging the patient to keep silent about the event, not being empathetic, and avoiding identification of fears does not help the patient in dealing with the loss

The most common psychological reaction is

shock and disbelief or the refusal to accept that a loved one is about to die or has died.

Some grieving people report physical symptoms

such as difficulty breathing or tightness in the throat, whereas some people show signs of pathologic grief through morbid behaviors.

Hope is the ingredient of life

that enables an individual to consider a future and to actively bring that future into being. One way the nurse can enable hope in the dying patient is to provide honest information about the progress of the illness

Restitution is the stage of grief

that involves the rituals surrounding loss; with death, it includes religious, cultural, or social expressions of mourning, such as funeral services.

A sign that death is approaching

the client's difficulty in swallowing. People who are dying do not experience decreased pain. They may not be in a position to report pain; therefore, the caregiver should observe the client closely. Urinary output decreases when a person is approaching death due to system failure and limited intake. The client approaching death has decreased sensory stimulation

During the acceptance stage,

the dying clients accept their fate and make peace spiritually and with those to whom they are close

During the protest phase,

the nurse should encourage expressions of diverse feelings, help the client use existing support systems and identify new support systems, and teach the client about the normal grief process.

A good death is one that allows a person

to o die on his or her own terms. Independence and dignity are central issues for many dying patients. The characteristics of a good death vary for each client. The care of a dying client should be guided by the values and preferences of the individual.

Palliative care is a structured system for care delivery that has what as its aim

to prevent pain and suffering

. The definition of a good death

varies for each patient, but there are factors important for a good death, including control of symptoms, preparation for death, opportunity to have a sense of completion of one's life, and a good relationship with healthcare professionals.

For the reorganization stage, an appropriate outcome

would be that the client resolves the emotional reactions to the loss.