Fundamentals of Nursing Chapter 17 (Loss, Grief, Dying)

Mourning

Actions associated w/ grief (crying, wearing black clothing)

Loss of Significant Relationship

Actual loss of spouse, siblings, family members, significant others through death, divorce, separation, military diployment

Palliative Care

Aggressively planned, holistic comfort care

Internal Loss

Another form of perceived/psychological loss

Anticipatory Grief

Before loss occurs (Caring for ill spouse, relative, friend)

Adolescence

Bereavement, emotions felt by adolescents along w/ confusion regarding identity, role can create major uncertainty

Spiritual/Cultural Beliefs & Practices

Can help or hinder the grieving process, Most cultures engage in rituals (funerals) - Place of happiness - Reborn into another form - Final, no afterlife

1 to 2 Weeks Before Death

Cardiovascular deterioration, reduced blood pressure, changes in pulse, skin color, extreme pallor of extremities

Death (Historical Definition)

Cessation of flow of vital bodily fluids

Psychological Loss

Challenges belief system, areas of sexuality, control, fairness, meaning, trust

Environmental Loss

Change in familiarity, even if the change is positive, moving to a new home, new job, going to college

Childhood

Cognitive development is not yet complete, children do not understand death is final

Adulthood

Cognitively able to understand nature of death, usually experienced other types of loss by this time

Timeliness of the Death

Death of child/young person universally more difficult to accept, sense of unfairness

Actual Loss

Death of loved one, relationship, theft, deterioration, destruction, natural disaster

Moments Prior to Death

Dying person does not respond to touch, sound, cannot be awakened, short series of long-spaced breaths

Hospice Care

Holistic care of patients dying or debilitated and not expected to improve (6 months)

Bargaining

If only I can live until...

Previous Loss

If person sustained more than 1 loss in short period of time, grieving process can become more complicated

Physical Loss

Injuries, loss of limb, removal of organ, loss of mobility

Perceived Loss

Internal, identified by person experiencing it

Higher-Brain Death

Irreversible cessation of all "higher" brain functions (cognitive, consciousness, memory, reasoning)

Whole-Brain Death

Irreversible cessation of all functions of brain, brainstem

Heart-Lung Death

Irreversible cessation of spontaneous respirations/circulation

Disenfranchised Grief

Loss not socially supported/acknowledged by usual rites/ceremonies (Miscarriage)

External

Loss of important objects, because of cost, sentimental value

Bereavement

Mourning & adjustment time following a loss

Uncomplicated Grief

Normal grief, natural response to grief

Denial

Not me

Acceptance

Not necessarily wanting death, but coming to terms w/ it, ceasing to fight it

Circumstances of the Loss

Opportunity to prepare, was it sudden, unexpected, etc., If the circumstances of the loss leave the bereaved feeling guilty/responsible, grieving process may be impeded

Support System

People w/ strong emotional/psychosocial support typically have less complicated grief

Loss of Aspects of Self

Physical losses, body organs, limbs, body functions, body disfigurement

Grief

Physical, psychological, spiritual responses to a loss

Complicated Grief

Prolonged acute grief, characterized by length of time, intensity of emotion - Chronic Grief: Begins as normal, but continues long term - Masked Grief: Grieving, but expressing grief through other types of behaviors - Delayed Grief: Put off until later time

Uniform Determination of Death Act

Provides highly reliable means of declaring death for respirator-maintained bodies, loss of brainstem function

Older Adulthood

Special difficulty for older adults is the cumulative effects of many losses they experience, likely to lose friends, siblings in rapid succession, physical/functional losses, loss of idependence

Days to Hours Before Death

Surge of energy, desire to eat, talk, tend to become dehydrated, difficulty swallowing

Significance of the Loss

The greater the attachment, the more difficult the grief

WHAT IS LOSS

Undesired change, removal of a valued object, person, situation

Unresolved Conflict

Unresolved conflict at time of death may cause prolonged grief

Anger

Why me

1 to 3 Months Before Death

Withdrawal from world/people, sleep increases, difficulty digesting food, appetite decreases, liquids preffered

Depression

Withdrawn sadness