Death & Dying

Overview

- Loss
- Hope
- Grief
- Death
- Nursing care
- Care of the nurse

Loss

- absence of an object, person, body parts or functioor emotion
- Five categories

o loss of external
o loss of a known environment
o loss of a significant other
o loss of an aspect of self
o loss of life

Grief, Mourning & Bereavement

• Bereavement- state of thought, feeling, and activity that follows loss
• Grief is a form of sorrow that follows the perception of anticipation of a loss
• Mourning- process that follows a loss and includes working through grief
• Many use these terms interchangeably

Theories of the Grieving Process

• All are similar
• People do not go thru stages or phases in order
• Move back and forth between phases
• Grieving is an individual process
• Each person experiences grieving differently

Assessment of Grief

• Explore the meaning of the loss
• Consider age, gender, and that grief is universal through all socioeconomic categories
• Consider the meaning of the relationship
      - the more dependent the relationship, the more difficult the grieving

Grief Assessment

• Social support system
• Nature of the loss
• Cultural and spiritual beliefs
• Goals of the dying person
• Hope

Dysfunctional Grieving

• See text
• Be careful before labeling
• Consider support systems
• Degree of loss

Care of the Dying

• Nurse cares for the dying individual
• Care for the family
• Promote physical comfort
• Promote hope
• Assess spiritual needs/ comfort

Care of the Nurse

• Go through same processes
• Explore and express feelings
• Be open and honest

Hospice

• Intent is to treat the symptoms of disease to allow the terminally ill patient to die in as much comfort as possible
• Primary goal of team is to minimize patient's pain and maximize comfort
• Patient needs spiritual and emotional comfort

Spiritual Comfort

• Recognize spiritual issues
• Dialogue about spiritual issue
• Foster reconciliation
• Share near death experiences

Spiritual Comfort

• Recognize spiritual issues
  - overt religious beliefs
  - subtle issues of meaning, purpose, forgiveness, and transcendence
• Dialogue about spiritual issues
  - facilitate sharing
  - explore meaning of life

Spiritual Comfort

• Foster reconciliation
  - resolving relationships
  - life review is encouraged to integrate life experiences so that meaning and forgiveness cabe found
• Share near death experiences
  - describe beautiful scene or sensing presence of benevolent being

Advance Directives

Purpose

Problems

Assisted Suicide

• Viewpoints
• ANA
• Other organizational standards
• DNR
• Terminal weaning

Factors affecting Grief & Death

• Developmental level
  - experience
  - age
• Family role
• SES- may lack insurance/pension
• Cultural expression of grief
• Religion

Factors affecting Grief & Death

• Cause of death
• Spiritual Assessment Instrument
• Faith
• Importance and influence
• Community
• Address

Spiritual Assessment Instrument

• What is your faith or belief?
  - Do you consider yourself spiritual or religious?
• - What things do you believe in that give meaning to your life?
• Is it important to your life?
  - What influence does it have on how you take care of yourself?
  
  
• Is it important to your life?
  - What influence does it have on how you take care of yourself?
  - How have your beliefs influenced your behavior during this illness?
  - What role do your beliefs play in regaining your health?

Spiritual Assessment

• Are you part of a spiritual or religious community?
  - Is this of support to you and how?
  - Is there a person or group of people you really love or who are really important to you?
  How would you like me to address these issues in your healthcare?