1/3/2008. Karen Burke Priscilla LeMone Elaine Mohn-Brown. Medical-Surgical Nursing Care, 2e Karen Burke, Priscilla LeMone, and Elaine Mohn-Brown

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1 Medical-Surgical Nursing Care Second Edition Karen Burke Priscilla LeMone Elaine Mohn-Brown Chapter 14 Loss, Grief, and End-of-Life Care Loss Valued object, person, body part, or situation is lost or changed Can no longer be seen, felt, heard, known, or experienced May be temporary or permanent, complete or partial May be subjective, physical, symbolic May be as painful as death BOX 14-1 The Most Common Fears of Loss. 1

2 Grief Emotional response to loss and its accompanying changes Internal process used to work through response to loss Mourning describes the actions or expressions of the bereaved Death Irreversible cessation of circulatory and respiratory functions Irreversible cessation of all functions of the entire brain An inevitable part of life May be accidental, result of terminal illness, or purposeful An immensely difficult loss for dying person and loved ones Kubler-Ross s Stages of Death and Dying Denial Shock and disbelief Anger Resists the loss Bargaining Attempts to delay reality of the loss Depression Prepares for impending loss by working through struggle of separation Acceptance Comes to terms with the loss and resumes activities 2

3 Factors that Interfere with Successful Grieving Perceived inability to share the loss Lack of social recognition of the loss Ambivalent relationships prior to the loss Traumatic circumstances of the loss Spirituality Integrating and transcending the physical, emotional, intellectual, and social dimensions Principles, values, personal philosophy, and meaning of life Spiritual beliefs provide comfort, help to find meaning in loss Nurse provides support by developing a trusting relationship and listening to the client Rituals of Mourning Dictated by culture Funeral ceremony serves needs of bereaved Symbolically express triumph over death Deny fear of death Adaptation to the loss 3

4 Nurse s Response to Client s Loss Need to analyze own feelings and values Conscious or unconscious reactions influence the outcome of interventions Self-reflection helps to approach interactions more objectively End-of-Life Care Client s wishes about death should be respected Principles of hospice care People live until the moment they die Care until death may be offered by a variety of health care providers Care is coordinated, sensitive to diversity, offered around the clock Incorporates physical, psychologic, social, and spiritual concerns of the client and client s family American Association of Colleges of Nurses defined competencies to provide high-quality end-of-life care Advance Directives Legal documents that allow a person to plan for health care and/or financial affairs in the event of incapacity Durable power of attorney for health care Living will 4

5 Do-Not-Resuscitate Orders Written by the physician for the client who is near death Based on wishes of the client and family No cardiopulmonary resuscitation for respiratory or cardiac arrest Provide comfort measures only Goal of care is a comfortable, dignified death Euthanasia Killing that is prompted by some humanitarian motive Considered malpractice to participate in a slow code Voluntary versus involuntary euthanasia Hospice Initiated for clients as they near the end of life Emphasizes quality of life Client and family are included in plan of care Provides support for a dignified and peaceful death Palliative rather than curative 5

6 Palliative Care Goal is improving the quality of life Focused on relief of physical, mental, and spiritual distress Involves single person or interdisciplinary team Outcomes of care are interventions to manage current manifestations of illness and to prevent new manifestations Physiologic Changes in the Dying Client Weakness and fatigue Anorexia and decreased food intake Fluid and electrolyte imbalances Hypotension and renal failure Neurologic dysfunction Respiratory changes Bowel and bladder incontinence Pain Manifestations of Death Absence of respirations, pulse, heartbeat Fixed and dilated pupils Eyes may stay open Release or stool or urine Pallor Drop in body temperature Lack of reflexes Flat encephalogram 6

7 Postmortem Care Document time of death Notify physician Assist family Remove jewelry and give to family Complete required paperwork Nursing Care of Clients Assess physical, emotional, cultural, and spiritual needs Provide comfort Provide anticipatory grieving interventions Explore death anxiety with the client Evaluate if client has a comfortable and dignified death Teach client care to family Nurse s Grief Crying with family is expression of empathy and caring Sharing grief with the family Reflect on responses to own losses Obtain support from peers Obtain counseling as needed 7