a nurse is educating a client who has a terminal illness about her request to decline resuscitation This is a topic that many people are looking for. amritsang.org is a channel providing useful information about learning, life, digital marketing and online courses …. it will help you have an overview and solid multi-faceted knowledge . Today, amritsang.org would like to introduce to you Nursing Fundamentals Grief and Loss Unit 15 F18. Following along are instructions in the video below:
And welcome to the unit. 15 lecture on grief. And loss.
These are your learning learning objectives for the unit. Please review them in preparation for class and for the so loss is felt by all individuals at some point or another and represents an actual or potential situation. Where something valued is changed or gone.
Glasses can be minor significant and can cause. Brief sadness. Long.
Lasting distress and depression colossus. Either material or psychological or a combination of the two material losses are losses of a tangible object or possession. Such as personal possessions in a house fire while psychological losses.
Do not have a physical form. But do have an important symbolic. Meaning in the instance of a mastectomy.
The loss is a combination a person has the material loss of breast tissue along with possible psychological loss of their feelings of sexuality. Grief. Is an emotional response to loss there several terms are related to grief mourning includes outward and socially expressed behaviors exhibited after the death of a loved one and practices vary from culture to culture bereavement is the state of desolation after a loss particularly of a loved.
One is the total response to the loss and includes emotional physical and social and cognitive responses from an individual anticipatory grieving is a pattern of psychological and physiological responses to a real or imagined impending loss of a loved one relationship or object this occurs before the actual loss happens. And it can help the person cope with the actual loss when it finally does it open the text lists several grief models will focus on the kubler ross theory this particularly relates to dying is made up of five stages denial anger bargaining depression and finally acceptance. Its important to note that the person can go back and forth in the stages.
Rather than progressing in a linear fashion through the stages. Make sure youre familiar with these stages. This diagram lists kubler ross theory and some behaviors.
People might have during each stage this diagram is off the nurse komm website. So theres several types of grief grief. Some are functional and some are dysfunctional normal grief includes resentment sorrow anger crying loneliness and temporary withdrawal from activities anticipatory grief occurs prior to the death or loss as we talked about previously complicated grief is brief that doesnt resolve as typical grieving should the individual might have distress that impairs their ability to function properly types of complicated grief are listed on the slide.
Thats the chronic delay. An exaggerated and masked grief so an individuals resources such as financial status developmental level and interpersonal support systems available helps to determine their response to grief or loss. Infants and toddlers have no concept of death.
So a death. If their main thing is just the separation anxiety. They dont understand that the person is gone.
But they understand that theyre not close to them. Anymore. Preschoolers and school age children.
Think. Death is reversible and avoidable. Adolescents begin to realize that death is real and final.
But they often are in denial that they could die. And that thoughts too overwhelming so they just tend to not think about it adult screen of death and then move on provided their grief follows normal patterns which well talk about in a while older adults might have several losses at once for example. A death of a loved one like a spouse.
The need to move to different housing or retirement and because of this they might not cope as effectively. Its harder to cope with things when theres a build up of different losses happening. Patients should be encouraged to think about and reach out to support systems to help them through the grieving process now keep in mind that the elderly might not have as many people in their support system.
So they might rely on health care workers for their support system. The nature of the loss. Is also going to influence the individual response to grief so for example a traumatic loss such as with murder or a car accident might be more difficult to get over than a slower death as seen with a patient on hospice.
And this can cause a complicated. Grieving process questions about loss should be a part of a nursing assessment. This slide lists various components to assess with your patients as well as their families be sure to assess normal patterns.
Such as belief systems especially spiritual faith systems and whether they have been helpful or unhelpful in the past resources stretcher. Stressors and social support. It is equally important to assess for dysfunctional patterns.
Such as suicide. Planning or alcohol and drug abuse. Keep in mind.
That it might be difficult to identify dysfunctional patterns on the first visit and the nurses need to be vigilant not only to apply theyre not only to do the assessments. But we dont want to apply inappropriate labels to patients who are grieving differently than the nurse would its important to let the patient guide their end of life preferences. If theyre able to will want to assess whats important to them and try to collaborate on ways that the patient continued continued to do whats important to them even at the end of life.
So heres some nursing diagnoses that would be appropriate for individuals experience loss grief or death. And then nursing interventions to assist patients. With grief are going to vary depending on their stage of grief.
Health promotion. Interventions include assisting in learning to deal with their loss to make effective decisions. And to adjust to the disappointment anxiety or anything else from the loss encourage them to express their feelings and work through them encourage effective coping skills such as support groups and watch for ineffective.
Coping. Such as alcohol and drug use. As well.
As poor nutrition. Now palliative care is aimed at improving the patients and families quality of life when theyre faced with life. Threatening illness.
Palliative care is important to initiate early in the course of illness. And it can work along with other treatments intended to prolong life. So the patient can be a full code and receive palliative care.
The goal is prevention and treatment of suffering. In combines psychological and spiritual aspects of care in a team approach hospice care on the other hand is intended for dying. Patients and their families patients qualifying for hospice.
Have a life expectancy of six months or less treatment focuses on symptom relief. Rather than life prolonging therapies and treatments. So.
The patient needs to be a dnr or do not resuscitate to qualify for hospice. So how do we as nurses know when our patients dying well. Theres several physical signs that can be observed skin becomes cool pale.
Mottled cyanotic or jaundiced and the picture on the slide is a picture of mottled skin heart rate. Becomes irregular and might speed up initially followed by a decrease respirations become shallow and may be labored. Irregular or may rattle.
And this is a fluid buildup in the airways that the patients not able to cough out urine output decreases or stops. Asked us to output patients lose their appetite now families can be reassured that their loved one is not hungry and feeding them might cause discomfort because their bowels are slowing down. As well the patient may be restless.
Anxious or samuelnt or have a decreased level of consciousness. Its always important to remember that hearing is the last to go so treat every patient as if they can hear you encourage family to touch and talk to their loved ones. Its also important to look for nonverbal indicators of pain such as grimacing or restlessness and treat the patient appropriately the patients might not be able to tell us theyre in pain.
But they might still be having pain. It is important to remember that each patient has a unique progression of death and dying no two patients are going to be the same now when you perform post mortem or after death care on a patient. We want to do so with dignity and sensitivity this often includes washing the body changing linens and preparing the body for the family to see if the patient died unexpectedly various iv lines and tubes will probably need to be left in place.
This is in case. The medical examiner needs to see the patient to the extent possible when youre caring for a deceased patient. This is my personal practice as i would elevate the head of the bed and place the patience hands on top of the bed linens to allow the family to touch the patient.
If they want to the simple act tells the family that its okay to touch the patient otherwise. They might miss out on this opportunity for closure and seeing goodbye. Now we want to be sure to reflect on how we as nurses are feeling about in dealing with a patients death.
This can be a strongly emotional time for staff as well as patients and families. It is important however to try to be a source of support for your patients family rather than them needing to support you be sure to draw in support from cowork co workers. If needed and dont rely on the patients family to console you during their time of grief.
Its essential to determine if a patient has an advanced directive. This tells health care provider is what the patient wants done in the event that theyre not able to make their wishes known due to an illness or accident. If they dont have an advanced directive provide them with information about why theyre important patients have the right to declare their personal wishes and be its directives are not just for those nearing death.
I would encourage each of you to complete an advanced directive if you dont already have one otherwise how will you make your health care. Wishes known if you cant talk for yourself you dont want the state making those decisions for you and vance directives are available for free and any health care center and you can download download them online also free of charge the two types of advanced care directives are living will which outlines the clients wishes regarding health care received if theyre unable to communicate in a durable health care power of attorney. This outlines the person the patient chooses to manage the health care decisions on their behalf of the patients unable the patient completes several questions about treatments that they would or would not be okay.
With such as feeding tubes. Nursing home placement or ventilator. Support.
So dnr orders. The key thing with a dnr order. Is that they do not hear that they mean do not resuscitate.
Or know cpr. Intubation or shocks. They do not mean do not treat.
The patient still should be treated to the extent possible for their condition with dnr. The providers are not hastening death. That means theyre not trying to bring about death.
More quickly. Theyre simply allowing natural death to take its place. If the patients heart stops or they start stop breathing with euthanasia.
However they are bringing about death. Quicker than would be with natural causes by providing usually a lethal dose of a medication. Its important to note that used euthanasia is illegal in most states.
So this slide. Just outlines the aaa recommendations for dnr orders pause here and review the slide. If you need to and that concludes our presentation on grief.
And loss. The next. One will be a presentation on spirituality thanks for watching and have a great day .
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