Grief

Loss, Grieving, and Death

Abstract This paper will explore the dying bill of rights, physical signs and symptoms of impending death, stages of grief, nursing diagnosis and interventions during palliative care, developmental perceptions of death, special needs of the family and client during palliative care, and appropriate nursing interventions during postmortem care. The primary function in nursing is to have the knowledge and ability to care for the patient and family during palliative care.

Outline 1. Loss, Grieving, and Death a. Dying Bill of Rights 1. Addressing each right and its importance b. Physical signs and symptoms of impending death 1. Unresponsiveness 2. No apparent work of breathing or movement 3. No reflexes 4. Absences of apical pulse 5. Absence of respirations c. Stages of grief 1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance d. Nursing Diagnosis and interventions during palliative care 1. Alteration in home maintenance 2. Alteration in health maintenance 3. Impaired or ineffective coping 4. Impaired or ineffective family coping 5. Caregiver role strain 6. Risk for powerlessness/hopelessness 7. Insufficient support system 8. Alteration or disturbed body image 9. Impaired swallowing 10. Alteration in appetite 11. Alteration in nutrition 12. Knowledge degicit 13. Change in bowel or urinary elimination 14. Incontinence 15. Risk for constipation e. The developmental perception of death 1. 0-5 yrs does not understand death 2. 5-9 yrs understanding of death but has illusions of own death and avoidance. 3. 9-12 yrs understands death is the end of life and is inevitable, may fear death. 4. 12-18 yrs defies death through reckless activities. 5. 18-45 yrs attitude is influenced by cultural and religious beliefs. 6. 45-65 yrs accepts death as own mortality, experiences death of parents and peers. 7. 65+ yrs fears prolonged illness, encounters death of family and peers believes they will be reunited with family and be free from pain. f. Special needs of family and the client during palliative care 1. Nurses serve as an advocate 2. Palliative care improves the quality of life for client and families. 3. Care and interventions used when caring for client and family 4. Teams for palliative care g. Interventions in caring for the special needs of client 1. Hygiene 2. Pain control 3. Respiratory difficulties 4. Ambulation/moving 5. Nutrition 6. Hydration 7. Elimination 8. Sensory changes 9. Spiritual support

h. Interventions in caring for the special needs of the family
1. Therapeutic communication
2. Teacher
3. Providing information continuously

Objectives
Learner Objectives
By the end of the presentation, the student should be able to: * Answer questions about the meaning of death to different age groups.

* Identify steps of the grieving process.

* Use a self-inventory to determine your feelings about caring for the dying patient.

* Provide post-mortem care.

* Meet the physical and psychological needs of the dying patient and their families.
Teacher Objectives
When presenting, each individual shall: * Communicate main points effectively.

* Class participation.

* Be organized and well prepared before the start of class.

Summaries
Summary for Peer Evaluations: The overall consensus for the peer evaluations was above average. The average score was 27/30 points. Summary for Pre/Post-Test: The pre-test scores averaged out at 68% . The post-test scores