1.Define the Concept of loss, grief, mourning and bereavement. •Loss is defined as: “occurs when a valued person, object or situation is changed or made inaccessible so that its value is diminished or removed”. Loss is the experience and feeling you get when dying. It has been felt by the individual dying as well as their family members and their significant others when their loved one is being taken away from them. •Grief is the emotional/behavioral reaction to loss. It occurs with loss caused by separation as well as loss caused by death. It is a very normal process, but it normally takes several months to work through. Grief could come in the form of denial, emotional numbing, rage, anger, anxiety, sadness, fear, confusion, difficulty sleeping, and loss of appetite. This process varies from person to person. •Mourning is “the period of acceptance of loss and grief during which the person learns to deal with the loss”. It is said to be very therapeutic because it is grief that is publically exposed. This includes: symbols and ceremonies such as a funeral or final celebration of a loved one’s life, memorial services, mourning dress, etc. Mourning is influenced by cultural customs, rituals and society’s rules of coping with loss. It is characterized by a return to more normal living habits, unlike a different type of grieving.
•Bereavement is “the state of grieving during which a person goes through a grief reaction”. This is experienced by both the patient and the family. The time a person spends in bereavement depends on how attached the person was to the person who died and how much time was spent together before the death occurs. This can affect a person physically as well as emotionally. 2.List and describe the Kubler-Ross stages of dying and grief. •This Kubler-Ross model is also called the Five Stages of Grief. The stages occur in no particular order. The stages are as follows: •Denial- “I feel fine” or “This can’t be happening, not to me” are some examples of statements made by a person in this stage. This is usually just a temporary defense. Some people can become stuck in this stage. •Anger- “Why me? It’s not fair!” or “How can this happen to me?” “Who is to blame?”; In this stage, the person recognizes that denial cannot continue.
The Essay on Loss Grief Nation Questions
Bozeman 1 Shana Bozeman 3 RD -4 TH Hour Mr. Allen Miss Mac Callum April 7, 2003 Learning to Live Means Learning to Grieve Whether it is a national tragedy or personal tragedy, grieving is dealt with differently with each individual. Grieving can be shared with someone or kept to yourself. People deal with things differently than we want them to. When my grandpa died I dealt with it like many ...
People are normally angry with those who are close to them. It is important to remain nonjudgmental when dealing with a person experiencing anger from grief. •Bargaining- “I’ll do anything for a few more years.” This stage involves hope that the individual can somehow postpone or delay death. This rarely provides a sustainable solution. •Depression- “I’m so sad, why bother with anything?” or “I miss my loved one, why go on?” In this stage the certainty of death is realized and acceptance of the situation occurs. •Acceptance- “It’s going to be okay.” A person comes to terms with mortality. This stage occurs varyingly according to the person’s situation. 3.Define end-of-life care, hospice care, and palliative care. •End-of-life care is medical care given specifically to individuals in the final hours or days of their lives. This care ensures that the patient is comfortable. This includes assistance in pain control and the treatment of other symptoms of death that the patient might have including constipation and shortness of breath.
The patients family is also treated during this time with that such as counseling. •Hospice care is a type of care in which care is provided for people with a limited life expectancy. This care assists to relieve suffering and pain which allows patients to pass peacefully and comfortably, most of the time in the patient’s own home. This care does not speed up nor does it slow down the process of dying. Hospice care can be given in either a home or an institutional setting. This care begins when the team works together to come up with a Plan of Care to provide services that will make better the quality of life and support for the patient and family during the terminal phases of illness and death. •Palliative care is focused on providing patients with relief from the symptoms, pain, and stress of a serious illness no matter what the diagnosis. The goal of this treatment is to improve the quality of life for both the patient and family. This treatment can be provided along with curative treatment. 4.Explain how death is medically defined.
The Term Paper on Improving Patient Care
There is growing enthusiasm in the United States about the use of electronic medical records (EMRs) in outpatient settings. More than $20 billion of the federal economic stimulus (the American Recovery and Reinvestment Act of 2009) is slated to assist physicians, hospitals, and other health care settings in adopting health information technology (Gill, 2009). The government wants to shift into the ...
•Death is medically defined as the cessation of all vital functions of the body including heartbeat, brain activity, and breathing. Death is irreversible damage and cessation of all brain functions.
5.Describe advance directives, the Patient Self-Determination Act, and a living will. •Advanced directives are legal documents stating the preferences of treatment as well as the designation of a surrogate decision-maker in the event that a person should become unable to make medical decisions on their own behalf. This is written and signed before such measures or care becomes necessary. This directive can either be in form of a living will or durable power of attorney. This document does not require an attorney but it must be witnessed and signed by two people.
•The Patient Self-Determination Act is a federal law that applies to all healthcare institution receiving Medicaid funds. This law requires those institutions to provide information about advance directives to adult patients upon their admission to the healthcare facility. •A living will is a legal document used to make a patient’s wishes known regarding life prolonging medical treatments. This does not become effective unless the patient is incapacitated. If the patient is not permanently unconscious, a living will does not have any effect either. 6.Discuss the physiological and psychological stages of dying. •The psychological stages of dying are that of the Kubler-Ross model: denial, anger, bargaining, depression, and acceptance. Patients go through the same process psychologically when dealing with the facing of death as do their family and loved ones. •There are 12 physiological stages of dying.
Physical weakness/ lack of energy/ loss of interest in everyday things is the first stage of dying. As the body’s systems weaken, less oxygen is available to the muscles and more effort is needed to complete everyday tasks. This is often a time of self-examination, questioning, and looking for the meaning of life. oWithdrawal form family and friends/increased sleepiness/coma is the second stage of dying. During this stage too many visitors can be exhausting. The person may sleep more and be difficult to arouse or uncommunicative. Although they may be asleep or in a coma, the person may be aware of what is being said and this may upset the dying. oLoss of appetite is the third stage of dying. As the digestive system gets weaker, food may become more of a discomfort that an enjoyment and the energy to process the food becomes greater than the energy received from the food. Refusal of the patient to feed their body is not a refusal for nourishment. It is a sign that their priorities have changed. The person approaching death needs to know that it is ok not to eat. oDifficulty swallowing is the fourth stage of death. As dying approaches, the swallowing reflex weakens. It may be frightening for the person to eat or drink.
The Essay on Euthanasia Mercy Killing Person Death One
Euthanasia mercy killing Euthanasia Sue Rodriguez has reminded us all of our own mortality and our need to think carefully about the kind of society we want to live and to die in. Sue Rodriguez was known through the media, and her well spoken and eloquent speeches. People painfully in support of what she believed in, watched as her strength was sapped by the devastating disease (amyotrophic ...
Mouth care is important for comfort and dignity during this time. oConfusion is the fifth stage of dying. A dying person’s level of awareness and cognition can change frequently and unexpectedly. When confusion occurs there can be a decrease in oxygen to the brain and they may not recognize family and friends and they might see or hear things. oRestlessness is the sixth stage of dying. A dying person may become restless and make repetitive motions like picking at the bed linen, their clothing or the air. This can be a sign of less oxygen available in the brain or of being distressed due to pain, nausea, constipation or a full bladder. This can also be a sign of spiritual crisis. oElimination is the seventh sign of death. Incontinence occurs as the bowels and bladder relax. The person may feel embarrassed. As the kidneys shut down, increased sweating and itching occurs. Changing bed linen soiled with sweat and repositioning is very helpful. oBody temperature and color are the eighth sign of death. The bodys ability to control its temperature will start failing.
The person may feel hot but say they are cold and vice versa. As the heart becomes weaker, circulation fails to reach the hands and feet and they will become cool to touch and the nails maybe bluish, while the arms and legs maybe pale, grey, mottled or purplish. oBreathing is the ninth stage of dying. If breathing is difficult with or without oxygen, sometimes a fan blown over the body to give the sensation of being in fresh air. Keeping the head elevated will help as well. A change in breathing pattern is significant during the dying process. When the exhalation is longer than the inhalation this is a sign that the dying process has begun. oUnexpected alertness and increased energy is the tenth stage. Most of the time a day or two or even a few hours before death, the person has a surge of energy, wakes up, becomes alert, can sometimes eat or talk and can spend some quality time with loved ones.
The Essay on Quality of Life for the Patient and Family
Quality of life has a different meaning for everyone. Many personal thoughts and feelings can come into play when caring for others during the end stages of life. However as a nurse and caregiver, these opinions must be put aside at this significant time. For some health care providers, we may feel that keeping the patient comfortable and having them surrounded by family is most important. ...
This normally doesn’t last long. oSigns of imminent death is the eleventh sign of death. Eyes have glassy fixed stare with large pupils, pasty grey, or blue greyish color present especially on lips, hands and feet. Hands and feet can be cold, the jaw opens, breathing through the mouth very rapid or very slow with pauses of 20-50 seconds between breaths. There is also no response to voice or pain. oClinical death is the final stage of dying. In this stage there is no breathing, no heartbeat, pupils are large and do not change and sometimes release of bowel or bladder occurs. 7.What are the clinical signs or manifestations of impending death? •The clinical signs or manifestations ofimpending death are as follows:
oEvidence of circulatory collapse
oDeterioration of physical and mental capabilities
oAbsence of corneal reflex
oSometimes release of bowel or bladder
oDisequilibrium of body mechanism
oVariation in blood pressure and pulse
oInability to close eyes
oPain: facial grimacing, tension in forehead and between eye brows
oAlteration in level of consciousness: increase drowsiness
oDelirium for instance agitation, moaning, groaning, non-purposeful movement of limb.
8.Discuss the criteria for hospice care.
•Hospice care is available for anyone who has a life expectancy of six months or less if the terminal illness or disease runs its normal course. The patient’s physician must provide certification that the patient has an advanced stage of a life-threatening illness with a life expectancy of approximately six months or less. The patient must also understand and elect palliative care versus curative care. A primary care giver needs to be available when the patient signs the consent form for hospice. 9.Identify variables that influence a person’s response to grief. •The nature of the relationship with the person who died; The availability, helpfulness, and ability of the person to make use of a social support system; the unique characteristics of the bereaved person; the unique characteristics of the person who died; the nature of death; the social expectations based on the sex of the survivor; and the ritual or funeral experience are all factors that influence a person’s response to grief. 10.Discuss the nurse’s own grief experience when caring for dying patients.
The Essay on Child Care The Effect On Family Life
More and more families are putting their children into daycare every day. There are different reasons as to why they have to do this. The main reasons are that both parents have to work, or the child is in a single parent situation, and the parent has to work in order to have an income to buy basic needs. In order to pay the child care bill and the cost of enrolment fees, etc, parents will need to ...
•Nurses in acute care settings often witness prolonged, concentrated suffering on a daily basis, leading to feelings of frustration, anger, guilt, sadness, or anxiety. Nursing students report feeling initially hesitant and uncomfortable with their first encounters with a dying client and identify feelings of sadness, anxiety, and discomfort. 11.The nurse is caring for Mr. B, a 57-year-old man who is terminally ill with metastatic bone cancer. He wants to donate his organs for research after his death but his wife is opposed to this. Review information on organ donation. Attach an article regarding organ donation. What is the best action(s) by the nurse in this situation? •Provide honesty and support for Mr. Bishop’s decision. •Determine if Mr. Bishop has signed a donor card
•Determine if Mr. Bishop’s advanced directive is on file at the hospital and see if it outlines his preferences on donation of his organs. •Allow the couple to reach a decision on organ donation
•Ask Mr. Bishop reasons for the decision and also ask his wife to explain reasons for her refusal. •Give the two privacy to sort out their differences of opinion •Continue to provide pain relief and basic care for Mr. Bishop
12.The nurse is caring for a 37 year old man who is admitted to the hospital for back surgery. The patient tells the nurse that his 12-year-old son died 6 months ago in an automobile accident where he was the driver. He is a builder and has been out of work since the car accident. The patient appears depressed. What losses has this patient experienced? What is the best action(s) by the nurse in this situation? •Not only has this patient suffered the loss of his son, but he has also suffered the loss of his physical ability to make a living. He has possibly felt a loss of self-respect due to the fact that he was driving the car in which his son was killed. •Be a good listener for the patient.
The Essay on Knowledge Of Information Ralph Nurse Care
Knowledge of Information DESCRIPTION OF THE CASE: Ralph is a recent widower in his midi-60's, who was diagnosed colon cancer. He is a home health agency patient, and his primary caregivers are his two daughters. Ralph is unaware of the severity of his condition and wanted to know what his state of health and prognosis were. The nurse evaded his questions initially, and his daughters did not want ...
•Set up a meeting with a social worker or case manager to see what can be done as far as applying for possible disability or counseling. •Notify the physician of your observations.
•Continue to provide adequate care for the patient without passing judgment 13.Mr. S, 88 years old, recently died after a long illness. His granddaughter has two small children, age 9 and age 6. She wants her children to attend his funeral. The granddaughter asks the nurse for assistance in handling this issue. What is the best action(s) by the nurse in this situation? •Encourage the two to discuss their reasoning for both opinions. •Ask the mother and grandmother to take into consideration both children separately and evaluate their levels of thinking and maturity. This might lead to one child going and the other one not attending. Different children can handle death at different ages differently.
14.Baby Smith, 3 months old, died unexpectedly an hour ago (child was admitted with a fever).
Mrs. Smith sits in the rocking chair, rocking her baby, and crooning to him. When approached she keeps saying, “Shhh, my baby’s sleeping. We don’t want to wake him.” Her husband is out of town and Mrs. Smith has no other family close by. What is the best action(s) by the nurse in this situation? •Ask a chaplain or social worker to come speak with the woman and stay with her through this tough time. •Ask her if it is ok to notify the father. His presence might help her to deal with the situation better. •Denial of death is a stage in the grieving process. However, persistent denial can lead to refusal to bury the dead child that can lead to complicated grief. 15.Define and discuss the role of the nurse in postmortem care for the patient who is deceased and for the family. Be specific. •Post mortem care is the care provided to a patient immediately after death. The nurse takes care of the body carefully by ensuring that the body is moved from the clinical unit in a good condition. There should be high consideration to the deceased cultural and or family rituals. The nurse should document fact and time relating to death of the patient and label his or her belongings by name. The nurse should verify that the appropriate documentation is completed by all parties required. •Nursing roles in postmortem care:
oEnsure physician or other healthcare provider complete necessary document as required by the state regulations
oCaring for the patient’s body
oCaring for the family and notify clergy or support person if family asked or the dead client requested before his or her death. oFollow the wish of the client
oIdentify cultural and or family desire
oDischarging specific legal responsibility
oEnsure death certificate is issued and signed
oLabel the body and determined if client has signed a donor card or has made a decision to donate any organs oReview organ donation arrangement if available
16.There are culturally and religious specific rituals and mourning practices that loved ones use to achieve a sense of acceptance and inner peace and participate in socially accepted expressions of grief. Discuss some of the cultural and/or religious practices of the following groups regarding death/burial. Hispanic/Latino, Chinese, Native American (Indian), Jewish, and Islamic. •Hispanic/latino: Central focus is on extended family at time of death. Family members may help with care of the body and are likely to want time with the body. Organ donation and autopsy are not common, but they are not prohibited. •Chinese: Family usually stays with deceased for up to 8 hours after death. Chinese oldest son or daughter bathes the body under direction from older relative or temple priest. Often believe the body should remain intact, so organ donation and autopsy are uncommon. •Native American Indians: Care of the body in the large Navajo tribe includes cleansing the body, painting the deceased’s face, dressing in clothing, and attaching an eagle feather to symbolize a return home. Mourners also have ritual cleansing of their bodies. Burial sites are on the deceased’s homeland.
•Jewish: In orthodox Judaism, there should be no preparation of the body until it is known whether members from the Jewish Burial Society are coming to the facility. A family member may stay with the body until burial. Usually the burial occurs within 24 hours, but not on the Sabbath. Families participate in a mourning period during which grief is expressed openly and in keeping with ritual. In some, but not all types of Judaism, cremation, autopsy, and embalming are avoided. •Islamic: Deceased’s body is ritualistically washed, wrapped, cried over, prayed for, and buried. Non-Muslims should not touch body. Islamic law forbids cremation, because the body continues after death. At time of death deceased faces Mecca. Modesty is important, so use same-sex caregivers when possible. Autopsies are not allowed; organ donation is sometimes allowed. 17.Write a 5-page formal paper on Hospice Nursing (definition, purpose, indications, benefits, issues, etc).
Five references must be used. APA format is required.