Nursing Chapter 43 Homework The Traditional Clinical Signs Death Are Cessation

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Describe types and sources of losses.

Concepts for Lecture

1. The are two general types of loss: actual and perceived. An actual

loss can be recognized by others. A perceived loss is experienced by

one person but cannot be verified by others. Psychological losses are

often perceived losses in that they are not directly verifiable.

Both losses can be anticipatory. Anticipatory loss is experienced

before the loss actually occurs.

Loss can be viewed as situational or developmental. Examples

of situational losses include the loss of one’s job, the death of a

2.

There are many sources of loss: (a) loss of an aspect of oneself—a body

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Discuss selected frameworks for identifying stages of grieving.

Concepts for Lecture

1. Many authors have described stages or phases of grieving. Kübler–

2. Engel (1964) identified six stages of grieving: shock and disbelief,

3. Sanders (1998) described five phases of bereavement: shock, aware-

4. Martocchio (1985) described five clusters of grief—shock and disbe-

lief; yearning and protest; anguish, disorganization, and despair;

5.

Rando (1991, 1993, 2000) has described three categories of responses:

avoidance, confrontation, and accommodation. Avoidance is similar to

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LOSS, GRIEVING, AND DEATH

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Compare and contrast the various stages of

grieving as identified by the researchers listed

in the textbook.

strate movement through the stages of grief and

loss and how individuals are helped to express

308 CHAPTER 43 / Loss, Grieving, and Death

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Identify clinical symptoms of grief.

Concepts for Lecture

1. Physiologically, the body responds to a current or anticipated loss

with a stress reaction. The nurse can assess the clinical signs of this

response (see Chapter 42).

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Discuss factors affecting a grief response.

Concepts for Lecture

ing and acceptance of life, loss, and death.

Significance of the loss depends on the perception of the indi-

vidual experiencing the loss. A number of factors affect the signifi-

cance: importance of the lost individual, object, or function; degree

of change required because of the loss; and the individual’s beliefs

and values.

Socioeconomic status often affects the support system available

at the time of a loss. A pension plan or insurance can offer a wid-

owed or disabled individual a choice of ways to deal with a loss. An

individual who is confronted with both severe loss and economic

hardship may not be able to cope with either.

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Show a videotape demonstrating the signs and

symptoms of grief and interventions to help.

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Have a nurse from the emergency department

describe how individuals react to unexpected

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Have the students interview staff nurses,

asking each to discuss factors affecting the

grief responses they have observed in practice.

Discuss findings in conference.

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• Have each student interview a person from a

different culture to determine what the cultural

group considers to be acceptable losses, how the

culture responds to these losses, and rituals or

rites used to assist individuals experiencing loss.

CHAPTER 43 / Loss, Grieving, and Death 309

Individual and societal views on the cause of a loss or death may

significantly influence the grief response. Some diseases are consid-

ered “clean” and engender compassion, whereas others may be

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Identify measures that facilitate the grieving process.

Concepts for Lecture

1. Explore and respect the client’s and family’s ethnic, cultural,

religious, and personal values in their expressions of grief.

Teach the client or family what to expect in the grief process.

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6

List clinical signs of impending and actual death.

Concepts for Lecture

1. Manifestations of impending death include loss of muscle tone

(relaxation of the facial muscles, difficulty speaking, difficulty swal-

lowing, gradual loss of the gag reflex, decreased activity of the

2. The traditional clinical signs of death are cessation of the apical

3. In 1968, the World Medical Assembly adopted the following guide-

lines for health care providers as indications of death: total lack of

4.

Another definition of death is cerebral death or higher brain death, which

occurs when the higher brain center, the cerebral cortex, is irreversibly

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Invite nurses from inpatient and home hospice

organizations to discuss measures to facilitate

the grieving process that they have used in

their practice.

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Invite a member of an organ procurement

team to discuss the issues related to organ

donation.

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Review agency policies and procedures

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Describe helping clients die with dignity.

Concepts for Lecture

1. Nurses need to ensure that the client is treated with dignity, that is,

with honor and respect. Helping clients die with dignity involves

maintaining their humanity, consistent with their values, beliefs, and

culture.

By introducing options available to the client and significant

2. Clients want to be able to manage the events preceding death so they

can die peacefully. Nurses can help clients to determine their own

3.

It is natural for people to be uncomfortable discussing death. Some strat-

egies to be taken to make this discussion easier include: the nurse should

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Describe the role of the nurse in working with families or caregivers of dying

clients.

Concepts for Lecture

1. The most important aspects of providing support to the family mem-

bers of a dying client involve using therapeutic communication to

facilitate their expression of feelings. The nurse can provide an

empathetic and caring presence. The nurse also serves as teacher,

explaining what is happening and what the family can expect. The

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Discuss the Dying Person’s Bill of Rights and

nursing implications.

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• Discuss how the agency implements regulations

related to advance directives.

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Have the students discuss whether the nursing

care for a client is altered depending upon

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Discuss how nurses can provide support by

teaching and assisting family members to

participate in care for the dying client. Provide

examples.

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• Tour the agency’s chapel to identify resources

available in this area.

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If possible, arrange for the students to have an

experience with a home hospice nurse to

CHAPTER 43 / Loss, Grieving, and Death 311

they are prepared for the client to “let go,” to die when ready.

2.

After the client dies, the family should be encouraged to view the body

because this has been shown to facilitate the grieving process. They may

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Describe nursing measures for care of the body after death.

Concepts for Lecture

1. Nursing personnel may be responsible for care of the body after

death. Postmortem care should be carried out according to the policy

of the hospital or agency.

Because care of the body may be influenced by religious law,

the nurse should check the client’s religion and make every attempt

2. Normally, the body is placed in a supine position with the arms

either at the sides, palms down, or across the abdomen. One pillow is

3. Soiled areas of the body are washed, absorbent pads are placed under

the buttocks to take up any feces and urine released because of

4.

After the body has been viewed by the family, the deceased’s wrist iden-

tification tag is left on and additional identification tags are applied. The

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• Obtain a postmortem pack and have the students

practice postmortem care on a manikin.

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Invite nurses who work with dying clients and

their families to discuss how they deal with

the death of these clients. Ask the nurses to

discuss how they care for themselves to pre-

vent “burnout.”

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