Loss, Death, and Grieving

Nursing Fundamentals
NURS B20
 Loss, Death, Grieving
Nursing by its nature is involved in all
processes of life from birth to death.
Nurses interact daily with clients and
families experiencing loss and grief.
 Loss
Loss of external objects
Loss of known environment
Loss of a significant other
Loss of an aspect of self
Loss of life
 Concepts and Theories of the
Grieving Process
Engles Theory (1964)
Shock and Disbelief
Developing Awareness
Reorganization and Restitution
 Concepts and Theories of the
Grieving Process
Kubler-Ross Stages of Dying (1969)
Denial
Anger
Bargaining
Depression
Acceptance
 Concepts and Theories of the
Grieving Process
Rando
Avoidance
Confrontation
Accommodation
 Hope
Hope is not a single act but a complex
series of thoughts, feelings, and actions that
change often. Clients and families facing
terminal illness or serious loss experience
different dimensions of hope.

Generalized hope- I hope all is well

Particular hope- A particular outcome
 Assessment of the Grieving
Client
Age
Toddler
Preschooler
School-age
Young adult
Middle age
Elderly
Nature of relationship
Nature of the loss
Cultural and spiritual beliefs
Gender roles
Socioeconomic status/ social support system
 Nursing Diagnoses
Anticipatory Grieving
Dysfunctional Grieving
 Implementation
Therapeutic communication
Maintenance of self-esteem
Promotion of return-to-life activities
 The Dying Client
When does death occur?
Traditionally

Since the 1st transplantation

Who can pronounce a person dead?

 Coroners Case
Request family member consent and
signature for autopsy. Several reasons for a
death becoming a case for the coroner:
Death by suspicious means or not under a
doctors care
Death resulting from an accident
Client has been hospitalized for less than 24
hours
 Death with Dignity
Dying Persons Bill of Rights (page
Passive euthanasia
California Law (1976)- Right to Die bill
California Natural Death Act
Promotion of comfort
 Death with Dignity
Maintenance of independence
Prevention of loneliness and isolation
Promotion of spiritual comfort
Support for the grieving family
Hospice Care
 Physical Changes Indicating
Approaching Death
Temperature usually elevates to 104+
Pulse= fast, irregular, weak, difficult to find
Respirations= rapid, shallow, noisy,
Cheyne-Stokes
BP= decreased
Peripheral circulation
 Physical Changes Indicating
Approaching Death
Thirst= dry mouth
Sight fails
Aphagia
Mental alertness varies
Hearing- supposed to be last sense to be
lost
Relaxation of muscles
 After Death
Physical Changes After Death
Pupils- Fixed and dilated
Algor Mortis- Rapid cooling of the body
Rigor Mortis- Stiffening of the body, develops 2-
4 hours after death
Livor Mortis- Purple discoloration of skin in
dependent areas
 Care After Death
Certification of death
Time of death
Notification nursing and admissions office
Clients belongings
Removal of therapies
Dentures
Raise head of bed
 Care After Death
Clean body
Remove valuables
Positioning
After the family views the body