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Online Companion: Fundamentals of Nursing Standards and Practice 2E
In Chapter 21, the reader is introduced to the concepts of loss, grief and death. Four major categories of loss are described: loss of external objects, loss of familiar environment, loss of aspects of self, and loss of a significant other. Grief is the response of the individual to a loss. Loss leads to a period of adaptation called mourning. The period of grief following the death of a loved one is bereavement. Four theories of the grieving process are discussed. For instance, John Bowlby describes grief as occurring when attachment bonds are severed. Four phases of grieving are proposed by Bowlby: Numbing, Yearning, Disorganization and Reorganization. Bowlby's and other theorists' ideas can be used by nurses to understand and describe the response to loss that are observed in clinical situations. There are different types of grief: uncomplicated, dysfunctional, and anticipatory. The manifestations of grief are evident in the individual's thoughts, feelings, behaviors and physical sensations. The developmental stage of the grieving person is another dimension of the grief response. Children vary in their ability to comprehend death; they need honest explanations given in terms they can comprehend. Children should be encouraged to express their feelings and reassured that they will not be abandoned. The school-age child understands the finality and inevitability of death and may experience guilt over the death. The older adult may experience multiple losses during the aging process. The nurse can be an important source of support for the grieving client. The steps of the nursing process guide the nurse to assess the meaning of the loss to the client, to make an appropriate nursing diagnosis and to identify outcomes such as "Client will verbalize feelings of grief." During the implementation step, the nurse listens to the client. The nurse remains accepting and nonjudgmental. The nurse may refer the client to a support group. Chapter 21 continues on to the discussion of death and the stages of dying and death according to Kubler-Ross. The nursing diagnosis of Powerlessness in the dying client is explored. The dying client has physiologic needs, comfort needs, psychosocial needs and spiritual needs. The client's family need to be involved in the care of their dying loved ones. Chapter 21 lists the competencies developed by the American Association of Colleges of Nursing that are needed for nurses to improve quality of life for clients and families at the end of life. The care of the client at the time of death and related legal issues are discussed. Chapter 21 ends with a case study of a terminally ill client.
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