Professional Documents
Culture Documents
Unit 5
chapter 25
special populations
Living wills Directive documents for medical treatment per a clients wishes.
Durable power of attorney for health care A document that appoints an individual to
make medical decisions when a client is no longer able to do so on his own behalf.
Types of Loss
Necessary loss
Part of the cycle of life, anticipated but may still be intensely felt
Actual loss
Perceived loss
Maturational loss
Situational loss
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Theories of Grief
Kbler-Ross: Five Stages of Grief Stages may not be experienced in order, and the length
of each stage will vary from person to person.
Depression The client is saddened over the inability to change the situation.
Acceptance The client accepts what is happening and plans for the future.
Worden: Four Tasks of Mourning Completion of all four tasks generally takes about a year,
but this may also vary from person to person.
Task II Using coping mechanisms to experience the emotional pain of the loss
Task III Changing the environment to accommodate the absence of the deceased
Task IV Readjusting emotional ties to new individuals, and moving thoughts about
the deceased to a less prominent place in everyday thoughts
Socioeconomic status
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Assessment
Types of Grief
Normal grief
Anticipatory grief
Dysfunctional grief
Disenfranchised grief
Nursing Interventions
Facilitate Mourning
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Use therapeutic communication. Name the emotion that the client is feeling. For
example, a nurse may say, You sound as though you are angry. Anger is a normal
feeling for someone who has lost a loved one. Tell me about how you are feeling.
Avoid communication that inhibits open expression of feelings, such as offering false
reassurance, giving advice, changing the subject, and taking the focus away from the
individual who is grieving.
Assess for signs of ineffective coping, such as refusing to leave her home months after
a clients spouse has died.
Share information about mourning and grieving with the client, who may not realize
that feelings, such as anger toward the deceased, are expected.
Encourage the client who is grieving to attend a bereavement or grief support group.
Initiate a referral for psychotherapy for a client who is having difficulty resolving grief.
Ask the client if contacting a spiritual advisor would be acceptable, or encourage the
client to do so.
Participate in debriefing provided by professional grief/mental health counselors.
Client Outcomes
palliative Care
Overview
The nurse serves as an advocate for a clients sense of dignity and self-esteem by providing
palliative care at the end of life.
Palliative care improves the quality of life of clients and their families facing end-of-life
issues.
Palliative care interventions are used primarily when caring for clients who are dying and
family members who are grieving.
Palliative care can be provided by an interdisciplinary team of:
Physicians
Nurses
Social workers
Massage therapists
Occupational therapists
Music/art therapists
Touch/energy therapists
Hospice care is a comprehensive care delivery system for the terminally ill that is usually
implemented when a client is not expected to live longer than 6 months. Further medical
care aimed toward a cure is discontinued, and the focus becomes symptom relief and
maintaining the clients quality of life.
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Assessment
Characteristics of Discomfort
Pain
Anxiety
Dyspnea
Nausea or vomiting
Dehydration
Diarrhea or constipation
Urinary incontinence
Inability to perform ADLs
Identify the desires and expectations of the family and client for end-of-life care.
Nursing Interventions
Assist the client and family to set priorities for end-of-life care.
Physical Care
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Remove products of elimination as soon as possible to maintain a clean and odorfree environment.
Promote decision making in food selection, activities, and health care to permit the
client as much control as possible.
Encourage the client to perform ADLs if the ability and desire exist.
Psychosocial Care
Assist the client in clarifying personal values to facilitate effective decision making.
Encourage the client to use coping mechanisms that have worked in the past.
Make presence known by answering call lights in a timely manner and making
frequent contact.
Determine where the client is most comfortable, such as in a room close to the
nurses station.
Suggest that family members plan visits in a manner that promotes client rest.
Ensure that the family receives appropriate information as the treatment plan changes.
Provide privacy so family members have the opportunity to communicate and express
feelings among themselves without including the client.
Determine family members desire to provide physical care. Provide instruction as
necessary.
Educate the family about physical changes to expect as the client moves closer to
death.
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Client Outcomes
Postmortem Care
Overview
A nurse is responsible for following federal and state laws regarding requests for organ
or tissue donation, obtaining permission for autopsy, certification and appropriate
documentation of the death, and providing safe postmortem (after-death) care.
The clients family now becomes the nurses primary focus.
Nursing Interventions
Provide care with respect and compassion while attending to the desires of the client
and family per their cultural, religious, and social practices.
Recognize that the provider certifies the clients death by pronouncing time and
documenting therapies used, and actions taken prior to the death.
Preparing the body for viewing includes:
Maintaining privacy
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Removing all tubes and soiled linens, unless organs are to be donated or this is a
coroners case
Removing all personal belongings to be given to the family
Cleansing and positioning the body with a pillow under the head, arms outside
the sheet and blanket, dentures in place, and eyes closed.
Asking the family if they would like to remain with the body, honoring any
decision. This process should not be rushed.
Clarifying where the clients personal belongings should go either with the body
or to a designated person.
Adhering to the same procedures when the deceased is a newborn, while adding
the following:
Post viewing
Complete documentation.
Organ Donation
Recognize that request for tissue and organ donation must be made by specially
trained personnel.
Provide support and education to family members as decisions are being made. Use a
private area for any family discussions concerning donation.
Autopsy Considerations
The nurses role is to answer the familys questions and support the familys choices.
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Cultural/Religious Beliefs
Documentation and completion of forms following federal and state laws typically
includes:
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Caring long-term for a client can create personal attachments for nurses.
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4. A nurse is caring for an older adult female client who was recently placed in a residential care facility
by her three adult children. The clients spouse died 1 year ago, and the client is no longer able to care
for herself. What assessment data should the nurse collect from the clients children?
Previous coping strategies for each member of the family
Familys cultural rituals, if any
Familys religious/spiritual affiliations, if any
Stage of grief in which each family member is involved with regard to the fathers death and
the mothers illness
Current state of the mothers illness, and the familys understanding of it
NCLEX Connection: Psychosocial Integrity: Grief and Loss
5. A nurse is caring for a client who is dying. Identify three nursing interventions that the nurse can use
to assist the client to maintain dignity and self-esteem during end-of-life care.
Listen to the clients concerns.
Maintain cleanliness and odor control in the clients physical environment.
Allow the client to participate in ADLs as desired.
Provide personal grooming assistance as necessary.
Encourage the client to make decisions regarding food selection, activities, and health care.
NCLEX Connection: Psychosocial Integrity: End-of-Life Care
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