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
 Engle’s 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?

 Coroner’s 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
doctor’s 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
 Client’s belongings
 Removal of therapies
 Dentures
 Raise head of bed
 Care After Death
 Clean body
 Remove valuables
 Positioning
 After the family views the body