• Actual
• Perceived
• Physical
• Psychological
• Anticipatory
• Maturational
• Situational

What are the different types of loss?

There are 7.

Loss

Occurs when a valued person, object or situation is changed or made inaccessible so that its value is diminished or removed.

Actual

Loss

A type of loss that can be regcognized by others as well as by the person sustaining the loss.

Loss of a limb, of a spouse, of a valued object such as money, loss of a job.

Perceived

Loss

This type of loss is felt by the person but is intangible to others.

Loss of youth, financial independence, a valued environment.

Physical Loss

&

Psychological Loss

Directly related to Actual & Perceived losses are these 2 losses. 

A person who loses an arm in car accident suffers from both of these losses because of the loss of the arm & the loss that may be caused by an altered self-image & the inability to return to his or her job.

These losses are simultaneous.

Maturational  Loss

This type of loss is experienced as a result of natural developmental processes.

The first child may experience a loss of status when her sibling is born.

Also, happens when sending children off to kindergarten or college.

Situational Loss

A type of loss experienced as a result of an unpredictable event, including traumatic injury, disease, death, or national disaster.

Anticipatory Loss

A type of loss in which a person displays loss and grief behaviors for a loss that has yet to take place.

Often seen in families of patients with serious and life-threatening illnesses, and serves to lessen the impact of the actual loss of a family member.

Grief

The emotional reaction to loss.

It occurs with loss caused by separation as well as loss caused by death. 

Ex:  divorce loss of job, house, pet.

It is a process that varies from person to person.

Bereavement

The state of grieving during which a person goes through a grief reaction.

Experienced by both the patient and the family, may have profound health consequences that require addtional care.  They often neglect their healthe to an extreme.

Mourning

The period of acceptance of loss and grief during which the person learns to dea with the loss.

It is characterized by a return to more normal living habits, unlike a different type of grieving.

Dysfunctional

Grief

A grief response that is abnormal or distorted

It may be unresolved or inhibited

Anticipatory Grief

This type of grief occurs before the actual loss, as in the extended terminal illness of a family member.

Dysfunctional

Grief

This type of grief is abnormal or distorted

It can be unresolved or inhibited

Unresolved Grief

With this type of grief, a person may have trouble expressing feelings of loss or may deny them.  It also describes a state of bereavement

that extends over a lengthy period

Inhibited

Grief

With this type of grief, a person suppresses feelings of grief and may instead manifest

somatic symptoms.

Engel's Six Stages

of Grief

• Shock & disbelief - refusal to accept the loss, followed by a stunned or numb response.
• Developing awareness - physical & emotional responses: anger, crying, empty feeling
• Restitution - rituals surrounding the loss, cultural, religious, social
• Resolving the loss - dealing with the void left by the loss.
• Idealization - exaggeration of the good qualitites that the person or object had, followed by acceptance of the loss & a lessened need to focus on it.
• Outcome - the final resolution of the grief process, dealing w/the loss as a common life occurrence.

Kubler-Ross (1969)

A pioneer in the study

of grief and death reactions

His five stages

1.  
   1. Denial & Isolation
   2. Anger
   3. Barginning
   4. Depression
   5. Acceptance

•  
  • Inability to swallow
  • Pitting edema
  • Decreased gastrointentinal and urinary tract activity
  • Bowel and bladder incontinence
  • Loss of motion, sensation and reflexes
  • Elevated temp, but cold or clammy skin; cyanosis
  • Lowered blood pressure
  • Noisy or irregular respirations
  • Cheyne-Stokes respirations

What are some of the clinical signs

of impending or approaching

death?

Palliative

Care

Taking care of the whole person--

body, mind, and spirit, heart and soul. 

It looks at dying as something natural and personal.

The goal is to give patients w/life-threatening illnesses the best quality of life they can have by the aggressive management of symptoms.

Sometimes called Hospice care.

This type of care is appropriate across the spectrum of the disease and illness, not just in the end (needs of the dying).

Advanced

Directives

This allows people to state in advance what their choices would be for healthcare should certain circumstances develop.

There are two kinds of written .......???

Living

Will

This type of written advance directive provide specific instructions about the kinds of healthcare that should be provided or foregone in particular situaitons.

Durable

Power of Attorney

This written advance directive

appoints an agent the person trusts to make decisions in the event of subsequent incapacity.

Comfortable-Measures-Only

Order

The goal of treatment is a comfortable, dignified death and that further life-sustaining measures are no longer indicated.

Terminal

Weaning

The gradual withdrawal of mechanical ventilation from a patient w/a terminal illness or irreversible condition w/poor prognosis.

A nurse's role in terminal weaning is to participate in the decision-making process by offering helpful info about the benefits & burdens of continued ventilation and a description of what to expect if terminal weaning is initiated.

• Impaired adjustment
• Decisional conflict
• ineffective denial
• Hopelessness
• Caregiver Role Strain
• Death anxiety
• Anticipatory or Dysfunctional grieving 

What are some nursing dx's that specifically address human responses to loss and impending death in the problem statement?

• Pain/Symptom relief
• Clear decision making ability
• Preparation for death
• Completion
• Contributing to tohers
• Affirmation of the whole person

What are some things involved with

End Of Life Care???

The ANA issued position statements stating that assisting in suicide and participating in active euthanasia are in active violation of the Code for Nurses, the ethical traditions and goals of the profession & it's covenant with society.

What is the American Nurse's Association position on nurses assisting in suicide and active euthanasia.

• Inform their patients about ADVANCE DIRECTIVES.
• They (AD) vary from state to state.
• The pt. appoints a family member or close friend as a surrogate decision maker & NOT a nurse or healthcare professional.
• They (AD) are developed by the patient.
• Nurses & doc's may play a role in providing education related to advance directives, that is all.

The Patient Self-Determination

Act of 1990

requires all hospitals to do what?

• The scarcity of organs has resulted in legisation mandating hospitals and other healthcare agencies to notify transplation programs of potential donors.
• New protocols allow the retrieval of organs from non-heartbeating cadavers.
• The family of a deceased patient may decide to donate the organs, and a donor card is not necessary in this circumstance.
• Attention to optimal patient and family care at the time of life-sustaining therapy withdrawal should remain the nurse's priority in care.

A critical care nurse is aware of the legislation that surrounds organ donation. When caring for a potential organ donor, the nurse is aware that...???