Mental Health Nursing IMental Health Nursing INURS 1300NURS 1300

Unit VIIIUnit VIIISpirituality, Death, and Spirituality, Death, and

GriefGrief

Objective 1Discuss the basic concepts of

spirituality

Spirituality = searching for meaning in events that may be either joyous or tragic, and consists of transcendence, connection, balance, and purpose

Transcendence = finding meaning larger than the person’s individual self and life

Objective 1 (cont’d)

Connection = the integration of all the aspects of being human, which include the self, other people, the surrounding world, and, for some, a supreme being

Balance = harmony with self, others, and nature

Objective 1 (cont’d)

Purpose = a person’s understanding of the impact of his or her life and includes the understanding of the impact of his or her life and includes the understanding of life events

Religion = the system of beliefs and practices that usually involves a community of like-minded people

Objective 1 (cont’d)

The terms religion and spirituality are not necessarily interchangeable

People with strong spiritual beliefs and lives may not be “religious” individuals

Differentiation important because clients’ spirituality needs should be assessed even if they are not affiliated with a formal religion

Objective 2Describe beliefs and practices

related to dying and death

Bereavement practices can be greatly influenced by cultural and religious beliefs

Nurses should know what the client’s beliefs are in order to provide culturally sensitive care

Objective 3Describe responses of clients and their families to terminal illness

and impending death

Awareness of terminal illness closed awareness

family and patient recognize patient is ill lack of awareness related to impending

death mutual pretense

patient, family, and care providers know of the terminal prognosis

no one discusses the issue openly people make every effort to avoid the

subject open awareness

preferred by health care providers patient and others involved freely discuss

impending death

Fears associated with terminal illness and death fear of pain

tendency to associate death with pain pain control measures should be available to client to

relieve pain and discomfort fear of loneliness

most terminally ill patients don’t want to be alone many patients are afraid they will be abandoned by

loved ones who can’t cope with imminent death fear of meaninglessness

life review examination of actions and expression of regrets

about what might have been patients need to look at positive aspects of their lives the worth of the dying person needs to be expressed

Objective 4Identify nursing measures

appropriate for the terminally ill client

Nursing Assessment

Limited to essential data Abbreviated physical assessment Neurological assessment important

Nursing Interventions

Open discussion of feelings Nonjudgmental listening Patient/family teaching

grief response is normal honesty in answering questions

and giving information Demonstrate respect for patient’s

privacy and need to talk (or not to talk)

Nursing Interventions (cont’d)

Encourage realistic hope within limits of the situation feelings of hopelessness and

powerlessness common in terminal illness

allow patient and family to identify and deal with what is within their control

patient-identified goals can be encouraged to restore sense of power

Physical care maintenance of physical needs/comfort

Objective 5List categories of loss

Change in self-image Developmental changes Loss of possessions Loss of significant others

Objective 6Discuss factors which influence a

grief reaction

Developmental considerations Religious and cultural beliefs Relationship with the lost entity Cause of death

Objective 7Discuss age-related beliefs about

death Infancy to 5 years (preschool)

little or no understanding of death death is temporary and reversible,

like sleep 6-9 years (school age)

death is final own death can be avoided death is related to violence wishing or hoping for death can make

it happen

Objective 7 (cont’d) 10 to 12 years (preadolescent)

death is an inevitable end to life grasps own mortality by discussing fear of

death or life after death expresses feelings of death based on adult

attitudes 13 to 18 years (adolescent)

afraid of prolonged death may act out defiance for death through

dangerous or self-destructive acts has a philosophical or religious approach to

death seldom thinks about death

Objective 7 (cont’d)

19 to 45 years (young adulthood) cultural and religious beliefs influence

attitudes death is seen as a future event

45 to 65 years (middle adulthood) accepts own mortality as inevitable faces death of parents and peers may experience death anxiety

Objective 7 (cont’d)

65 years and older (older adulthood) afraid of prolonged health problems faces death of family members and

peers sees death as inevitable examines death as it relates to

various meanings, such as freedom from discomfort

Objective 8Explore the nurse’s response to working with the terminally ill

client Not immune to feelings of loss when

caring for terminally ill or dying clients Feelings of helplessness and

powerlessness when dealing with death

Need to express feelings of sorrow, guilt, and frustration

Must be able to identify what can and can not be controlled

Objective 9Define the following terms: anticipatory grief, grieving

process, denial, palliative, hope, hospice, loss, and respite care

Anticipatory grief = the occurrence of grief work before an expected loss

Grieving process = a total individual experience associated with thoughts, feelings, and behaviors that is usually most profound when the loss experienced is death

Denial = refusal to acknowledge a loss; serves to protect the patient, family, or both from the reality of the loss

Palliative = care provided for the sole purpose of providing comfort to the client rather than curing any problems

Hope = a belief in a positive outcome related to events and circumstances in one’s life

Hospice = a type of care for the terminally ill which allows individuals to die with dignity and be surrounded by those who love them; clients enter hospice care when aggressive medical treatment is no longer an option or when the client refuses further aggressive medical treatment

Loss = the real or potential absence of someone or something that is valued

Respite care = the temporary care of an aged or disabled person provided on behalf of and in the absence of the usual caregiver to allow that caregiver relief from the stresses and responsibilities of providing continued care