Spirituality, Loss and Grieving

Transcription

1 Nurse Caring Concepts 1A Spirituality, Loss and Grieving Week 16, December 1, 2003 Definitions Religion: organized system of beliefs concerning cause, nature & purpose of universe, especially belief in worship of God. Spirituality: quality or essence that strives to find meaning and purpose, even for those who do not believe in any god. Strives to be in harmony with the universe; comes into focus when one faces emotional stress, illness or death The 5 Top Reasons Why RNs Fail to Provide Spiritual Care View religious & spiritual needs as private matter Uncomfortable about own religious beliefs Lack knowledge about spirituality & religious beliefs of others Mistake spiritual needs for psychosocial needs View spiritual needs of patient as family or pastoral responsibility 1

2 Spiritual Nursing Care Goal: assist patients to discover own God or truth that gives meaning to their lives in relation to healthcare crisis that has created need for nursing care Spiritual interventions are as appropriate as physiologic, psychosocial or teaching interventions Holistic nursing care mandates that we address spirituality, just as we address other very personal areas of patients lives Objectively Assessing Spiritual Needs Religious objects Special clothing Church bulletins, religious reading material Prayer Special diet requests Mentions God, Allah, Buddha, etc. Requests clergy Expresses doubt, fear & anxiety regarding spirituality Response to visitors Visits from clergy Subjectively Assessing Spiritual Needs Religious preference Interest in chapel/clergy Concept and importance of God Source of hope and strength Religious practices and rituals Relationship between spiritual beliefs/ health 2

3 NANDA: Spiritual Distress Definition: experiences a disturbance in belief or value system that provides strength, hope & meaning to life. Major Defining Characteristic: individual experiences disturbance in belief system Related Factors: challenged belief system; separation from spiritual ties, conflict between beliefs & prescribed treatment, divorce, death or illness, barrier to practicing spiritual rituals Goals STG: Patient will, by the end of discussion: Express one feeling related to the change in his spiritual beliefs since becoming ill Describe one religious/spiritual practice that he would like to perform LTG: Patient will express satisfaction with spiritual belief system Implementation Assess for & eliminate or reduce factors contributing to spiritual distress: Use self therapeutically Communicate about spiritual needs Accompany patient Promote therapeutic environment Provide access to spiritual advisors Support faith practices 3

4 Definitions Loss: parting with object, person, belief or relationship that one values Bereavement: State of desolation occurring as a result of loss, particularly death of significant other Grief: pattern of physiologic and psychological responses to loss Mourning: conventional behaviors displayed after the death of significant other Anticipatory grief: pattern of physiologic and psychological responses made to impending loss Normal Grieving Patterns Grief work: Grieving person s efforts to deal with physical and psychological pain associated with bereavement. Elizabeth Kubler-Ross Model: Five stages associated with facing one s own death (denial, anger, bargaining, depression, acceptance) Parkes Model: Four stages of grief associated with bereavement (numbness, yearning, disorganization, reorganization) Dysfunctional Grieving Falls outside of normal response range, grief may be exaggerated, prolonged or absent Patient stuck in one stage of grief process Person spends so much energy repressing or dealing with grief that has little left over for normal functioning 4

5 Factors Affecting Grief Response Age Gender Nature Timing Support systems Relationship with deceased Coping mechanisms Previous grief experiences Physical condition Cultural Considerations Mourning is cultural behavior RNs health-focused & may ignore death & dying Nurses often with pt & family through stages of dying and death Knowing religious & cultural heritage of a pt may help nurse to meet pt s needs. All individuals want to die with dignity Ask and then listen to what the family wants. Grief Assessment Shock, denial, numbness, confusion Hysteria, crying, anger, rage, stoicism, calmness Helplessness, despair, hopelessness, apathy Hypo or hyperactivity Self-care neglect (nutrition, hygiene, rest) Social withdrawal, absent-mindedness Substance abuse: smoking, ETOH, drugs Mummification Panic attack symptoms 5

6 Dysfunctional Grieving Risk Factors Uncertain, sudden, or complicated circumstances surrounding loss History of depression, low self-esteem, guilt or previous complicated grief reactions Socially unspeakable, negated or disenfranchised losses History of current or past substance abuse Decrease or loss of social support systems Cumulative grief over multiple unresolved losses NANDA: Dysfunctional Grieving Definition: experiences prolonged, unresolved grief & engages in detrimental activities Defining characteristics: unsuccessful adaptation to loss, delayed emotional reaction, prolonged denial & depression, inability to resume normal patterns Related factors: loss of person, independence function, possession, job, status, home, body parts Implementation Assess for causative and contributing factors to dysfunctional grieving Promote a trust relationship Support the person and the family s grief reactions Promote grief work with each response Provide health teaching and referral 6

7 Goals STG: Patient will, by the end of my shift: Acknowledge that she has experienced a loss Describe two feelings expected with loss Verbalize intent to seek professional help Verbalize intent to contact hospice Verbalize intent to contact a grief support group LTG: Client will contact professional help Caring for a Terminally Ill Client Goal of treatment shifts from curative to palliative (comfort care) Caring for two clients, the dying person & family Interventions: Comfort measures Pain control Dehydration management Therapeutic communication Nursing Care of the Deceased Dignity for deceased & sensitivity to family Remove all unneeded medical equipment & supplies; clean, position & cover patient Organ donation: California law mandates notification of all deaths to organ donor center Autopsy: postmortem examination of body s organs to determine cause of death. Consent required & obtained by MD (if death suspicious, autopsy required regardless of consent) 7