Nursing Process for Client with Loss

Nursing Proses for Client with Loss
Nursing the terminally ill and supporting their families calls for a human and holistic approach. Client reports indicate that the caring presence of the nurse is valued as highly as is excellent symptom management. Paying attention to the client religious and spiritual preferences can positively affect the plan of care. Hospice nurses draw on each other’s and on physician’s knowledge to deliver expert palliative and comfort-oriented treatment. They have a heightened educational role with family caregivers and the client. Lastly, they must practice good self-care to manage and replenish their own emotional and professional reserves. These elements are explored in more dept in the sections that follow.
The nursing process
Assessment
Assessment of client in the grieving or mourning process includes an accurate perception of the loss from their viewpoint. You begin by identifying the loss, be it a person or a relationship or a change in health status, roles in life, or dreams and aspirations for the future. Seek to understand the nature of the attachment to the lost person, object, or expectation. Assess past experiences with loss and the impact those have on the present experience. Assess cultural rituals and rules about mourning to understand the unique experience of grieving individuals.
Spiritual Assessment Tool: S.H.A.R.E
Spirituality
What does spirituality mean to you? How would you describe your belief or faith system?
• Secular/ Spiritual
What is the meaning of what is happening to you in your life?
How do you need to respond?
• Religious/ Spiritual
What is God’s place in what is happening to you?
How do you need to respond?

How important
What role does your faith/spirituality have in your life?
• Secular/ Spiritual
What is most important in your life?
How would your life change if this were taken away?
• Religious/ Spiritual
What has been most meaningful to you in your faith community?
What is meaningful right now?

Activity
What actions connect you to your belief?
• Secular/ Spiritual
What calms your anxieties?
What puts you in touch with a sense of strength, peace, or hope?
• Religious/ Spiritual
What faith practices (prayer, music, movement, mediation, ect.) do you use calm or center yourself?

Relationship
How do you beliefs and values related to your present circumstance (diagnosis, prognosis, comfort, hope, ect.)?
• Secular/ Spiritual
Do you think there is a reason why this is happening to you?
Do you feel incomplete about aspect of your life?
• Religious/ Spiritual
Has this illness changed your relationship whit God?
Do you feel incomplete in your relation to your church or faith?
Do you have any unmet needs?

Empower
How can we be most affective in supporting your faith/ belief?
If we could do just one thing to help you with part of your life, what would it be?

Do not seek to fix or answer everything that comes up.
Diagnosis
Possible nursing diagnoses for survivors of a family member who has died include Anticipatory grieving, Dysfunctional grieving, Social isolation, Altered role performance, Risk for altered parenting, Ineffective family coping: compromised, and Family coping: potential for growth. Nursing diagnoses for children of divorce include Altered family processes, Risk for caregiver role strain, and Family coping: potential for growth. For adolescents who lack a peer group, nursing diagnoses might be Impaired social interaction and Self-esteem disturbance. Nursing diagnoses for middle adults experiencing loss might be Impaired adjustment, Self-esteem disturbance, and health-seeking behaviors. Nursing diagnoses in late adulthood include Spiritual distress, Social isolation, and Hopelessness. Nursing diagnoses for families experiencing loss through mental illness include Impaired social interaction, Social isolation, Caregiver role strain, Ineffective family coping: compromised, Family coping: potential for growth, and Ineffective community coping.


Nursing interventions
Behavioral :Coping Assistance
Grief Work Facilitation
Assisting individuals an families to progress through the grief process is an important nursing intervention. Encourage people to express their feelings about the loss and help them identify their greatest fears concerning the loss. Help them recognize that all these feelings are a normal part of grieving. Discuss the active process of grieving as they meet new challenges in coping. Let them know that you understand grieving takes a great deal of time and energy.
As new skill are identified and implemented, support those which are most effective. If appropriate, suggest alternative ways of dealing with challenges while supporting them in following their own choices. An important aspect of grieving is establishing autonomy and direction in their own lives. (Attig, 1996; McCloskey and Bulechek, 1996)
Discuss potentially difficult times such as holiday seasons or anniversary dates. Role playing may be helpful as they anticipate these painful events. Assist survivors to identify goals that are unattainable because of the loss while encouraging realistic goal setting. Explore the ways in which social support system have changed as a result of the loss or death. Refer to appropriate self-help groups for survivors of death, families of mentally ill persons, and individuals who are psychiatrically disabled (Klebanoff and Smith, 1997)
Spiritual care includes helping grieving person to seek new meanings in both life and death. Encourage them to implement religious beliefs and rituals surrounding death. Guide them through the process of self-reflection as they think about what has happened to them. As grieving progresses, you can provide a listening ear while they recover old and discover new goals and purposes in life (Attig, 1996; McCloskey and Bulechek, 1996)
If children are involved in the grieving process, answer their questions associated with the loss. Use clear words, such as dead or died, rather than euphemisms, such as passing on or gone to sleep. Clear up any misunderstanding the children may have. Use play, art, or journal therapy to help children identify and work through their feelings. Refer to community resources designed to help children cope with the loss of a family member (McCloskey and Bulechek, 1996)
Families have specific needs as they address losses associated with having a member who is psychiatrically disabled. Assist them in redefining roles, responsibilities, and functions within the family. Teach them how to navigate the mental health system to obtain treatment and locate sources of emotional and financial support. If necessary, help them locate respite care to prevent caregiver burnout. Teach them locate respite care to cope with deficit behaviors and intrusive or acting out behaviors by their loved one. Discuss stigma and ways to respond to prejudice from individuals, from communities, and from state and federal legislative branches as health care resources are allocated. Act as an advocate in preventing family exclusion as a member of the team, all of whom work together to support the individual in living the fullest life possible.

Evaluation
Living with losses is a normal but very stressful part of life. When coping with loss through grieving or mourning, people may respond in adaptive or maladaptive ways. Some never loss their sense of despair. In the face of this overwhelming negativism, family and friends often avoid the despairing person. Others are able to move though the process and focus on positive achievement and celebrate the relationship that was or is now. Family and friends find delight in sharing this positive process.
Some nurses have difficulty dealing with loss and death since they view the essence of caring as supporting life process. To accept death as a process of life enables other nurses to support people through this final stage of growth. To be effective caregivers, nurses must be willing to talk openly about death as well as accept their own mortality. As Hoff (1989 p. 418) states: “ A healthy attitude toward our own death is our powerful asset in assisting the dying through this final life passage and comforting their survivors.”