NURSING INTERVENTIONS FOR PATIENT AND FAMILY EXPERIENCING

LOSS, GRIEF, or DEATH

Nursing Assessment of the client experiencing loss:
1. Nursing History - If there is a current or recent loss
2. Assessment of personal coping resources
3. Physical Assessment
Effective Communication for loss and grief:
- The skills most relevant to situation of loss and grief:
1. Attentive listening
2. Silence
3. Open and closed questioning
4. Paraphrasing
5. Clarifying and reflecting feelings
6. Summarizing
- Less helpful to clients are:
1. Responses that give advice and evaluation
2. Interpret and analyze
3. Give unwarranted reassurance
- Communication with grieving clients needs to be relevant to their stage of grief because it
affects how the client hears message and how the nurse interprets the clients statements.
Facilitating Grief Work
1. Explore and respect the clients and familys ethnic, cultural, religious, and personal
values in their expressions of grief.
2. Teach the client or family what to expect in the grief process, such as that certain thoughts
and feeling are normal.
3. Encourage the client to express and share grief wit support people.
4. Teach family members to encourage the clients expression of grief. If the client is a child,
encourage family members to be truthful and to allow the child to participate in the
grieving activities of others.
5. Encourage client to resume normal activities on a schedule that promotes physical and
psychologic health.
Providing Emotional Support
1. Use silence and personal presence along with techniques of therapeutic communication.
2. Acknowledge the grief of the clients family and significant others.
3. Offer choices that promote client autonomy.
4. Provide appropriate information regarding how to access community resources: clergy,
support groups, counseling services.
The major nursing responsibility for clients who are dying is to assist the client to a peaceful death.
More specific responsibilities are the ff.:
1. To provide relief from loneliness, fear, and depression
2. To maintain the clients sense of security, self-confidence, dignity, and self-worth
3. To help the client accept losses
4. To provide physical comfort

 Helping client dies with dignity - That is with honor and respect
1. It involves maintaining their humanity, consistent with their values, beliefs and culture.
2. Introducing options available to the client and significant others. Some choices that clients
can make are the location of care, time of appointments with health care professionals,
activity schedule, use of health resources, and time of visits from relatives or friends.
3. Help clients to determine their own physical, psychologic, and social priorities.
4. Supports the clients will and hope.
5. Discussion about death for both the nurse and the client strategies:
a) Identify personal feelings about death and how they may influence interactions with
clients.
b) Focus on the clients needs.
c) Talk to the client or the family about how the client usually copes with stress.
d) Establish a communication relationship that shows concern for and commitment to the
client. Communication strategies that the client know you are available to talk about
death:
i. Describe what you see
ii. Clarify your concern
iii. Acknowledge the clients struggle
iv. Provide a a caring touch
e) Determine what the client knows about the illness and prognosis.
f) Respond with honesty and directness to the clients question about death.
g) Make time to be available to the client to provide support, listen, and respond.
Meeting the Physiologic Needs of the Dying Client
- The physiologic needs of people who are dying are related to slowing of body processes and to
homeostatic imbalances. Interventions include:
1. Providing personal hygiene measures
2. Controlling pain
3. Relieving respiratory difficulties
4. Assisting with movement, nutrition, hydration and, elimination
5. Providing measures related to sensory change
Physiologic Needs of the Dying Client and the Nursing care

Problem

Nursing Care

Airway clearance

Fowler's position: Conscious clients.

Throat suctioning: Conscious
Lateral Position: Uconscious clients.
Nasal O2 for hypoxic clients

Bathing/hygiene

Frequent baths & linens changes if diaphoretic.

Mouth care as needed for dry mouth.
Liberal use of moisturizing creams & lotions for dry skin. Moisturebarrier for incontinent client.

Physical mobility

Nutrition

Constipation

Urinary
elimination

Sensory/
perception
changes

Assist client out of bed periodically, if client is able.

Regularly change bedridden client's position.
Support client's position with pillows, blanket rolls, or towels as needed.
Elevate client's legs when sitting up.
Implement pressure ulcer prevention program & use pressure-relieving s
urface as indicated.
Antiemetics or a small amount of an alcoholic beverages to stimulate
appetite.
Encourage liquid foods as tolerated.
Dietary fiber as tolerated.
Stool softeners or laxatives as needed.
Skin care in response to incontinence of urine or feces.
Bedpan, urinal, or commode chair w/in easy reach.
Call light w/in reach for assistance onto bedpan or commode.
Absorbent pads placed under incontinent client; linen changed as often
as needed.
Catheterization, if necessary.
Keep room as clean & odor as free as possible.
Check preference for a light room.
Hearing is not diminished; speak clearly and do not whisper.
Touch is diminished, but client will feel pressure of touch.
Implement pain mgt. protocol if indicated

Providing Spiritual Support

1. The nurse has a responsibility to ensure that the clients spiritual needs are attended to,
either through:
a) Direct intervention, or
b) Arranging access to individuals who can provide spiritual care.
2. Facilitate of expressions of feeling, prayer, meditation, and reading
3. And facilitate of the discussion with the appropriate clergy or a spiritual adviser.
4. Family should be encouraged to participate in the physical care of the dying person as much
as they wish to and are able. Nurse can suggest they assist with bathing, speak or read to
the client, and hold hands.
5. Those family members who feel unable to be with the dying person also require support from
the nurse and from the other family members.
6. After the client dies, the family should be encouraged to view the body, to facilitate the
grieving process.
* They may wish to clip a lock of hair as a remembrance
7. Children should be included in the events surrounding the death if they wish to.
Lifespan considerations
Elders who are dying often have a need to know that their lives had meaning. An excellent way
to assure them of this is to make audiotapes or videotapes of telling stories of their lives. This
gives the client a sense of value and worth and also let him/her know that family members and

friends also benefit from it.

REFERENCE:
Kozier, B., Erb, G., Berman, S., & Snyder, S.. Fundamentals of Nursing: Concepts, Process, and
Practice. New Jersey: Pearson Education, Inc.. 7th Edition. Pages 1039,1041,1050-1052.

Prepared by:

GLECYL MARIE B. ESQUILLA

BSN 3C

PROF. ROSARIO M. LUDOVICE

ELECTIVE 1-N: HOSPICE PALLIATIVE CARE