Sabtu, 19 Desember 2009
VI. THE NURSING PROCESS
1. Assessment
Nursing assessment of the client experiencing a loss includes three major components:
a. Nursing history
b. Assessment of personal coping resources
c. Physical assessment
Assessment Interview
Previous Lossess
« Have you ever lost someone or something very important to you ?
« Have you or family ever moved your home ?
« What was it like for you when you first started school ?
Moved away from home ? Got a job ? Retired ?
« Are you physically able to do all the things you used to do ?
« Has anyone important or close to you died ?
« Do you think there will be any losses in yor life in the near future ?
If there is a current loss :
« What have you been told about (the loss) ? Is ther anything else you would like to know or don’t understand ?
« What changes do you thing this (illness, surgery, problem) will cause in your life? What do you think it will be like without (the lost object) ?
« Have u ever experience a loss like this before ?
« Can you think of anything good that might come out of this ?
« What kind of help do you think you will need ? Who Is going to be helping you with this loss ?
« Are there any people or organizations in your community that might be able to help ?
2. Diagnosing
Nursing diagnoses (NANDA, International, 2003) relating specifically to grieving include the following :
« Anticipatory Grieving: Intellectual and emotional responses and behaviors by which individuals, families, communities work through the process of modifying self concepts based on the perception of potential of loss.
« Dysfunctional Grieving : Extended, unsuccessful use of intellectual and emotional responses and behaviors by which individuals, families, communities attempt to work through the process of modifiying self concept based on the perception of loss.
Other diagnoses may include:
« Interrupted family processe if the loss has such impact on the individual and family that ususal effective roles and interactions are negatively affected.
« Impaired adjustment if the client has great difficulty placing the loss in appropriate to his or her other life activities.
« Risk for loneliness related to the loss of relationships with others.
3. Planing
The overall goals for clients:
« To adjust to the changed ability
« To redirect both physical and emotional energy into rehabilitation
« To remember that person without feeling intense pain
« To redirect emotional energy into one’s own life and adjust to the actual or impending loss.
Planning Home Care
Clients who have sustained or anticipate a loss may require ongoing nursing care to assist them in adapting to the loss:
« The determination of how much and what type of home care follow-up is needed is based in great part on the nurse’s knowledge of how the client and family have coped with previous losses.
« In preparation, the nurse reassesses the client’s abilities and needs.
4. Implementing
Stages Nursing Implication :
1. Denial
« Verbally support client’s denial for its protective function.
« Examine own behavior to ensure not sharing in client’s denial.
2. Anger
« Help client understand that anger is a normal response to feelings of loss and powerlessness.
« Avoid withdrawal or retaliation with anger; do not take anger personality.
« Deal with needs underlying any angry reaction.
« Provide structure and continuity to promote feelings of security.
« Allow client as much control as possible over life.
3. Bargaining
« Listen attentively, and encourage client to talk to relieve guilt and irrational fears.
« If appropriate, offer spiritual support.
4. Depression :
« Allow client to express sadness.
« Communicate noverbally by sitting quietly without expecting conversation.
« Convery caring by touch, if appropriate.
« Help persons understand importance of being with client in silence.
5. Acceptance :
« Help family and friends understand client’s reduced need to socialize and need for short, quite visits.
« Encourage client to participate as much as possible in the treatment program.
5. Evaluating
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.
« Did the client has been spontaneously express his/her feelings ?
« Did the client can explained the loss meaning of his/her life ?
« Did the clinet had a support system to expressed the feeling (friends,families,groups, and other communities) ?
« Did the client have had acceptance signs ?
« Did the client can respected a new relationship with other person ?
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