Loss & Grief (Fundamentals of Nursing, Chapter 36)

Vocabulary flashcards covering types of loss, forms of grief, theoretical models of bereavement, clinical signs of approaching death, advance directives, end-of-life decision-making, and postmortem nursing care from Chapter 36.

Actual Loss

The loss of a valued person, item, or status that can be recognized by others.

Necessary Loss

A loss related to the natural cycle of life that is anticipated, can still be intensely felt, and can be replaced by something different or better.

Situational Loss

An unanticipated loss caused by an unpredictable external event (such as a home burning down).

Perceived Loss

A loss defined internally by an individual that is not obvious or verifiable to others.

Maturational/Developmental Loss

A loss associated with normal life transitions (such as a child moving out of the parents' home) that helps develop coping skills.

Anticipatory Loss

A loss that is felt or experienced before the actual loss event occurs.

Normal Grief

An uncomplicated, common, and universal reaction to loss and death characterized by complex emotional, cognitive, social, physical, behavioral, and spiritual responses.

Anticipatory Grief

Grief that occurs prior to the actual loss or death, common in situations of prolonged or predicted loss, such as family members caring for someone with dementia or ALS.

Disenfranchised Grief

Grief that occurs when a relationship is not socially acceptable, cannot be shared openly, or seems of lesser significance (e.g., death of an ex-spouse, homicide, suicide, or terminated pregnancy).

Ambiguous Loss

A type of disenfranchised grief occurring when the lost person remains physically present but is psychologically unavailable, such as in cases of severe dementia or traumatic brain injury.

Complicated Grief

A prolonged, disruptive yearning for the deceased involving chronic sorrow and painful emotions that persist for more than $1\text{ year}$, making it significantly difficult to move forward.

Chronic Grief

A normal grief response that extends for an abnormally prolonged period, ranging from years to decades of intense grieving.

Exaggerated Grief

A grief response where an individual exhibits maladaptive or self-destructive behaviors, obsessions, or psychiatric disorders; patients experiencing this are at high risk for suicide.

Delayed Grief

A grief response that is postponed or suppressed because the initial loss was overwhelming, often triggered later by a second, less severe loss.

Masked Grief

A type of grief in which survivors develop disruptive behaviors that impair normal daily functioning without being consciously aware that these behaviors stem from an unresolved loss.

Kübler-Ross Model

A model describing five stages of dying and grief—Denial, Anger, Bargaining, Depression, and Acceptance—where the order and duration of stages vary per individual.

Rando’s "R" Process Model of Mourning

A six-phase framework of mourning consisting of: Recognize, React, Recollect and Re-experience, Relinquish, Readjust, and Reinvest.

"Death Rattle"

Audible, noisy respirations observed in patients nearing death, caused by the accumulation and pooling of thick secretions that the patient can no longer swallow or clear.

Cheyne-Stokes Respirations

An irregular breathing pattern alternating between periods of deep, rapid breathing (dyspnea) and temporary cessation of breathing (apnea), commonly seen as a sign of approaching death.

Living Will

A written advance directive specifying the type and aggressiveness of medical care a patient desires or refuses if they become incapacitated, as well as instructions regarding how they wish to be treated.

Durable Power of Attorney (POA)

A written legal document designating a healthcare surrogate or proxy to make medical decisions on behalf of the patient if the patient becomes unable to do so.

Palliative Care

Interprofessional, comprehensive care focused on symptom management, dignity, and holistic relief of physical, spiritual, and psychosocial distress for patients with incurable chronic or terminal conditions.

Hospice Care

Comprehensive comfort-oriented and dignified end-of-life care for patients with a medical prognosis of living $< 6\text{ months}$, including respite care and support services for surviving family members.

NURSE Technique

A therapeutic communication approach for loss and grief comprising Name (identifying the emotion), Understand, Respect, Support, and Explore (asking open-ended questions).

Postmortem Body Alignment

The nursing intervention of placing the deceased patient supine with a single pillow beneath the head, arms resting outside covers with palms facing downward, dentures inserted, and eyes/mouth closed.

Coroner's Case

A death that must legally be reported to the coroner or medical examiner, including deaths from accidents, suicide, homicide, illegal therapeutic practices, or occurring within $24\text{ hours}$ of hospital admission.

Slow-Code

An ethically controversial practice in which resuscitation efforts are intentionally delayed until revival measures are guaranteed to be ineffective.

Terminal Weaning

The gradual withdrawal of mechanical ventilatory support from a terminally ill patient, allowing natural death to take place.

Voluntary Cessation of Eating and Drinking (VSED)

An end-of-life decision in which a competent patient intentionally stops eating and drinking to hasten death.

Active Euthanasia

The direct administration of a lethal agent or substance (such as a medication overdose) to intentionally end a patient's life.

Passive Euthanasia

The withdrawal or withholding of life-sustaining medical treatments, allowing a terminally ill patient to die naturally from their underlying condition.

Palliative Sedation

The controlled administration of medications to intentionally lower a dying patient’s level of consciousness to suppress awareness of severe, intractable suffering.