Mental Health Nursing I
NURS 1300
Unit VIII
Spirituality, Death, and Grief
Objective 1
Discuss the basic concepts of
spirituality
Spirituality = searching for meaning in
events that may be either joyous or
tragic, and consists of
transcendence, connection, balance,
and purpose
Transcendence = finding meaning
larger than the person’s individual
self and life
Objective 1 (cont’d)
Connection = the integration of all the
aspects of being human, which
include the self, other people, the
surrounding world, and, for some, a
supreme being
Balance = harmony with self, others,
and nature
Objective 1 (cont’d)
Purpose = a person’s understanding of
the impact of his or her life and
includes the understanding of the
impact of his or her life and includes
the understanding of life events
Religion = the system of beliefs and
practices that usually involves a
community of like-minded people
Objective 1 (cont’d)
The terms religion and spirituality
are not necessarily interchangeable
 People with strong spiritual beliefs
and lives may not be “religious”
individuals
 Differentiation important because
clients’ spirituality needs should be
assessed even if they are not
affiliated with a formal religion
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Objective 2
Describe beliefs and practices related
to dying and death
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Bereavement practices can be greatly
influenced by cultural and religious
beliefs
Nurses should know what the client’s
beliefs are in order to provide
culturally sensitive care
Objective 3
Describe responses of clients and their
families to terminal illness and
impending death
Awareness of terminal illness
 closed awareness
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mutual pretense
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family and patient recognize patient is ill
lack of awareness related to impending death
patient, family, and care providers know of the
terminal prognosis
no one discusses the issue openly
people make every effort to avoid the subject
open awareness
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preferred by health care providers
patient and others involved freely discuss
impending death
Fears associated with terminal illness and death
 fear of pain
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fear of loneliness
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tendency to associate death with pain
pain control measures should be available to client to
relieve pain and discomfort
most terminally ill patients don’t want to be alone
many patients are afraid they will be abandoned by
loved ones who can’t cope with imminent death
fear of meaninglessness
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life review
examination of actions and expression of regrets about
what might have been
patients need to look at positive aspects of their lives
the worth of the dying person needs to be expressed
Objective 4
Identify nursing measures appropriate
for the terminally ill client
Nursing Assessment
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Limited to essential data
Abbreviated physical assessment
Neurological assessment important
Nursing Interventions
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Open discussion of feelings
Nonjudgmental listening
Patient/family teaching
 grief response is normal
 honesty in answering questions and
giving information
Demonstrate respect for patient’s
privacy and need to talk (or not to
talk)
Nursing Interventions (cont’d)

Encourage realistic hope within limits
of the situation
feelings of hopelessness and
powerlessness common in terminal illness
 allow patient and family to identify and
deal with what is within their control
 patient-identified goals can be
encouraged to restore sense of power
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Physical care

maintenance of physical needs/comfort
Objective 5
List categories of loss
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Change in self-image
Developmental changes
Loss of possessions
Loss of significant others
Objective 6
Discuss factors which influence a grief
reaction
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Developmental considerations
Religious and cultural beliefs
Relationship with the lost entity
Cause of death
Objective 7
Discuss age-related beliefs about
death
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Infancy to 5 years (preschool)
little or no understanding of death
 death is temporary and reversible, like
sleep
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6-9 years (school age)
death is final
 own death can be avoided
 death is related to violence
 wishing or hoping for death can make it
happen
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Objective 7 (cont’d)
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10 to 12 years (preadolescent)
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death is an inevitable end to life
grasps own mortality by discussing fear of death
or life after death
expresses feelings of death based on adult
attitudes
13 to 18 years (adolescent)
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afraid of prolonged death
may act out defiance for death through
dangerous or self-destructive acts
has a philosophical or religious approach to
death
seldom thinks about death
Objective 7 (cont’d)
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19 to 45 years (young adulthood)
cultural and religious beliefs influence
attitudes
 death is seen as a future event
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45 to 65 years (middle adulthood)
accepts own mortality as inevitable
 faces death of parents and peers
 may experience death anxiety
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Objective 7 (cont’d)
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65 years and older (older adulthood)
afraid of prolonged health problems
 faces death of family members and peers
 sees death as inevitable
 examines death as it relates to various
meanings, such as freedom from
discomfort
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Objective 8
Explore the nurse’s response to
working with the terminally ill client
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Not immune to feelings of loss when
caring for terminally ill or dying clients
Feelings of helplessness and
powerlessness when dealing with death
Need to express feelings of sorrow,
guilt, and frustration
Must be able to identify what can and
can not be controlled
Objective 9
Define the following terms:
anticipatory grief, grieving process,
denial, palliative, hope, hospice, loss,
and respite care
Anticipatory grief = the occurrence of grief
work before an expected loss
Grieving process = a total individual
experience associated with thoughts,
feelings, and behaviors that is usually
most profound when the loss experienced
is death
Denial = refusal to acknowledge a loss;
serves to protect the patient, family, or
both from the reality of the loss
Palliative = care provided for the sole
purpose of providing comfort to the client
rather than curing any problems
Hope = a belief in a positive outcome
related to events and circumstances in
one’s life
Hospice = a type of care for the terminally
ill which allows individuals to die with
dignity and be surrounded by those who
love them; clients enter hospice care
when aggressive medical treatment is no
longer an option or when the client
refuses further aggressive medical
treatment
Loss = the real or potential absence of
someone or something that is valued
Respite care = the temporary care of an
aged or disabled person provided on
behalf of and in the absence of the usual
caregiver to allow that caregiver relief
from the stresses and responsibilities of
providing continued care