c. Bargaining: The patient tries to barter for more
time.
d.Depression: The patient goes through a period
of grief before death.
e.Acceptance: The patient feels tranquil; he/she
has accepted death and is prepared to die.
3.As soon as possible, the patient should be told her
diagnosis and prognosis, how the disease is likely
to progress, and what this will mean for her.
4.Answers will vary with student’s experiences.
5.Nursing’s role is to participate in the decision-making
process by offering helpful information about the
benefits and burdens of continued ventilation and
description of what to expect if it is initiated. Sup-
porting the patient’s family and managing sedation
and analgesia are critical nursing responsibilities.
6.Sample answers:
a.Communicate openly with patients about their
losses and invite discussion of the adequacy of
their coping mechanisms.
b.Respond genuinely to the concerns and feelings
of dying patients and their families; do not be
afraid to cry with the patient and to allow feel-
ings to show.
c. Value time spent with patients and family
members in which supportive presence is the
primary intervention.
7.Sample answers:
a.The patient shall make healthcare decisions
reflecting his values and goals.
b.The patient shall experience a comfortable and
dignified death.
c. The patient and family shall accept need for
help as appropriate and use available resources.
8.Sample answers:
a.In favor of: It is a beneficent and compassionate
act. It takes the matter outside the reach of
“medical power” and scrupulosity. It respects
autonomy by preserving the patient’s control of
the manner, method, and timing of death.
b.Against: It undermines the value of, and respect
for, all human life. A focus on euthanasia will
divert attention from other valuable palliative
techniques. If legalized, it is predicted patients
will feel a subtle pressure to conform in order to
relieve the economic and emotional burdens
they impose on family and friends.- a.No-code: If a physician has written DNR on the
chart of a patient, the patient or surrogate has
expressed a wish that there be no attempts to
resuscitate the patient in the event of a
cardiopulmonary emergency. The nurse must
clarify the patient’s code status.
b.Comfort measures only: Nurses should be
familiar with the forms used to indicate patient
preferences about end-of-life care. The goal of a
comfort measures only order is to indicate that
the goal of treatment is a comfortable, dignified
death and that further life-sustaining measures
are no longer indicated.
c. Do-not-hospitalize orders: These orders are used
by patients in nursing homes and other
residential settings who have elected not to be
hospitalized for further aggressive treatment.
The nursing responsibilities would be the same
as for comfort measures only.
d.Terminal weaning: The nurse’s role is to partici-
pate in the decision-making process by offering
helpful information about the benefits and bur-
dens of continued ventilation and a description
of what to expect if terminal weaning is
initiated.- a.Durable power of attorney: Nurses must facili-
tate dialog about this advance directive, which
appoints an agent the person trusts to make
decisions in the event of the appointing
person’s subsequent incapacity.
b.Living will: Nurses must also facilitate dialog
about this advance directive, which provides
specific instructions about the kinds of health-
care that should be provided or avoided in par-
ticular situations.
APPLYING YOUR KNOWLEDGE
REFLECTIVE PRACTICE USING CRITICAL
THINKING SKILLS
Sample Answers
1.How might the nurse react to Ms. Malic in a manner
that respects her right to privacy while at the same
time helping her through the grief process?
The nurse should realize that Ms. Malic is
experiencing anticipatory loss and use this knowl-
edge to help her cope with the potential loss of her
baby. To develop meaningful communication, the
nurse must develop a trusting relationship with the
patient. The nurse needs to use open-ended
questions to elicit information and listen to Ms.
Malic, recognizing both her verbal and nonverbal
cues. The nurse should also be encouraging without
giving false reassurances. If she agrees to participate,
Ms. Malic would benefit from grief counseling.
2.What would be a successful outcome for this patient?
By next visit, Ms. Malic vocalizes her fears for her
baby and herself and lists the benefits of grief
counseling.
3.What intellectual, technical, interpersonal, and/or
ethical/legal competencies are most likely to bring
about the desired outcome?
Intellectual: ability to identify the impact that loss,
grief, and death and dying have on the patient and
his or her family members
Interpersonal: ability to establish trusting relation-
ships, even in times of great crisis related to antici-
patory loss
Ethical/Legal: commitment to safety and quality,
strong sense of responsibility and accountability,
and strong advocacy skills
4.What resources might be helpful for Ms. Malic?
Grief counseling, information on premature babiesCopyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing:ANSWER KEY 415
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