Introduction According to the fundamental of nursing (1992), Loss is defined as “The experiencing of parting with an object, person, belief, function or relationship that is valued”. When faced with a loss, crisis or life-changing event you are suddenly thrust into an unfamiliar world, one that can be frightening and unsettling. Loss can be categorized as subjective or objective material or psychological, expected or unexpected, actual or perceive. In this study the loss and life changing experience by Mrs Mendis and possible coping strategies will be highlighted.
Mrs Mendis a 79 year old client experienced material and objective loss when she was no longer able to mobility, and dependent entirely on a wheel chair to move around. In addition, material loss was also experience when she was relocated to a continuing care facility and also her loss of speech. On the other hand she experienced subjective and psychological loss at the death of her husband and the loss of social relationship with her church family and family member; all these losses were unexpected and contributed to several changes in her life.
These changes include a new environment with new people and new method of surviving, example use of wheel chair and having others perform activities of daily living. The Newman’s System model supports a holistic approach and would be of help in addressing Mrs Mendes Psychological and physical needs. The Newman Model System will be integrated into a plan of care for Mrs Mendes. In advocating for Mrs Mendes, the researcher would recommend that she returned to her home and a familiar care giver will be provided.
The reason for this is that being in a familiar environment with familiar faces will lessen the degree of depression or anxiety that Mrs. Mendes will face. In addition the researcher would identify activities she once performed on a regular basis (gardening and going to church) and creates these circumstances regularly. Taking client to the garden regularly and keeping church service in her room will minimize her anxiety and keep her hope alive. Diagnosis Possible nursing diagnosis for Mrs.
Mendes include impaired verbal communication related to slurred speech; ineffective individual coping related to loss of ability to perform activity of daily living; impaired physical mobility related to severe neurological dysfunction; high risk for physical injury related to confusion and disorientation; hopelessness related to deteriorated physical condition; anxiety related to loss of control; and normal grieving related to loss of significant person evidenced by withdrawal, crying and calling her husband.
Goal Based on the above diagnosis the expected outcome for Mrs. Mendes follows: Within three months Mrs. Mendes will experience no physical injury; increase range of motion and muscular strength; decrease anxiety and hopelessness; increased coping and communication skills; decreased crying spells and express a willingness to socialize. She will also begin acceptable transition to life without her husband. Planning
In order to achieve these outcome the following strategy must be implemented: schedule and follow up physical therapy appointment; carry out daily range of motion exercises; administered prescribed analgesic before physical therapy and range of motion exercises; sit client out of bed daily; use restraining strap when sitting out in wheel chair; return client to bed before evening; use padded bed rails when client is in bed; use restraint as prescribed; schedule regular visit by church members, clergy, and family members; schedule and follow up appointment with counsellor; take client to garden regularly; schedule and follow up appointment with speech therapist; speak slowly and clearly to client and look directly into client eyes when communicating; employ counselling skill of empathy and positive regards; be non-judgemental; teach family members about the emotional needs of the client; provide appropriate reading material on the grieving process and allow discussions with persons having similar experience; and reinforce use of healthy coping skills and be nonjudgmental. Rationale Physical therapy and range of motion exercise are effective method of strengthen muscle and joint.
Strong muscle and joint promotes increase mobility. Likewise speech therapy of the correct speech deficit. In addition speaking slowly to client using eye contact and careful listening will encourage more effort from the client. Client with impaired physical mobility often experience pain, administering analgesic before treatment will increase client tolerant to the treatment. Use of restraining straps, padded bed rails and restraints as prescribed will limit the chances of injury. Meeting spritual and psychological needs promotes healthy responses to loss. Meeting with friends and finding new activity eases the emotional loss and give new meaning to life.
Counselling skills can be used to illicit unrecognized thoughts and feelings, identification with other bereaved person can be therapeutics. During a crisis a person may be too over whelmed to use his or her usual coping skills, therefore the nurse must help him/her to remember these skills. In addition been non-judgemental will allow the client be more open and acceptable to suggestions. EVALUATION At the end of the three months, Mrs. Mendes experienced no physical injury; became more sociable; demonstrates increased physical strength and mobility; began transition to new roles; communicates more effectively; experienced no further deterioration in physical health and accepts the reality of the loss of her husband.