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annie morel
grief process and interventions
| Question | Answer |
|---|---|
| Loss and change is a normal process--what are the different types of losses..? | identity lossmaturational losssituational lossactual lossperceived loss |
| What is identity loss? | loss of dignity and self worth and function--cold be a pet, job, death. |
| What is maturational loss? | last kiddo leaved for school |
| what is situational loss? | a sudden loss--car wreck |
| what is actual loss? | loss of a person or a body part |
| what is perceived loss? | indicidual--less obvious--loss of confidence |
| What is grief? | loss-intense feelings |
| What is bereavement? | a time after a loss-grief and mourning time |
| What is mourning? | process by which we adapt--rituals and rules of society |
| Grief, mourning and bereavement all vary from person to person in how they deal with it | |
| What is the purpose of grief? | to allow time for the individual to accept t loss |
| what process of responses fall under grief? | shock and disbelief (common), protest and disbelief (anger and frustration), emotionless cognitive activity (go to 1st planning of the funeral) yearning (missing the person disorganization (confusion and lacks clarity-wanders)rebuilding(adjustment life) |
| The grief processes are dynamic and changing and are not linear and are not the same for....? | everyone |
| Do the grief processes start before death occurs? | yes, sometimes |
| What are the theories of grief? | Lindeman, Engels. and Kubler Ross's |
| Lindeman was a pioneer in... | "grief work" |
| Lindeman was the forst to describe....? | the acute stmptoms of grief and he studied survivors and families in 1944 after the Coconut Grive Fire in Boston |
| What was Engels theory of grief? | Ther are 5 phases of grief |
| what are the 5 stages of grief? | initial phase-shock and disbelief2nd phase=developing awareness3rd phase-resolution4th phase-resolution of the loss5th phase-recovery |
| What happens in the initial phase? | the reality is too painful for the person to accept-numbness and denial of event |
| What happens in the 2nd phase? | emotional response as individual realizes the loss has occurred-emotional response is intense suffering, sobbing, hyperventilating signaling to others their need for support and concern |
| What happens in the 3rd phase? | work of grieving becomes incorporated, integrated, acceptance of loss into one's life |
| What happens in the 4th phase? | it is characterized by preoccupation with the loss. The loss is idealized this preoccupation usually decreased over a year or more as the person puts more energy into other areas of the environment |
| What happens in the 5th phase? | individuals start to go on with their life and the obsession with the loss has ended--reestablishemt of their life |
| What are Kubler Ross's stages of dying? | initalangerbargainingdepression acceptance |
| What happens in the first phase? | unconscious protection of self from painful reality and refusla to accept the loss--denial. May doctor shop to avoid confronting the diagnosis--defense mechanism |
| What happens in the 2nd phase? | attacking of others or blaming others in an attempt to be in control when one is feeling out of control--emotional response--why me? -may criticize staff or hostile behavior--displacing of anger |
| what happens in the 3rd phase? | starts to bargain and make arrangements in hopes of changing reality. If I can just live until my child wedding day then I will accept death... This stage indicates the beginning of acceptance. Between person and their God-knows going to happen prolongs |
| What happens in 4th phase? | the individual mourns for that which has been or will be lost. Very painful stage and the person must address feelings when having lost someone or something of value. Regression, withdrawal and social isolation may be observed iwth this phase |
| What happens in the 5th phase? | the person has worked through the previous stages and either accepts the loss or has become resigned to the loss. Coping methods for dealing with the loss have been established as anxiety diseases. person starts to become interested in environment |
| Is the 4th phase the longest and most painful? | yes--possible suicidal or triggers |
| The 5th phase the person has... | accepted it or not and there should be decreased anxieties |
| What are types of grief? | anticipatoryacute or normaldysfunctional(complicated)disnfranchised (unsupported) |
| what happens in anticipatory grief? | premourning-there is a catastrophic diagnosis and risk from WD from family and risk for depression |
| What happens in acute or normal grief? | not chronic depression-normal sadness and pain lessens over time-always a scar there- wound will heal |
| What happens in dysfunctional or complicated grief? | lasts longer-greater disability,^suicide, ^depression |
| With dysfunctional grief, there are 4 categories -what are they? | traumaticabsent or inhibitedconflictedchronic |
| What is involved with traumatic grief? | sudden violent loss-PTSD comlicates it |
| What is involved with absent or inhibited grief? | minimal expression-cannot express feelings and are delayed b/c of culture or related person says that they can handle ANYTHING! |
| What is involved with conflicted grief? | abusive realtionships-the abuser passes away and the abused feels as though they need to take care of them |
| What is involved with chronic grief? | unresolved grief co-dependent couple-one pasees and there is a loss of support or resources with that person--multiple losses in a short time...dementia, child with reatardation or loss is ongoing for parent or partner-disability and long-tern sorrow |
| What is involved with disenfranchised or unsuppored grief? | unsubstantiated grief-not socially sanctioned such as gays and affairs-persons cannot grieve the way they should in public |
| What are some variables that can afffect an individuals sense of a loss? | significance-the meaning of the loss to the personthe degree of preparation and past unresolved lossesnumber of recent lossesphysical healththe degree of ambivalence in the relationshipsupport systems availableconcurrent stressorsculture |
| Another variable....? | spirituality--would not fit above.. |
| These variables effect how a person is able to....? | COPE!!! |
| What are some responses to grief and loss? | physicalcognitivebehavioraland relatingaffective (emotional) |
| What are the physical S/S loss and grief? | weakness, anorexia, feelings of choking, SOB, tightness in chest, dry mouth, GI disturbances, physical state of grief can place a person at risk for health problems, panic states, lose breath, more vulnerable as a whole person |
| What are the cognitive S/S of loss and grief? | This involves the preoccupation with the deceased person--conversations, halluciantions, (with deceased) and difficulty concentrating |
| Are the hallucinations and conversation with the deceased healthy? | yes only if it does not go on for too long--momentary glimpses and hearing their voices is a healthy response but needs to be evaluated if too long (usually with life partners) |
| What are the behavioral S/S of loss and grief? | Axis IV areas that may or may not be directly related to grief-- |
| These are.....? | death of a family memberhealth problems in familyinadequate social supportadjustment to life-cycle transitioninadequate financesmarital difficulties |
| What are the affective S/S of loss? and grief? | usually overwhelmed with sadness, guilt, loneliness, hopelessness, and anger-EMOTIONAL! |
| Why would a person experience guilt? | surviving an accident someone did not |
| Anger comes from....? | being powerless-feeling anxious--sometimes the anger is towards the members of the healthcare team |
| What is the pathway of guilt? | pre-loss, shock, the grief fog, the hard times, healing, new beginnings and living |
| What are possible reactions the nurse may have to pt's experiencing guilt? | may feel helpless and uncomfortable with what to saymay fear saying the wrong thing will cause the family/patient more painmay fear losing emotionsmay become detached from the dying pt to avoid the pain of losing them |
| What are some things to remember while doing the nursing assessment on those grieving? | assess the meaning of loss for the ptobserve the behaviors and other symptoms indicative of grief responsenote quality and extent of pt's family support system |
| What are some potential nursing diagnoses for acute grief? | Disturbed Personal Identitysituational low self esteemimpaired social interactionfearanxietyhopelessnessspiritual distresssocial isolationpowerlessness |
| what are some potential nursing diagnoses for dysfunctional grief? | risk for self-directed violencecomplicated grieving |
| what are some potential nursing diagnoses for chronic sorrow? | Caregiver rolse strainanticipatory grieving |
| what are some important patient outcomes? | verbalize absence of suicidal ideationsexpress guilty or angry feeling related to the deathexpress positive and neg feelings about deceased rather than the qualities of the deceasedexplore the relationship wth the deceased both pos and neg feeling |
| soem more patient outcomes ? | formulate reasonable plans for adapting to life and the role rt to the current circumstancesparticipate in at least one social or community activity once a week |
| With dysfunctional grief what kinds of people fall into this category? | hermits--not wanting to go out.. |
| what should the nurse say? | I am sorry-sorry for your lossdo yo want to talk about itwhat hurts mostwhat are you feeling nowit is ok to crywhat can I get for you or do for you |
| what should the nurse not say? | at least they did not sufferit is all part of Gods planyou will get over iti know just how you feelwhy don't you just go out and have some fun |
| what are some nursing interventions? | accept grieving beavioruse open-ended questions and reflection to give opportunity to share feelings and concernsrecognizethat your tole may be to serve as an active listeneer if pt has need to vent feelings |
| what are some other interventions to facilitate mourning? | helo the pt to accept the loss is realsupport efforts to live without the deceased person or lossallow pt time to grieveencourage establishmetn of nwe relationshipsinterpret normal behaviorprovide continuing supportalert for ineff. coping |
| more interventions....? | health promotioncontact support services (spiritual too)support cultural and religious beliefs during the grief process |
| What are two aspects of caring for persons that are grieving? | Pharmacological and spiritual aspects |
| What are some pharmacological aspects of care and teatment? | sedatives and hypnotics may be used to reduce intense emotions and promote rest/sleep anti-depressants might be helpful in pts with prolonged or dysfunctional grief |
| What are some spiritual aspects of care and treatment? | grief can threaten spiritual beliefs and test faithnegative feelings can be interpreted as personal spirital failure |
| What is comprised of the evaluation? | the pt's ability ot continue to express feelings associated with the loss and related to the relationship with deceased. the expression of feelings should not only be about the loss itself but also rt to their relationship with the deceased person |
| evaluation....... | the pt's ability to develop effective coping mechanisms |
| What are some important aspects to undrstand when working with a child that is grieving? | include children in the process of griefchildren generally display grief differently than adultsmay use symbolic or non-verbal language to communicate their feelings related to the losstheir grief rx may be delayed b/c need time to assimilate loss |
| when working with children....? | encourage families to let teachers know about the loss and what the child may be experiencing |
| When working with the elderly and grief...? | loss of spouse is associated with higher morbidity and mortality2 months after death the elderly report more illness and greater use of meds and poor health ratingsthey face many losses-spouse, job,peers, financial status,health and mobility |
| when working with the elderly cont....? | grief can be masked by symptoms of dementia, depression, suicidal ideations, and substance abuse |
| Does the older adult adapt to losses better? | yes |
| What is the greatest loss? | a child or spouse |
| Kids nee more time to grieve true or false? | true |
| Should you encourage story telling with the older adult? | yes |
| Between school age children and adolescence there is a high risk for....? | substance abuse when trying to understand death |
Created by:
anniemorel
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