Grief & Loss

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  1. Kubler-Ross's Stages of Grieving:
    Stages I-V
  2. Stage I:
  3. Stage II:
  4. Stage III:
  5. Stage IV:
  6. Stage V:
  7. Shock and disbelief
  8. May be expressed toward God, family, or providers of care.
  9. Asks God or fate for more time.
  10. With awareness of finality.
  11. Coming to terms with death.
  12. D
    • D - Denial
    • A - Anger
    • B - Bargaining
    • D - Depression
    • A - Acceptance
  13. Maslow's Hierarchy of Needs and "losses"

    Losses such as an amputation
    • Physiological losses
  14. Maslow's Hierarchy of Needs and "losses"

    Loss of a safe environment as with domestic violence
  15. Maslow's Hierarchy of Needs and "losses"

    Loss of security and a sense of belonging such as...
    loss of a loved one.
  16. Maslow's Hierarchy of Needs and "losses"

    Loss of self esteem such as...
    a change in how one is valued or perceived
  17. Maslow's Hierarchy of Needs and "losses"

    Loss of self-actualization threats to...
    goals and potentials.
  18. Length of grieving process:
    One year.
  19. Time may vary and is defined as completed when:
    The bereaved can remember (their loss) in a healthy context.
  20. Acute phase of grieving process typically lasts how long:
    6-8 weeks.
  21. Factors that add to difficulty with grieving:
    • Dependency issues
    • Cumulative losses
    • Loss of a young person
    • Strained relationships
    • Poor support systems
    • Unexpected loss
    • Bereaved person's state of health is poor or they feel "responsible"
    • Violent death
  22. Beneficial factors in dealing with a loss:
    • Intact support systems
    • Strong role as caretaker of loved one before their death
    • Preparation for the loss of anticipatory grieving.
  23. Typical physiological responses to grief:
    • Insomnia
    • Headaches
    • Impaired appetitie
    • Weight loss
    • Lack of energy
    • Palpitations
    • Indigestion
    • Changes in the immune and endocrine system
    • Sleep disturbances (most common)
  24. Normal grieving may include:
    • Feelings of sadnes, anxiety, guilt, and/or anger
    • Thoughts of confusion, hopelessness and/or preoccupied.
    • Oversensitive to stimuli
    • Depersonalization
  25. Depersonalization is:
    Feeling unreal or de-realization where they see or talk to the deceased.
  26. Grief over a loss that is not or cannot be acknowledged openly, mourned publicly, or supported socially.
    Disenfranchised grief
  27. The relationship was not recognized or supported socially such as same-sex marriage, unmarried couples.
    Disenfranchised grief
  28. The loss was not recognized such as prenatal death, loss of a pet, job loss, divorce, or placing a child for adoption.
    Disenfranchised grief
  29. The griever is not recognized as in cases with nurses or other caregivers.
    Disenfranchised grief
  30. Which type of grief is an unexpected response as outlined by prolonged periods of grieving or the grieving is disproportionate in intensity.
    Complicated grieving
  31. The bereaved person remains fixed in the denial stage.
    Delayed or inhibitied grief
  32. Instead of normal grieving the bereaved may avoid discussions about the deceased, immerse themselves in work, or immerse themselves in others problems.
    Delayed or inhibited grief
  33. Their grief may be triggered spontaneously or with a subsequent loss - may see "overreaction to others losses"
    Delayed or inhibited grief
  34. Causes may be ambivalence, poor resources, or trying to maintain "normal" appearances.
    Delayed or inhibited grief
  35. All symptoms associated with grief are exaggerated.
    Distorted (exaggerated) grief response
  36. The person is "dysfunctional" and often self-destructive.
    Distorted (exaggerated) grief response
  37. The bereaved person remains in the anger stage.
    Distorted (exaggerated) grief response
  38. Their anger may be toward others or turned inward.
    Distorted (exaggerated) grief response
  39. This grief is difficult to assess but may be considered with behaviors.
    Chronic or prolonged grief
  40. Maintains personal possessions aimed at keeping the lost one alive.
    Chronic or prolonged grief
  41. Disabling behaviors prevent the bereaved from normal activities of daily living.
    Chronic or prolonged grief
  42. Intense preoccupation with memories of the deceased
    & Loss of self-identity
    Chronic or prolonged grief
  43. Additional types of abnormal grieving:
    • Absence of grieving
    • Suicidal
    • Self-neglect
    • Drug and alcohol abuse
  44. General interventions for grieving patients:
    • Facilitate their movement through the process
    • Decrease their "negative" emotional symptoms
    • Ensure that their physical and spiritual needs are met
    • Promote independence
    • Provide resources
  45. Normal VS. Maladaptive Grieving:
    • Marked feelings of "worthlessness"
    • Normal grief does not interfere with the bereaved person's self esteem
    • Depression is identified when the bereaved person experiences guilt and worthlessness
  46. Usually with maladaptive grieving the patient may come out with a disorder/mental illness.
  47. Communication skills that are useful wit grieving patients:
    • Refer to the loved one by name
    • Simple and nonjudgemental
    • Consider using therapeutic touch
    • Be honest, consistent and trustworthy
    • Don't expect to have all the answers
    • Silence is effective in many cases
    • Respect their unique form of grieving
    • Respect their own personal beliefs
    • Slow down and realize that this process takes time.
  48. The Patient and Family Value Directed Model of Care:
    • Accepts grief and bereavement as normal
    • Guides patients and families through life closure and completion tasks
    • Uses primary prevention (avoiding complicated grief)
    • Focuses on the survivor and uses a holistic approach
  49. Nurse's Role summarized:
    • 1. Adequate perception regarding their loss
    • 2. Adequate support while they are grieving
    • 3. Adequate coping behaviors during the process.
  50. Self care issues:
    • Nurses are exposed to death frequently and this could put them at risk for unresolved grief and bereavement overload.
    • Recommended to use colleagues as one type of support system
    • Person's with control issues and confrontational coping styles were at risk.
  51. Other self care issues:
    • Watch for use of escape and avoidance strategies - consider professional help with necessary
    • Consider alternative therapies such as journaling, exercise, yoga
    • Encourage employers to establish quiet areas for staff to congregate and meditate. Request applicable in service training.
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Grief & Loss
2012-02-15 01:54:57
Grief Loss

Grief & Loss
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