Chapter 10 Grief & Loss

Question 1

Grief

Answer 1

Refers to the subjective emotions and affect that are a normal response to the experience of loss

Question 2

Grieving

Answer 2

AKA Bereavement

Refers to the process by which a person experiences the grief

Involves not only the content (what a person thinks, says, and feels) but also the process (how a person thinks, says, and feels)

Question 3

Anticipatory Grieving

Answer 3

When people facing an imminent loss begin to grapple with the possibility of the loss or death in the near future
Ex) Patient w/ terminal illness

Question 4

Mourning

Answer 4

The outward expression of grief

Rituals of mourning include having a wake, sitting shiva, holding religious ceremonies, and arranging funerals.

Question 5

Maslow’s Hierarchy of Needs

Answer 5

When these human needs are taken away or not met for some reason, a person experiences loss

The hierarchy begins with physiological needs: Food, air, water, sleep

Safety needs: Aa safe place to live and work, and

Security and Belonging needs: satisfying relationships

Self-esteem needs: Lead to feelings of adequacy and confidence.

The last and final need is self-actualization: The ability to realize one’s full innate potential

Question 6

Physiological Loss

Answer 6

Examples include amputation of a limb, a mastectomy or hysterectomy, or loss of mobility

Question 7

Safety Loss

Answer 7

Loss of a safe environment is evident in domestic violence, child abuse, or public violence
- A person’s home should be a safe haven with trust that family members will provide protection, not harm or violence

Some public institutions, such as schools and churches, are often associated with safety as well.
- That feeling of safety is shattered when violence occurs on campus or in a holy place

Question 8

Security & Belonging Loss

Answer 8

The loss of a loved one affects the need to love and the feeling of being loved

Loss accompanies changes in relationships, such as birth, marriage, divorce, illness, and death
- As the meaning of a relationship changes, a person may lose roles within a family or group

Question 9

Self-Esteem Loss

Answer 9

Any change in how a person is valued at work or in relationships or by themself can threaten self-esteem.

It may be an actual change or the person’s perception of a change in value.

Death of a loved one, a broken relationship, loss of a job, and retirement are examples of change that represent loss and can result in a threat to self-esteem.

Question 10

Loss Related to Self-Actualization

Answer 10

An external or internal crisis that blocks or inhibits striving toward fulfillment may threaten personal goals and individual potential.

Ex) A person who wanted to go to college, write books, and teach at a university reaches a point in life when it becomes evident that those plans will never materialize

Ex) A person loses hope that they will find a mate and have children.

Question 11

Elisabeth Kubler-Ross

Answer 11

Established a basis for understanding how loss affects human life.

As she attended to clients with terminal illnesses, a process of dying became apparent to her.

Through her observations and work with dying clients and their families, Kübler-Ross developed a model of five stages to explain what people experience as they grieve and mourn

Question 12

Kubler-Ross’s Stages of Grieving

Answer 12

1) Denial is shock and disbelief regarding the loss.

2) Anger may be expressed toward God, relatives, friends, or health care providers.

3) Bargaining occurs when the person asks God or fate for more time to delay the inevitable loss.

4) Depression results when awareness of the loss becomes acute.

5) Acceptance occurs when the person shows evidence of coming to terms with death

Question 13

Grieving Tasks: “The 6 R’s”

Answer 13

1) Recognize: Experiencing the loss, understanding that it is real, and that it has happened

2) React: Emotional response to loss, feeling the feelings

3) Recollect and reexperience: Memories are reviewed and relived

4) Relinquish: Accepting that the world has changed (as a result of the loss) and that there is no turning back

5) Readjust: Beginning to return to daily life; loss feels less acute and overwhelming

6) Reinvest: Accepting changes that have occurred; reentering the world, forming new relationships and commitments

Question 14

Acculturation

Answer 14

Altering cultural values or behaviors as a way to adapt to another culture

Question 15

Disenfranchised Grief

Answer 15

Grief over a loss that is not or cannot be acknowledged openly, mourned publicly, or supported socially

Question 16

Circumstances that can result in disenfranchised grief include the following

Answer 16

A relationship that has no legitimacy
The loss itself is not recognized
The griever is not recognized
The loss involves social stigma

Question 17

Complicated Grieving

Answer 17

Occurring when a person is void of emotion, grieves for prolonged periods, or has expressions of grief that seem disproportionate to the event

People may suppress emotional responses to the loss or become obsessively preoccupied with the deceased person or lost object.

Others may actually suffer from clinical depression when they cannot make progress in the grief process.

Previously existing psychiatric disorders may also complicate the grief process, so nurses must be particularly alert to clients with psychiatric disorders who are grieving

Question 18

Characteristics of Susceptibility to Complicated Grieving

Answer 18

Low self-esteem
Low trust in others
A previous psychiatric disorder
Previous suicide threats or attempts
Absent or unhelpful family member
An ambivalent, dependent, or insecure attachment to the deceased person

An especially strong, rewarding relationship with the deceased person
- In a strong, rewarding relationship, the remaining partner cannot envision going on with life without the lost partner

Question 19

Ambivalent Attachment

Answer 19

At least one partner is unclear about how the couple loves or does not love each other

Ex) When a person is uncertain about and feels pressure from others to have an abortion, they are experiencing ambivalence about their unborn child

Question 20

Dependent Attachment

Answer 20

One partner relies on the other to provide for their needs without necessarily meeting the partner’s needs

Question 21

Insecure Attachment

Answer 21

Usually forms during childhood, especially if a child has learned fear and helplessness (i.e., through intimidation, abuse, or control by parents)

Question 22

Risk Factors Leading to Complicated Grief Vulnerability

Answer 22

Death of a spouse or child

Death of a parent (particularly in early childhood or adolescence)

Sudden, unexpected, and untimely death

Multiple deaths

Death by suicide or murder

Sudden and violent losses, including natural or human-made disasters, military losses, terrorist attacks, or killing sprees by an individual, are all more likely to lead to prolonged or complicated grief

Question 23

Adaptive Denial

Answer 23

The client gradually adjusts to the reality of the loss, can help the client let go of previous (before the loss) perceptions while creating new ways of thinking about themself, others, and the world

While taking in the loss in its entirety all at once seems overwhelming, gradually dealing with it in smaller increments seems much more manageable.

The person may have had assumptions about how others should act or respond to the loss, but those assumptions proved incorrect