Chapter 23 Flashcards
behaviors used to incorporate loss into one’s life
mourning
individuals response to loss
grief
superimposed losses without adequate time for grieving can create crisis known as…
bereavement overload
nurse responsibility of dealing with loss
help pts family adjust in a healthy manner
active and evolving process as one copes with grief
bereavement
life transitions in later life
- significant roles
- financial security
- independence
- physical health
- mental stability
- life - death
proposed dual processes model weaving loss and restoration
loss-restoration model
includes concentrated thinking about life before loss or with person and circumstances and events surrounding death or loss
loss oriented coping
includes death new things, distracting oneself from grief, assuming new roles, transcendence
restoration-oriented coping
model of grief
-physical and psychological manifestations
beginning
grief model
-day to day functioning may be altered
middle
grief model
-individual re emerges refocused and adjusted to the loss
end
loss response model
- impact
- functional disruption
- informing others
- engaging emotions
- reorganizing structures
- reframing memories
ways to move toward integration of the loss
- inform others
- each time the story is told it becomes more real
- movement toward a new steady state
typical grief progression
- chaos
- make sense out of chaos
- movement toward integration of loss
- engagement and expression of emotions
- role replacement
type of grief:
- response to real or percieved loss before it occurs
- may see sudden change in attitude toward the thing or person to be lost
- selling home or possessions, moving to nursing home
- preoccupation with the loss, detailed planning
anticipatory
type of grief:
- somatic and psychological changes occur
- often occurs in waves
- preoccupation with loss
- self blame or guilt may be present
- functional disruption
- simple things seem complex
acute grief
in what stage of grieving is grief work most effective
acute grief
type of grief:
- lingering status
- can be triggered
- each deals in different ways
- may be healthy or a sign of complicated grieving
chronic grief
- reestablishment of equilibrium is disrupted
- guilt, anger, ambivalence
- insomnia
- depression
- cognitive difficulties
- social withdrawal
- can be misinterpreted as dementia
complicated grief
- relationship is not recognized
- grief is not sanctioned
- suicides, hiv/aids, pets, gradual losses caused by chronic conditions
- situations often distance an individual from the family, making open grief impossible
disenfranchised grief
disenfranchised grief is often accompanied by…
complicated grief
what to watch out for with disenfranchised grief
self destructive behaviors
factors affecting coping with loss
- physical
- psychological
- social
- specific to dying and death
characteristics of good coppers
- avoid avoidance
- confront realities and take appropriate actions
- focus on solutions
- redefine problems
- consider alternatives
- good communication with others
- seek and use constructive help
- accept support
- keep up their morale
pt suspects they are dying, but it is never openly discussed
suspected awareness
pt does not know they are dying
closed awareness
there is “let’s pretend’ atmosphere (real feelings are kept hidden)
mutual pretense
acknowledges the reality of the approaching death
open awareness
interventions for loss
- gently established rapport
- be ready to listen
- offer support and direction
- encourage the griever to talk and tell story of relationship it had been
kubler-ross stages of grief
- denial
- anger
- bargaining
- depression
- acceptance
6 c’s for promoting a good death
- core
- control
- composure
- communication
- continutioy
in paliative care, research basis and plan of care is based on…
pain
barriers to completing advanced directive
- inaccesible documents
- level of education
- income
- younger age
- race
treatment administered when other palliative treatments are not sufficiently effective , a suffering pt unconscious in the proximity of death
terminal sedation
signs of impending death
- coolness
- increased sleeping
- incontinence
- disorientation
- restlessnes
- decreased urine output
- altered breathing pattern
- noisy respirations
when a nurse encourages the griever to share stories with others after a loss, the nurse is employing which intervention?
collaboration
