EF - GRIEF Flashcards
Grief can be defined as
eelings or reactions that an individual has to a loss in ir life
loss that an individual faces is not always related to a
death
grief can be experienced w/ many
types of loss
every person experiences grief in ir
own unique way
Most individuals, if not all, will
experience grief at some point in ir life
American Psychological Association defines grief as
“ anguish experienced after significant loss, usually death of a beloved person”
Grief can occur after
eceiving bad news about one’s health or from many life situations
C. may experience grief due to
loss of a loved one such as a spouse, a parent, a sibling, a child, or a close friend
divorce,
retirement,
loss of a job,
loss of friendship,
loss of financial stability,
a miscarriage, or
moving to a new city
Grief can include both
emotional and physical manifestations,
grief is usually accompanied by
physiological stress
C.s may exhibit
anxiety,
difficulties in concentrating,
thinking about past excessively, and
agitation
Grief is body’s way of
healing after one has suffered a loss
Types of Grief
Normal
Anticipatory
Prolonged Grief Disorder
Disenfranchised Grief
Normal grief, also known
uncomplicated grief
Normal grief, also known as uncomplicated grief, is caused by
loss of a loved one, through death or ending of a relationship
grief can be triggered by or
experiences that are considered to be painful or traumatic to C.
period of time for which an individual grieves a loss will
differ for every person, most people will experience grief after a loss for several months to a year
normal grief is different for
everyone
individual’s sense of loss is
unique to that person, and people’s feelings regarding loss reflect ir own unique make-up
Feelings experienced during grief often include
sadness, guilt, yearning, anger, and regret
no timeline for how long
an individual will experience grief,
nor is re an ordinary degree or severity to which
an individual will experience grief
Grief typically lessens
over time as feelings decrease in intensity, and person experiencing grief simultaneously moves forward in ir acceptance of loss
Grief is primarily thought of as being caused by death of a loved one, but it has many or causes—for example
loss of identity, loss of safety, loss of autonomy, and loss of dreams or expectations
Loss of identity can be experienced when
a C. faces loss of a role or relationship,
Exs of loss of role or relationship
such as after divorce, when one is no longer considered a spouse; or when a child goes off to college, leaving parent as an empty nester; or after having undergone a double mastectomy, when a C. might feel a loss of femininity
Loss of safety (think of Maslow’s hierarchy of needs) is experienced when
C.s perceive that y have lost physical, emotional, and mental happiness
Loss of security can be experienced when
C.s find mselves evicted or have erratic housing arrangements, among children of divorced parents, or when a survivor of physical abuse fears for ir safety on a daily basis
Loss of autonomy is experienced
as a result of older adults’ inability to take care of mselves and belief that y can no longer contribute to society, or when individuals have a worsening condition that affects ir physical or cognitive capability
Loss of dreams and expectations is experienced when
an individual’s hopes and dreams remain unfulfilled
Exs of lost of dreams/expectations
C.s whose career path fails to mirror ir expectations; students struggling to find where y belong in real world; and a couple who are coming to terms w/ infertility
Common manifestations of normal grief include
sadness, guilt, yearning, anger, and regret
Anticipatory grief is defined as
grief that is experienced before loss of someone or something
anticipatory grief arises when
a loss is expected
Anticipatory grief commonly occurs when
C. has been identified as having a terminal illness or has been suffering from a chronic disease over an extended period of time
anticipatory grief can be experience by
C.s who have a connection w/ dying person or are dying person mselves
re is no exact amount of time over which
a person may experience anticipatory grief
Even though a person has experienced anticipatory grief previously, prior experience will
not affect present grief experience or degree of grief an individual experiences after a loss
C.s who suffer anticipatory grief can display both
mental and physical manifestations
According to Metzger, common findings of anticipatory grief include
sadness, anger, loneliness, guilt, anxiety, fear, fatigue, and poor concentration
normal to have anticipatory grief when
someone or something that a C. loves is expected to be lost, and C.s can experience anticipatory grief when y face a looming crisis or end of life
Prolonged grief disorder (PGD), previously known as
complicated grief,
Prolonged grief disorder (PGD)
grief that lasts longer than 6 months and can be so significant that it affects C.’s ability to function
C.s who are experiencing prolonged grief are unable to
accept death of loved one
behavior is marked by a persistent need to
find deceased person, and y are preoccupied w/ thoughts of deceased person
Or manifestations of prolonged grief disorder include
feelings of guilt (self-blame), anger, and difficulty participating in new and different activities
It is not unusual for C.s experiencing prolonged grief to
detach mselves from ir friends or family, making it harder for m to recover as y become isolated and lonely
Nursing interventions for PGD include
showing concern, allowing C.s to voice ir feelings, and providing emotional support and guidance
If a nurse becomes concerned that a C. has potential for self-harm, nurse has an ethical responsibility to
notify provider immediately to get mental health services for C.
Health care providers can diagnose complicated grief as a
medical disorder and can provide C. w/ most appropriate treatment available, including support and rapy
Disenfranchised grief is grief related to
a relationship that does not coincide w/ what is considered by society to be a recognized or justified loss
Disenfranchised grief loss is considered by society to
be one of shame or socially uncomfortable and, refore, not worthy of grief
Because loss is not regarded as worthy of grief,
social support is not provided to grieving individual
C.s who are experiencing disenfranchised grief are left to
grieve alone and in silence, as compared to C.s experiencing normal grief, for whom rituals are routinely utilized to lessen burden after a loss
isenfranchised grief can occur as a result of
a loss being unrecognized as significant (eg, loss of a pet or miscarriage),
an unrecognized relationship (eg, an extramarital affair),
an unrecognized griever (eg, a young child),
or loss itself being disenfranchised (eg, suicide)
C.s experiencing disenfranchised grief can suffer from
depression, unstable emotions, social isolation, physical symptoms, insomnia, and low self-esteem
Kubler-Ross Five Stages of Grief
named after psychiatrist Elizabeth Kubler-Ross, who initially developed ory for dying in 1969
Kubler-Ross model identifies five stages in grieving process:
denial, anger, bargaining, depression, and acceptance
Originally it was believed that those who were grieving had to go
through all five stages in a precise, sequential order
revised ory,
stating that five stages were not sequential, and an individual may not necessarily experience all of m; also may bounce back and forth between stages
Denial
C. refuses to believe reality,
is first stage in Kubler-Ross ory and is an
attempt to lessen pain of loss
not uncommon for C. to have a feeling of
numbness and shock
mind is trying to adjust to a loss of someone or something and wonders how life will continue in this altered state
C. is trying to understand what has happened and deal w/ feelings of losing someone or something
Denial is a time in which C.
reflects on and relives time spent w/ person, and questions how life can move forward w/out person
Denial is bodys way of
slowing things down and giving time to adjust to loss, so that C. will not become emotionally overwhelmed
Anger is
second stage, in which C. is trying to adjust to loss and is feeling severe emotional distress
C. thinks, “Why me?” and “It’s not fair”
During anger stage, If C.s have a strong religious faith, y may
question ir belief in deity
Anger provides a means of
releasing emotional discomfort
During anger stage ir may also be blaming
Blaming of ors for loss can also occur, w/ anger being targeted at loved ones such as family and close friends
Anger is a necessary and healthy stage of grief It will
eventually dissolve,
and more anger that is felt,
faster a person will heal
After a loss, many people feel
abandoned and left alone
feeling of anger connects C. to
reality, and it is something that will connect C. to people once again
Bargaining is
third stage
In bargaining, C. tries
different approach - attempt to relieve /minimize / pain felt from /loss
/try bargaining w/ higher power (iemaking promise to do something in exchange for different / better outcome
ex: “I promise I will be a better person if you let this person live”
bargaining response is an attempt to
avoid grief through act of negotiating
In bargaining stage, this is also commonly expereienced
guilt
Ex; If only I had driven m to work that day, y would still be here today”
Depression is which stage of kubler ross model
4th stage
What happens in depression stage
reality sets in,
loss of loved one / thing - deeply felt
realization loved one is gone or situation is over becomes real
in depressions tage, C. feels
numbness and a sense of immense loss,
mourns loss,
wonders if it is worth continuing in life alone
Some C.s might w/draw, not wanting to be around ors as y try to deal w/ loss
It is natural and appropriate to have feelings of _________ during grieving process
depression
what is last stage of kubler ross model
acceptance
acceptance stage
person still feels pain of loss
realizes that all will eventually be well
acknowledges new reality, such as a spouse or child who is never coming back or a job that y will never return to
in what stage are re Some days better than ors, w/ a higher number of good days versus bad days
acceptance stage
in what stage does person begins to connect w/ friends again, and may perhaps make new friendships
acceptance stage
person recognizes that nothing will take place of loss, but that life goes on
Dual Process Model of Grief
suggests that process of grieving oscillates (shifts back and forth) between two types of responses: loss-oriented and restoration grief
During loss-oriented process
grief is conveyed through intense thoughts / feelings
person feels sad,
longs for person who has died,
feels sad about how person died
believes it is unfair person will not be part of griever’s future
restoration grief process involves
coping w/ or losses that come w/ death of a loved one (secondary losses)
rebuilding one’s life w/out loved one
loss of a loved one brings about not only feelings of grief, but also
changes that are a result of loss
restoration process is a time of
thinking about future, filled w/ new tasks and obligations
secondary losses
or losses that come w/ death of a loved one
undamental aspect of Dual Process Model is process of
going back and forth between loss-oriented responses and restoration-oriented responses
C.s shift between se responses over and over again
For example, when a C. becomes tired of focusing on feeling sad and longing for person who has died, C. will
switch to focus on ir new roles and responsibilities
Concentrating on one process too much can be
detrimental, especially if C. uses this approach to avoid dealing w/ emotions of losing a loved one
Dr J William Worden developed Four Tasks of Grieving model as an alternative to
Kubler-Ross’s Five Stages of Grief ory
Worden’s ory suggests that a grieving C. commonly engages in
four tasks as part of grieving process
In Wordens ory, key idea is that
grieving C.s can involve mselves in grieving process, permitting mselves to acknowledge loss and adjust to life after loss
In Wordens ory, 4 tasks of grieving are
(1) accept reality of loss,
(2) experience pain of grief,
(3) adjust to an environment w/out deceased, and
(4) find an enduring connection while embarking on a new life
first taks in Wordens model
Accept Reality of Loss
overcoming denial of loss and accepting loss that has occurred
accepting loss as reality versus believing that it never happened
Denying loss does not
make it go away
Grief is a natural way of
mourning that body and mind must be permitted to go through
first step in grieving is
acceptance,
accepting loss allows
mourner to move forward in grieving process
second task in Wordens model
be aware of emotion and to experience pain of grief
In today’s culture, many people are fearful of feeling strong emotions y may do everything in ir power to avoid feeling, yet preventing feeling of strong emotions only
makes pain worse
Coping w/ emotions can be handled through
writing, creating songs, or whatever works best for C.
important thing is that feelings are dealt w/ and not
suppressed
Third stage in Wordens model
Adjust to an Environment w/out Deceased
get used to living w/out loved one being around
Life is no longer same, and C. may feel as if moving on in ir life is a
betrayal of loved one or that becoming closer to a friend is betraying friend whom y have lost
C.s in this phase have to
reestablish mselves and rearrange ir lives w/out presence of loved one
Fourth and final task in Wordens model
Find an Enduring Connection While Embarking on a New Life
stay connected to deceased loved one while simultaneously moving forward in one’s life
Instead of C.s focusing on what y have lost, y should focus on what y had
Death is considered a
normal occurrence in life,
yet it is also one of most difficult challenges that a person may experience
Bereavement is a term used to describe
period of time in which a person experiences grief and mourning after a loss
Mourning is described as
expression of grief in public
Mourning can be affected by
religious beliefs, ethnic background, or cultural customs
Practices associated w/ mourning often provide
structure to grieving process
reaction of C. experiencing a loss reflects
circumstances surrounding death and relationship w/ deceased
If C. experiencing grief fails to process that grief w/in a month to a year, person could be experiencing
complicated grief
Most C.s see a decline in grief manifestations after
6 months
Parents must process __________along w/ usual findings of grief after death of a child
additional issues
Parents may feel
an injustice has occurred—that a parent should not lose a child
Losing a child takes away parent’s ability
to fulfill parenting role—a role that y anticipated carrying out for many more years to come
When a parent loses a child, y lose
piece of mselves, regardless of child’s age
grief response after a parent has died reflects
factors such as circumstances in which parent died (violent deaths can lead to grief disorders),
child’s relationship w/ parent prior to parent’s death,
if child believes it was time for parent to die, and gender of child and parent
Not having an opportunity to say goodbye to a parent has an impact on
a child’s coping ability and may lead to feelings of anger and depression
death of a parent can be especially painful for children who
had a troubled relationship w/ deceased parent
loss due to suicide, can be harder to
process because of feelings of shame, guilt, and rejection felt from loss
In many cultures, suicide of a loved one is still associated w/
sense of shame and disgrace
may worsen bereaved person’s feelings of loneliness
bereaved person may be w/out some of support previously provided in past
common for C. who has lost a pet to experience
intense feelings of sorrow
loss of a pet is a
significant blow to many individuals, and C.s should allow mselves to fully grieve that loss
grief associated w/ loss of pet may include
feeling shock and confusion, followed by extended periods of sadness and depression
re is no standard period for a person to grieve and recover from loss of a pet, although mourning for
months to a year or more is not uncommon
Grief is frequently reoccurring, as
intensity of grief comes and goes in cycles
Reactions to grief can involve
complicated feelings, thoughts, physical sensations, and behaviors
Grief reactions are defined as
a person’s response to loss
range of feelings for a C. who has experienced a loss may include
shock, anger, anxiety, numbness, denial, guilt, sadness, relief (if death is expected), and depression
range of psychological experiences may include
disbelief, fixation, trouble concentrating, and hallucinations
Physical sensations related to grief include
tightness or heaviness in chest or throat that is non-cardiac related, gastrointestinal findings such as nausea or upset stomach, dizziness, headache, muscle weakness, and tiredness
behaviors of a person experiencing grief may include
difficulty falling asleep or staying asleep, lost interest in consuming food or socializing, and becoming short-tempered or hostile
Sometimes feelings of grief are intensified around
significant dates and anniversaries such as deceased person’s birthday or death date, or around holidays
circumstances in which a person died can influence
a person’s grief (EX was death sudden or had person been suffering from a terminal illness)
deceased person’s age can influence
reaction to death, including wher deceased person was a young child versus an older adult
Customs, religious, or spiritual beliefs of grieving person can also play a role in how
C. displays grief for a loss
Prior experience w/ loss can have an impact on
C. who is grieving, just as any previous experiences affect future experiences
For person who has unresolved issues w/ person who has died, grieving process may be
?
age of person experiencing grief will influence
grief response
Death is a natural life event that all people
experience at some time in ir life
infants and toddlers
can detect when those who are caring for m are experiencing grief
can sense anxiety or distress of adults who are around m
Common reactions of infants and toddlers include
irritability, changes in eating or sleeping patterns, or increased crying infant or toddler may be clingy, jumpy or anxious, or less active, or may experience weight loss
Preschoolers perceive death as
temporary and reversible
may think y are to blame for persons death
preschoolers believe thoughts/feelings can cause
death
Some preschoolers may appear unaffected by death, a response caused by
child’s inability to understand that death is permanent
Common reactions of preschoolers include
searching for person who has died, anxiety, clinging to people, irritability, increased tantrums, trouble sleeping, toileting problems, and changes in eating
8-12 years old understand that death is
everlasting
Because 8-12 YEAR OLDS recognize that world does not revolve around m, y can have
increased fears related to death and are more preoccupied w/ both ir own well-being and well-being of ir loved ones
Common reactions to death during middle childhood include
anger, sadness, anxiety, aggressive behavior, and potentially trouble in school
may hold back ir feelings, appearing w/drawn—a response that is more prevalent in boys
12-18 years old have what kind of understanding of death
complete understanding of death, although y may not respond to it in same manner as an adult does
12-18 year olds inability to express se feelings can lead to
high-risk behaviors as a way of escaping emotions and reality while seeking comfort
may rely more on ir friends, or y may detach mselves from ors
Grief is different in adulthood as compared to or stages of growth and development, as adults have
ull comprehension of death and have memories of deceased
Manifestations experienced by adults may include
depression, anxiety, anger, and rapid changes in mood y may react to grief w/ emotions of shock, numbness, or doubt
Some adults experiencing grief may also have physical manifestations such as
tightness in chest similar to a heart attack, upset stomach, lighadedness, and fatigue
Or responses to grief that may occur are known as “looking for” behaviors; y include
hallucinations, dreams in which deceased person continues to exist, “observing” deceased person in road, and or illusions and misconceptions
One’s culture provides guidelines for how to
express a grief experience and, in turn, serves as foundation for grieving person’s actions
China, color of mourning is
white vs western culture - color is black
Korea, ashes of loved one are
processed into colorful beads that are displayed in home
Rituals and customs can serve as a
method for a person, family, and community to process and communicate ir grief as well as to prepare for loss of a loved one
Rituals serve as a
guide to grief expressions, actions, or behaviors that are expected w/in culture
rituals may describe how …
dying person is cared for
what is stipulated after person’s death (who is present / which formal procedures are performed)
who handles body after death, how body is cleansed / dressed,
wher body is cremated / buried
how grief is expressed (silently or loudly),
expected length of grieving process,
how family members act during mourning phase,
ongoing rituals in celebration of loved one’s death
Cultural factors may define expected family roles, such as
when widow or widower may remarry, and wher oldest son becomes head of family
practices involving use of religion and spirituality have produced
better C. outcomes post bereavement
Religious traditions can provide comfort during grieving process by
offering rituals defining what should happen after death
Members of Christian faith traditionally hold a wake where
deceased body is displayed for viewing, and family and friends come toger to see deceased, share memories, and comfort one anor
In Judaism, body is
buried as soon as possible, followed by a week-long period of grief and mourning, called shiva, when friends and family visit
afterlife can be described as
any condition of mind or state of being that happens after a person has departed this earth
Nurses are responsible for providing, and expected to deliver
compassionate nursing care to both C.s and ir families
To ensure nurses are capable of delivering best care for those experiencing grief and loss, nurses need to remain
emotionally balanced while caring for C.s and families experiencing grief and loss
Nurses may experience grief after a C.’s death ir reactions may differ in way grief is expressed, however, and are affected
clinical circumstances of C.’s death, as well as personal factors specific to nurse
Some grieving nurses may display
anger, depression, irritation, or helplessness
death of a C. can be one of most difficult
experiences in a nurse’s career
A plan for self-care begins w/
nurses performing a self-reflection / evaluation of current state of being
take a holistic view of ir life,
including physical, psychological, spiritual, relationships, financial status
physical improvement self-care activities might include
eating healthy, getting regular exercise, and maintaining a healthy weight
Psychological improvement can be attained through
use of relaxation and imagery techniques, reading books, and engaging w/ groups that facilitate happiness
Spiritual self-care is achieved through
participation in activities such as joining a religious group that develops higher self, practicing meditation, or yoga
Economic self-care includes
living w/in one’s financial budget
Psychological self-care activities focus on
participating in activities that stimulate one’s mind through creativity and play
Grief can be exhibited through various emotional and physical manifestations, including
anxiety, difficulty sleeping, headaches, and joint pain
Keeping emotions to oneself and not dealing w/ m can cause nurses to be
less effective in providing care for ir C.s Nurses, like C.s, need to verbalize and process feelings of grief
American Nurses Association’s Code of Ethics states that nurses have a duty to
take care of mselves as y do ors (including health and safety), preserve competence, protect ir character and dignity, and continue personal and professional growth
Self-care relieves stress that is associated w/
being a nurse, restores ability to be compassionate and empatic, and promotes safety and higher-quality C. care
Strategies for self-care focus on maintaining a
healthy body and mind, including eating a healthy diet, participating in physical exercise, socializing w/ family and friends, and getting adequate rest
Compassion fatigue
cumulative stress that develops from desire to help those who are suffering combined w/ inability to relieve that suffering, which results in a feeling of professional uselessness and self-blame
Certain types of nursing specialties ____________ are at increased risk of compassion fatigue
eg, emergency room, critical care, and end-of-life care)
Findings of compassion fatigue include
difficulty in focusing, feeling nervous, anxiety, disruptive behavior w/ coworkers, and problems connecting w/ C.s sympatically
Strategies to prevent compassion fatigue include
reflective journaling, participating in continuing education activities to restore mind, and engaging in non-nursing activities that reduce job-related stress, such as meditation, spiritual practices, reading, going to movies, spending time w/ family and friends, and exercising
first task in providing support for C.s and families as y cope w/ grief and loss is to
develop a relationship w/ m
One rapeutic communication skill that nurses can utilize when discussing emotional subjects is called
NURSE technique
NURSE stands for
Name, Understand, Respect, Support, and Explore
An example of NURSE technique follows
A family member or loved one states: “This is overpowering”
nurse replies:
•Name: “This is overpowering” Identify what person stated a moment ago nurse is identifying emotion expressed by C.
•Understand: “re is a lot happening right now What can I do to assist you?” nurse demonstrates understanding by recognizing C.’s feelings and providing an opportunity for C. to discuss those feelings
•Respect: “I’m very impressed w/ your ability to manage everything” Voice your respect for C. under se circumstances
•Support: “I’m here all day for you” Inform C. that you are available to m
•Explore: “What is most difficult aspect?” Asking an open-ended question will extend conversation and provide a more detailed expression of C.’s feelings and beliefs
In determining a nursing diagnosis of grief, nurse’s initial action is to
assess for indications that C. is grieving Assessment is first step in nursing process, a methodical guide that nurses use in providing C.-centered care
nursing process consists of five sequential steps
assessment, analysis, planning, implementation, and evaluation
When using nursing process, nurse first assesses
wher C. or family member is experiencing grief This includes assessing for signs or behaviors that are suggest grieving, such as crying, speaking loudly, or exaggerated body movements NOTE: PN CAN ONLY COLLECT DATA - NOT MAKE ASSESSMENT
nurse must furr assess which
which phase of grieving is being experienced
also determine wher C.’s grieving is healthy or complicated
C.’s capacity to make decisions should be assessed as well
determine reliability of C.’s support system and
assess need for or assistance such as legal counselors, support groups, or social services support
nurse should evaluate a C.’s potential or actual problem related to grieving process
analysis stage of nursing process
identification of C.s problem begins which stage of nursing process
planning
Establishing a potential or actual problem determines
which interventions a nurse will utilize in caring for person and ir expected outcomes
In planning phase, nurse
evelops a plan of care (treatment plan), which includes C.-specific goals and outcomes
For example, nurse might use following interventions in a care plan related to grief:
• rapeutic communication techniques to facilitate verbalization of feelings
• Providing a nonjudgmental and trusting environment
• Encouraging C. to learn about and utilize effective coping strategies
• Providing additional resources, including community resources
• Highlighting strengths and progress to C. and family
• Recognizing need of C. or loved one to reassess loss experience
Expected outcomes for C.s experiencing grief and loss include
ability to verbalize and express ir feelings, C. asking for help and support as needed, and successful use of coping strategies
Grief is pain experienced after
significant loss, typically death of a loved one
Grief is sensation that is felt when
someone or something that a C. loves is lost
Exs of loss that can cause grief
divorce, retirement, joblessness, financial instability, a miscarriage, end of a friendship, or moving to a new city
Grief is usually accompanied by
physiological stress, separation anxiety, disorientation, longing, thinking about past excessively, and nervousness or anxiety about future
Normal grief, also known as
uncomplicated grief
Normal grief, is caused by
loss of someone very close through death or ending of a relationship
Or causes of grief include
loss of identity, loss of safety, loss of autonomy, and loss of dreams or expectations
Anticipatory grief is grief that is experienced
before loss of someone or something
anticipatory grief can be expereinced by C. who has
a connection w/ a dying person, or dying person mself can experience anticipatory grief
Prolonged grief disorder (PGD), previously known
complicated grief
Prolonged grief disorder (PGD) may be experienced by C.s
who are unable to accept death of a loved one
PGD grief is marked by
persistent need to find deceased person, and y are preoccupied w/ thoughts of deceased person
Disenfranchised grief is grief related
relationship that does not coincide w/ what is considered by society to be a recognized or justified loss
Kubler-Ross’s Five Stages of Grief
denial, anger, bargaining, depression, and acceptance
stages are not sequential,
individual may not necessarily go through all of m
Dual Process Model
process of grieving oscillates between two types of responses: loss-oriented and restoration grief
loss-oriented process
grief is conveyed through intense thoughts and feelings
restoration grief process
involves coping w/ or losses that come w/ death of a loved one (secondary losses) and rebuilding one’s life w/out loved one
secondary losses
or losses that come w/ death of a loved one
Worden’s Four Tasks of Grieving model
mourner commonly completes four tasks that minimize risk of developing complicated grief
accept reality of loss;
experience pain of grief;
adjust to an environment w/ deceased not re; and
find an enduring connection w/ deceased while embarking on a new life
Common manifestations of grief include
crying spells, difficulty sleeping, changes in food intake, and decreased productivity in work setting
Culture may provide guidelines for how
people express ir grief experience and, in turn,
serves as foundation for ir actions
Religious–spiritual rituals can help a person who is grieving to
deal w/ death and grieving process
Religion can provide comfort during grieving process by
providing knowledge of what supposedly comes after death
NURSE mnemonic is a rapeutic communication skill that nurses can utilize when discussing
emotional subjects
NURSE mnemonic
NURSE stands for Name,
Understand,
Respect,
Support, and
Empathy
NURSE mnemonic technique provides an opportunity for
nurse to demonstrate empathy and build a relationship
As nurse assists C.s and families experiencing grief and loss, goal is for those involved in grieving process to
verbalize ir feelings and have a reliable support system
Nurses, like C.s, need to verbalize and process
ir own feelings of grief Nurses need to take time to care for mselves and make self-care a priority
Compassion fatigue
cumulative stress that develops from desire to help those who are suffering combined w/ an inability to relieve suffering,
Certain types of nursing specialties can increase risk of developing compassion fatigue
(eg, emergency room and end-of-life care)
Compassion fatigue can lead to
feeling of professional uselessness and self-blame
anticipatory grief
Grief experienced before loss of someone or something
bereavement
period of time in which a person experiences grief and mourning after a loss
compassion fatigue
Caused by cumulative stress that develops from desire to help those who are suffering care provider is unable to relieve suffering, leading to feelings of professional uselessness and self-blame
disenfranchised grief
Grief related to a relationship that does not coincide w/ what is considered by society to be a recognized or justified loss
Dual Process Model
Suggests that process of grieving “oscillates” (shift back and forth) between two types of stressors: loss-oriented and restoration grief During loss-oriented process, grief is conveyed through intense thoughts and feelings restoration grief process involves coping w/ or losses that come from death of a loved one (secondary losses) and rebuilding one’s life w/out loved one
Four Tasks of Grieving
Suggests that re are four tasks a mourner completes to avoid risk of developing complicated grief four tasks to complete in order are to accept reality of loss, experience pain of grief, adjust to an environment w/ deceased not re, and find an enduring connection w/ deceased while embarking on a new life
grief reactions
A person’s response to loss
Kubler-Ross’s Five Stages of Grief
A ory that suggests re are five stages an individual experiences during grieving process: denial, anger, bargaining, depression, and acceptance
mourning
expression of grief in public
normal grief
Also known as uncomplicated grief; caused by death of a loved one or ending of a relationship
prolonged grief disorder (PGD)
Previously known as complicated grief; experienced by C.s who are unable to accept death of loved one
- A nurse is caring for a client whose spouse recently died. The client is from a different culture than the nurse. Which of the following information should the nurse consider when caring for the client? (Select all that apply.)
Cultural-based rituals can assist clients in handling the death of a loved one.
Culture may determine how a client expresses their grief.
Rituals regarding death direct what procedures are performed on the body after death.
- A nurse is discussing types of grief with a group of clients who have a serious illness. Which of the following information should the nurse include?
Anticipatory grief occurs prior to the actual loss of someone or something.
- A nurse learns that a coworker has died unexpectedly. Which of the following actions should the nurse take?
Recognize their feelings of grief.
- A charge nurse is discussing Worden’s Four Tasks of Mourning with a newly licensed nurse. Which of the following statements should the charge nurse include?
“The pain of grief is experienced during the second task.”
- A nurse is using the NURSE mnemonic while speaking with a client who is experiencing grief. Which of the following responses by the nurse demonstrates the concept represented by the “U” in the NURSE mnemonic?
“There is a lot going on right now, how can I be of help to you?”
- A nurse is assessing a school-age child whose friend recently died. Which of the following findings should the nurse expect?
The child holds back their feelings.
- A nurse is assessing a client who is getting divorced and reports feelings of loss associated with no longer being in the role of a spouse. The nurse should identify that the loss of a previously held role is which of the following types of losses?
Loss of identity
- A nurse is caring for an adult client who is mourning the death of a sibling. Which of the following information should the nurse consider when caring for the client?
Grief differs for adults due to their full understanding of death and memories of the deceased.
- A nurse is reviewing Kübler-Ross’s five stages of grief. The nurse should identify that Kübler-Ross placed the stages in which original order? (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.)
Denial
Anger
Bargaining
Depression
Acceptance
- A nurse is caring for a client for who recently lost their job. Which of the following actions should the nurse take during the assessment step of the nursing process? (Select all that apply.)
Identify whether the client is experiencing feelings of grief.
Check the client for physical manifestations of grief.
Ask the client about their support system.
- A nurse is assessing a 16-year-old client whose parent recently died. Which of the following findings should the nurse expect?
The client displays high-risk behaviors.
- A nurse is preparing for an initial visit with a client who is experiencing grief. Which of the following tasks should the nurse plan to complete first?
Develop a relationship with the client.
- A charge nurse is reviewing Kübler-Ross’s five stages of grief with a newly licensed nurse. Which of the following statements should the nurse make? (Select all that apply.)
Clients might not go through all five stages of grief.
Clients can return to a stage of grief after moving into one of the other stages.
Client who are grieving might attempt to bargain with a higher power.
- A palliative care nurse is preparing an in-service for newly hired staff members about common grief reactions. Which of the following information should the nurse include? (Select all that apply.)
A client who is grieving often experiences a wide range of emotions.
A client may feel a sense of relief if the death of a loved one was expected.
A client may experience difficulty concentrating and hallucinations as a psychological response to loss.
Behavioral responses to grief can include the refusal to eat or participate in social activities.
- A nurse is assessing a client who is experiencing disenfranchised grief. Which of the following findings should the nurse expect?
Social isolation
- A nurse is discussing the Dual Process Model of Grief with a newly licensed nurse. Which of the following statements should the nurse make?
“A client’s grief will oscillate between loss-oriented grief and restoration-oriented grief.”
- A nurse is caring for a client who was recently diagnosed with chronic kidney disease. The client asks the nurse, “Why me? This is not fair.” The nurse should identify the client’s statement as an expression of which of the following stages of grief?
Anger
- A nurse is caring for a client whose partner recently died. In which step of the nursing process should the nurse and client identify the goals for the client’s care?
Planning
- A charge nurse is preparing an in-service for staff members about spiritual influences on grief. Which of the following information should the nurse include?
Religion can provide comfort during the grieving process.
