Exam 3: Lecture 10 Flashcards
What are the types of grief?
anticipatory
acute
shadow
disenfranchised
response to a real or perceived loss before it occurs a dress rehearsal
anticipatory grief
is a crisis – somatic, emotional, & functional symptoms
acute grief
moments of intermittent sadness – often with triggers (anniversary of event)
shadow grief
when a person cannot openly acknowledge or publicly mourn a loss – socially disallowed or unsupported – same sex, AIDS, suicide
Disenfranchised grief
What are the types of loss in older age?
loss of relationships
life transitions
What is loss of relationships?
Significant others – family, friends
Social contacts – variety of ways
Illness
Death
Distance
Decreased mobility
What is life transitions?
Roles
Financial security
Independence
Health
Mental stability
Loss of response model: beginning, middle, and end stages?
Grief is processed with 3 stages
Beginning
Physical and psychological manifestations
Middle
Day to day functioning affected
End
Griever emerges refocused and adjusted
Loss response model: steps 1, 2, and 3?
Person/Family/Grievers are a system
Loss creates chaos and disequilibrium
System must restore equilibrium
Step 1
Make sense of the loss
Search for meaning – why did this happen to us/me?
Why wasn’t it me?
Step 2
Integration and acceptance of the loss
Emotions stabilized or channeled
Others step in ready to assume roles of one lost
Step 3
System redefines itself
Reframing memories
Things may be different, but that is accepted
Cyclical Loss-Response Model for Older & Multiple Chronic Conditions?
The goal is not to prevent grief but to support those who are coping with grief and facilitate the return of stability to the system each time a new loss occurs.
LRM interventions?
Searching for Meaning
Engaging Emotions
Informing Others
Adaptation
Reframing Memories
Active Listening is a common to all of the above!
Loss of a spouse or partner?
Most difficult life loss – Second to loss of a child
Spousal bereavement:
- Greater in women than men
- Men tend to re-partner or re-marry sooner and more often than women
–> Loneliness, need to be cared for
–> High suicide risk on widowers (men)
73% women over 85 widowed
35% men over 85 widowed
Whole person effects: Physical, psychological, social, practical, and economic
What is the grief cycle?
The cycle of acceptance
- Normal Existence
- Receipt of Bad News
- Denial
- Anger
Aggression - Depression
Confusion, early bargaining, and continued anger and denial - Bargaining
- Acceptance
Nursing Actions Families Report as Helpful?
“They kept me informed”
Asked how I was doing and offered support”
“Put their arm around me when I cried”
“Brought me food”
“Knew my name”
“Cried with me”
“Brought me a bed and encouraged me to stay in the room while he was dying”
“Told me to hold his hand”
“Held my hand”
“Got the Chaplain for me”
“Let me take care of my husband”
Identifying Good Coping Skills?
Avoid avoidance
Confront realities
Focus on solutions
Redefine problems
Consider alternatives
Have good communications with others
Seek and use constructive help
Accept support when offered
Can keep up morale
Those WITHOUT these skills may need more help to process grief.
What are the six c’s for nursing actions?
Care
Control
Composure
Communication – p. 481 Read this section!
-Type & content varies by patient
-Auditory, visual & tactile
-Verbal & Non-verbal
-Closed awareness
-Suspected awareness
-Mutual pretense
-Open awareness
Continuity
Closure
Indicators of Appropriate and Good Death?
Care needed is received expertly and in a timely manner
Oneis able tocontrol one’s life and environmentto extent desired andpossible and in a way culturally consistent with one’s past life
Oneis able tomaintain composurewhen necessary and to the extentdesired
Oneis able toinitiate and maintain communicationwith significant othersfor as long as possible - Life continues as normally as possible while dyingwith added tasks needed to deal with and adjust to inevitable death
Onemaintainsdesirable hopeat all times
One reachessense of closurethat is culturally consistent with one’spractices and life patterns
What is the Hierarchy of theDying Person’s Needs?
Top: self-actualization and transcendence
self-esteem and self efficacy
belonging and attachment
safety and security
Bottom: biological and physiological integrity
“an approach to care which improves thequality of life of patients and their families facinglife-threatening illness, through prevention,assessment, and treatment of pain and otherphysical, psychological, and spiritual problems”
palliative care
Providing Palliative CareThrough Hospice?
Care provided is palliative within the specific context of a signedagreement between the individual and organization in which the personhas elected to receive care-only therapy for an identified diagnosis
Limited to those for whom two physicians have agreed that the personhas aprognosis of 6 months or less to live
The majority ofhospice care is provided in people’shomes to supportan identified informal caregiver
Hospice is provision of comfort for those dying and support of thoseclose to them
Core Competencies forPalliative/End-of-Life Care?
Nurse should be able to:
Recognize physical changes preceding eminent death
Deal with own feelings
Deal with angry patients and families
Be knowledgeable and deal with ethical issues in administeringend-of-life palliative therapies
Be knowledgeable and inform patients about advancedirectives
Be knowledgeable of legal issues in administering end-of-lifepalliative care
Be adaptable and sensitive to religious and culturalperspectives
Explain meaning of hospice
the highest expression of one’sindividual potential and implies inner motivation that hasbeen freed to express the most unique self or the “authenticperson”
Self-actualization
What is genotranscendence?
Human aging brings about a general potential forgerotranscendence, a shift from the material world tocosmic, and (concurrent with that), life satisfaction
Characteristics of individuals with a high degree ofgerotranscendence(Box 36-13)
What do you need to know about spirituality?
Indescribable need that drives individuals throughout life toseek meaning and purposein their existence
Spirituality must be considered a significant factor tounderstanding healthy aging
Spirituality is a broader concept than religion andencompasses a person’svalues or beliefs, search for meaning,and relationships with a higher power, with nature, and withother people
The majority ofolder adults describe themselves as bothspiritual and religious
Spiritual interventions?
Assessment
Spirituality is as important as assessment of physical, emotional, and social dimensions
Attention to spiritual needs of persons is a critical dimension of holistic care
Identifying elders at risk for spiritual distress:
Can’t participate inrituals
Diagnosis of a life-threatening, chronic, or terminal illness
Expressions of suffering
Depression
Cognitive impairment
Questioning or loss of faith
Loss of interpersonal support
What are the spiritual assessment tools?
There are formal spiritual assessments, butopen-ended questionscan also be used tobegin dialogue about spiritual concerns
Brief assessment of spiritual resources and concerns
Does it provide comfort or stress
Beliefs that conflict with health care decisions
Have a supportive faith community
Practices or rituals
Spiritual needs
The process of spiritual assessment is more complex than completing a standardizedform and must be done within the context of the nurse-patient relationship
What are the spiritual nursing responses?
Promote physical comfort:
Bathing
Positioning
Pain and symptom relief
Touch
Peaceful environment
Provide psychosocial comfort:
Active listening
Sharing fears
Provide guidance in the forgiveness of others and self
Authentic presence
Family support
What are the spiritual nursing responses?
Provide spiritual comfort by:
sharing caring words
reminiscence
listening to life stories
validating their lives
praying with and for
reading scripture
referring clergy
providing for religious objects and rituals
Nurturing the Nurse:Personal Spirituality Questionsfor Reflection for Nurses?
What do I believe in?
How do I find purpose and meaning in my life?
How do I take care of my physical, emotional, and spiritualneeds?
What are my hopes and dreams?
Who do I love, and who loves me?
How am I with others?
What would I change about my relationships?
Am I willing to heal relationships that trouble me?
