Exam 3 - Lecture 3 (Grief, Dying, Spirituality) Flashcards
what are the types of grief?
- anticipatory
- acute
- shadow
- disenfranchised
what is anticipatory grief?
response to a real or perceived loss before it occurs
what is acute grief?
a crisis that includes definite somatic, emotional, and functional symptoms
what is shadow grief?
moments of intermittent sadness caused by triggers (anniversary of event)
what is disenfranchised grief?
person cannot openly acknowledge or publicly mourn a loss
what do older adults typically lose in their old age?
- spouse
- friends
- family
- financial security
- independence
- health
- mental stability
- people in their community
the beginning stage of grief has physical and psychological manifestations
true
in this stage of grief daily functioning is affected
middle stage
end stage of grief
the griever is refocused and adjusted to the loss
what is involved in step 1 of restoring equilibirum after suffering a loss?
- making sense of the event
- searching for meaning
- survivor’s guilt
what is involved in step 2 of restoring equilibirum after suffering a loss?
- integration & acceptance of loss
- stabilized emotions
- channeled emotions
- others step in to assume roles left behind
what is involved in step 3 of restoring equilibirum after suffering a loss?
- creating a system to promote normalcy after the loss
- reframing memories
- accepting the different outcomes from the loss
how can one restore equilibrium in their lives?
set up a system to promote routines
cyclical grief is commonly experienced by which group of people?
those who have chronic illnesses
what are the interventions for reestablishing new memories among grievers?
- provide functional assistance
- engaging emotions
- informing others
- adaptation
- reframing memories
common denominator: active listening
what is the second most painful life loss?
death of a spouse
patterns of adjustment to widowhood
Box 34-3
- Step 1: Reactionary
- Step 2: Withdrawal (first few months)
- Step 3: Recuperation (six months after step 2)
- Step 4: Exploration (second year)
- Step 5: Integration (fifth year)
components of the cycle of acceptance
- normal existence
- receipt of bad news
- denial
- anger
- depression
- bargaining
- acceptance
good coping skills
Box 35-3
- avoid avoidance
- confront realities
- focus on solutions
- redefining problems
- consider alternatives
- good communication with others
- seek & use constructive help
- accept support when offered
- maintaining morale
the 6 C’s of nursing actions
- Care
- Control
- Composure
- Communication
- Continuity
- Closure
hierarchy of a dying person’s needs
- self-actualization / transcendence
- self-esteem / self-efficacy
- belonging & attachment
- safety & security
- biological & physiological integrity
physical factors influencing the grieving process
Box 35-2
- number of concurrent medical conditions
- use of sedatives
- inadequate nutrition
- inadequate exercise
what is palliative care?
an approach to care that improves the quality of life of patients and their families
what does palliative care offer?
- life-prolonging measures
- stabilizing care
palliative care needs the approval of two physicians
true
palliative care is only limited to people who have a prognosis of less than 6 months to live
true
core competencies of nursing regarding palliative care
what do they need to know?
- advanced directives
- legal & ethical issues in conducting end-of-life care
what is self-actualization?
- the highest expression of one’s individual potential
- implies inner motivation to express their most authentic
traits of self-actualized people
Box 36-2
- time competent
- self-directed
- flexible
- sensitive of self
- spontaneous
- values self
- accepts self
- positively views others & life
- acceptance of aggressiveness
- capable of warm relationships
characterstics of individuals with a high degree of gerotranscendence
Box 36-13
- high degrees of life satisfaction
- engage in self-controlled social activity
- experience satisfaction with self-selected activities
- views social activities as unessential to well-being
- midlife patterns & ideals are not their prime motivator
- demonstrates complex & active coping patterns
- has greater need for solitary philosophizing
- appears withdrawn when engaged in inner development
- feel shifts in perception of reality
- has accelerated development of gerotranscendence
what is spirituality?
the indescribable need that drives individuals throughout life to seek meaning and purpose in their existence
what does spirituality encompass?
- values
- beliefs
- search for meaning
- relationship with a higher power, nature, & others
older adults at risk for spiritual distress
Box 36-8
- experiencing events or conditions that affect ability to participate in rituals
- depression
- cognitive impairment
- loss of interpersonal support
- verbalized questioning or loss of faith
- diagnosed with life-threatening, chronic, or terminal illness
brief assessment of spiritual resources and concerns
Box 36-10
- Does your religion provide comfort or stress?
- Do you have any religious beliefs that might conflict with health care?
- Do you belong to a supportive faith community?
- Do you have any practices or rituals that help you express your beliefs?
- Do you have any spiritual needs that need to be addressed?
- How can HCPs help?
emotional factors influencing the grieving process
Box 35.2
- presence of concurrent stresses
- coping mechanisms
- previous experience with loss
- timelessness of the loss
- sex-role conditioning
- perception of the preventability
how can nurses provide psychosocial comfort?
- active listening
- sharing fears
- providing guidance in forgiving others & self
- encouraging family support
- showing up authentically
personal spirituality questions for nurses
Box 36.12
- What do I believe in?
- How do I find purpose & meaning in my life?
- How do I take care of my physical, emotional, and spritual needs?
- What are my hopes & dreams?
- Whom do I love?
- Who loves me?
- How am I with others?
- What would I change about my relationships?
- Am I willing to heal relationships that trouble me?
how can the nurse provide spiritual comfort?
- reminiscing
- reading scripture
- referring clergy
- providing religious objects & rituals
what are manifestations of anticipatory grief?
- unusually detailed planning
- sudden change in attitude toward the thing / person to be lost
- preoccupation with impending loss
- preparation of burials
- saying goodbye
what types of events precipitate acute grief?
- national disasters
- new diagnoses
- accidents
what is an example of disrupted daily functioning in the middle stage of grief?
an older adult is unable to perform their daily habits that involve the presence their deceased spouse
patterns of adjustment to widowhood
interventions for stage 1 (reactionary)
- reduce expectations
- listen
- support
- validate
- be available
patterns of adjustment to widowhood
interventions for stage 2 (withdrawal)
- protect individual against suicide
- monitor health status
- involvement with support groups
patterns of adjustment to widowhood
interventions for stage 3 (recuperation)
support new lifestyle that promotes exploration of new possibilities
patterns of adjustment to widowhood
interventions for stage 4 (exploration)
- prepare the client for unexpected reactions during anniversaries
- encourage & support new trial roles
patterns of adjustment to widowhood
interventions for stage 5 (integration)
assist individual to recognize & share own pattern of growth through the trauma of loss
