Geri End/OB Start: Module 6 - Coping and Death Flashcards
What may a mother with a handicapped or stillborn infant and the elder mourn the loss of (despite being alive?
the visualized “perfect” infant
memorialize the “perfect” self that no longer exists
Loss ___ an individual
changes
What can coming through the grieving process supported help do?
help the individual experience a loss to be able top put the loss into perspective and start to create a new life for themselves
Elizabeth Kubler-Ross Model Stages of Grief
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
Who were the stages of grief for?
Originally for a dying person but now it is used for the grievers
Denial Stage
First Stage
Usually only a temp. defense for the individual.
This is generally replaced with heightened awareness of situations and individuals that will be left behind after death
Ex: “I feel fine;” “This can’t be happening not to me”
Anger Stage
Second Stage
The individual recognizes denial cannot continue
Because of anger, the person is very difficult to care for due to misplaced feelings of rage and envy. Any individual that symbolizes life or energy is subject to projected resentment and jealousy.
Ex: “ Why me? Its not fair!”; “How can this happen to me?”; “Who is to blame”
Bargaining Stage
Third Stage
involves the hope that the individual can somehow postpone or delay death. Usually, the negotiation for an extended life is made with a higher power in exchange for a reformed lifestyle. Psychologically, the person is saying, “I understand I will die, but if I could just have more time…”
Ex: “Just let me live to see my children graduate.”; “I’ll do anything for a few more years.”; “I will give my life savings if…”
Depression Stage
Fourth Stage
the dying person begins to understand the certainty of death. Because of this, the individual may become silent, refuse visitors and spend much of the time crying and grieving. This process allows the dying person to disconnect himself from things of love and affection. It is not recommended to attempt to cheer an individual up that is in this stage. It is an important time for grieving that must be processed.
Ex: “I’m so sad, why bother with anything?”; “I’m going to die . . . What’s the point?”; “I miss my loved one, why go on?”
UPWARD TURN NEEDS TO COME ON ITS OWN NOT FORCED
Acceptance Stage
Fifth and Final Stage
comes with peace and understanding of the death that is approaching
generally the person in the fifth stage will want to be left alone
feelings and physical pain may be non-existent
Stage described as the “end of the dying struggle”
ex: “Its going to be okay”; “I cant fight it, I may as well prepare for it”
2 Problems with the Original 5 Stages of Grief?
- Dr Kubler Ross made it in 1969 while working with people DYING OF CANCER - the stages were supposed to be for the grief a dying person goes through, not those grieving the death of another person
- Stage interpretation neglected the patient’s situations and how they could affect the cycle (ex: relationship supports, effects of illnesses)
The Seven Stage Model
A 7 stage model for the grieving individual dealing with a loss
The stages move in a U shape of worsening mood with an upward swing
What are the 7 Stages of a Grieving Individual?
- Shock and Denial
- Pain and Guilt
- Anger and Bargaining
- “Depression”, Reflection, Loneliness
- The Upward Turn
- Reconstruction and Working Through
- Acceptance and Hope
Shock and Denial Stage
Stage 1 of 7
Griever will reach to learning of the loss with NUMBED DISBELIEF
May DENY reality of the loss as some level to avoid pain
Shock provides emotional protection from being overwhelmed all at once!!!!
Can last for weeks
Pain and Guilt Stage
Stage 2 of 7
Shock and denial is replaced with SUFFERING UNBELIEVABLE PAIN
While pain is excruciating and almost unbearable, IT IS IMPORTANT THAT IT IS EXPERIENCED FULLY - do not hide it, avoid it, or escape with drugs or alcohol
May have feelings of guilt or remorse over things they did or did not do with a loved one
Life feels chaotic and scary at this phase
Anger and Bargaining Stage
Stage 3 of 7
Frustration gives way to anger
May lash out and lay unwarranted blame for the death on someone else - could cause permanent relationship damage!
This is a time of release of bottled up emotion
May rail against fate with “why me?”
May try bargaining in vain with powers that be for a way out of despair (“I will never do ___ again if you bring them back”)
“Depression”, Reflection, Loneliness Stage
Stage 4 of 7
When friends may thing its time to get on with life, a long period of sad reflection will set in
This is a normal stage so they should not be “talked out of it”
Encouragement from others is not helpful to them during this stage!!
During this time they finally realize the true magnitude of their loss and it depresses them
May isolate on purpose, reflect on things, and focus on past memories
May feel emptiness or despair
The Upward Turn Stage
Stage 5 of 7
As the griever adjust to life post-loss, life becomes a little calmer and more organized
Physical symptoms lessen, and “depression” begins to lift slightly
Reconstruction and Working Through Stage
Stage 6 of 7
As they become more functional, their mind starts working again, and they find themselves seeking realistic solutions to problems posted by life without their loved one.
They will start to work on practical and financial problems and reconstructing themselves and their life
Acceptance and Hope Stage
Stage 7 of 7
Learn to accept and deal with the reality of the situation
Acceptance does not necessarily mean instant happiness!
Given the pain and turmoil experienced, they can never return to the carefree untroubled self that existed before this tragedy, but a way forward is found
What is the timetable for grief?
There is none
Is there a right or wrong way to grieve?
No
Grief is as ___ as the person experiencing a loss, their relationship with their lost one, and the circumstances of the death or loss are
individual!
Grief is a ___ and ___ process that may cause you to wonder what?
Grief is an unpleasant and lengthy process that may cause you to wonder as to how long it all will last and when you can expect some relief from the pain
How may grief differ between people?
Some may find within a few months it subsides and they can find closure while others may face years of relentless waves of grief, getting stuck in chronic mourning, and needing professional help
Grief never follows the neat progression of stages as it is complicated and personal, a person may have regression or backtracking
If a person regresses or backtracks to an earlier grief stage what does this mean?
it just means the individual was not finished with it yet and are fully working it through in their own way
Factors that influence loss and grief
Age of the individual dying and of the individuals surviving.
Significance of the loss
Culture
Spiritual beliefs
Gender
Socioeconomic status
Support system
Cause of loss or death
Cultural and religious differences can result in differences in how individuals or families…
View the significance of the event or loss.
Attribute the cause of the illness.
Feel about the appropriateness of medical interventions.
Communicate their responses to the event or loss.
Coping and Grieving Nursing Diagnoses Examples
Grieving
Complicated grieving
Interrupted family process
Risk-prone health behavior
Risk for loneliness
Role strain
Risk for ineffective parenting
What are the unit of care as defined by the patient in hospice?
the patient and family are the unit of care
Hospice uses what to address patient and family needs?
an interdisciplinary team
What is the emphasis in Hospice?
Comfort
Dignity
QOL
Autonomy
