Grief & Loss Flashcards
the experience of separation from something of personal importance.
Anything that is perceived as such by the individual.
Loss
-A significant other (person or pet); leave/runaway
Illness or debilitating conditions; stroke, accident
-Developmental/maturational changes; reality of being an adult
-Decrease in self-esteem
-Personal possessions
Examples of loss
Stage I;Denial Stage II; Anger Stage III; Bargaining Stage IV: Depression Stage V: Acceptance
Elisabeth Kubler-Ross Stages of grief
Stage I: Numbness or protest (Denial)
Stage II: Disequilibrium (Anger, bargaining, lil depression)
Stage III: Disorganization and despair (depression, helplessness)
Stage IV: Reorganization (Acceptance)
John Bowlby Stages of grief
Stage I; Shock & disbelief
Stage II; Developing awareness, mins of loss
Stage III; Restitution; making arrangements for funeral
Stage IV; Resolution of the loss; preoccupation with loss. Lost pt. is idealized
Stage V; Recovery; move forward with own life
George Engel; Stages of grief
Task I; Accepting the reality of the loss; identifies loss member with someone else.
Task II: Processing the pain of grief
Task III: Adjusting to a world without the lost entity
Task IV: Finding an enduring connection with the lost entity in the midst of embarking on a new life; acceptance
J. William Worden; Stages of grief
The grief process is very individual and may last for many years
Length of the grief process
Usually lasts about 6 to 8 weeks; longer in older adults
Acute grief
- the bereaved person was strongly dependent
- the relationship was an ambivalent one
- the individual has experienced a number of recent losses; anxiety state; psychosis can happen
- the loss is that of a young person; longtime
- the bereaved person’s health is unstable
- the bereaved person perceives some responsibility for the loss; guilty feelings
The grief process is more difficult if..
The individual has the support of significant others.
The individual has the opportunity to prepare for the loss.
Makes the grieving process easier
Is thought to have occurred when a bereaved individual is able to remember comfortably and realistically both the pleasures and disappointments of that which is lost.
Remember the good times & bad. Reality of situations
Resolution of the grief process
- The experiencing of the feelings and emotions associated with the normal grief response before the loss actually occurs.
- Difficulty arises when family members complete the process of anticipatory grief and detachment from the dying person occurs prematurely.
- Anticipatory grieving may be positive for some people and less functional for others.
Anticipatory Grieving
-The absence of grief when it ordinarily would be expected.
-Potentially pathological because the person is not dealing with the reality of the loss.
-Remains fixed in the denial stage of the grief process.
-Grief may be triggered much later in response to a subsequent loss.
(Denial Stage)
Delayed or inhibited grief (Maladaptive Responses to Loss)
All of the symptoms associated with normal grieving are exaggerated.
-The individual becomes incapable of managing activities of daily living.
-The individual remains fixed in the anger stage of the grief process.
-Depressed mood disorder is a type of distorted grief response.
(Anger Stage, depressed, lash out)
Distorted (exaggerated) grief [Maladaptive Responses to Loss
A prolonged grief process may be considered maladaptive when certain behaviors are exhibited.
- behaviors aimed at keeping the lost loved one alive (shrine or room)
- behaviors that prevent the bereaved from adaptively performing activities of daily living. (busy grieving)
Chronic or prolonged grieving
One crucial difference between normal and maladaptive grieving.
- The loss of self-esteem does not occur in uncomplicated bereavement.
- The loss of self-esteem ultimately precipitates depression (loss of helplessness and hoplessness)
Normal vs. Maladaptive Grieving
unable to understand death but can experience the feelings of loss and seperation (Do know seperation)
Birth to age 2; developmental issues; concepts of death
have some understanding about death but have difficulty distinguishing between fantasy and reality; believe death is reversible (When are they coming back?)
Age 3 to 5; developmental issues; concepts of death
beginning to understand the finality of death; difficult to perceive their own death; normal grief reactions include regressive and aggressive behaviors
Age 6 to 9; developmental issues; concepts of death
understand that death is final and eventually affects everyone; feelings of anger, guilt, and depression are common; peer relations and school performance may be disrupted.
Age 10 to 12; developmental issues; concepts of death
-Usually able to view death on an adult level;
-Have difficulty perceiving their own death
-May or may not cry; may withdraw
-May exhibit acting out behaviors
(Immature thinking; know they can die. Wondering who is going to be at their funeral. Cant separate won’t be @ own funeral)
Adolescents; concepts of death
-A time in life of the convergence of many losses.
-May lead to “bereavement overload”. Bereavement overload may result in depression.
-Bereavement overload
-Attachment to others
`Depressive symptoms; may seem as senile or dementia
Elderly adults; Concepts of death
- Risk for complicated grieving related to loss of a valued concept/object; loss of a loved one
- Risk for spiritual distress related to complicated grief process
Nursing Diagnosis Grieving and Loss
-Acknowledges awareness of the loss;
Is able to express feeling about the loss;
-Verbalizes stages of the grief process and behaviors associated with each;
-Expresses personal satisfaction and support from spiritual practices;
The Client Outcome for grieving and loss
- Provide assistance through the grief process in a healthful manner toward resolution.
- Encourage the individual to express feelings about the loss and how will affect his or her life.
- Encourage the individual to participate in usual religious practices form which he/she derives support.
- Assist the client to identify positive aspects about his/her life, past relationships, and prospects for the future.
Nursing intervention for the bereaved individual
age 60 to 70’s; have experienced numerous loses, and mourning has become lifelong process. Grief that is cumumulative; which has been implicated in the predisposition to depression in the elderly.
Bereavement overload
self-concept and self-image appear to remain stable over time.
-good psychosocial adjustments later in life.
‘Sustained family relationshipsmaturity of ego defenses
absence of alcoholism
`absence of depressive disorder.
Maintenance of Self-Identity
myth over reality; not death itself, but abandonment, pain and confusion they feared.
-Someone to talk to, show them there is life’s meaning.
Dealing with Death
the experience of separation from something of personal importance.
loss
deep mental and emotional anguish that is a response to the subjective experience of loss of something significant.
grief
psychological process or stages through which the individual passes on the way to successful adaptation to the loss of a valued object.
mourning and grief
grief work and the process of mourning are referred to as…
grief response.
is thought to facilitate the grief response that occurs at the time of the actual loss.
- grief work is more intense when the loss is sudden and unexpected.
- the experiencing of the feelings and emotions assoc. with the normal grief response before the loss actually occurs.
anticipatory grief
refers to the absence of evidence of grief when it ordinarily would be expected.
-person is not dealing with the loss.
fixed in Denial phase.
could be triggered, many years later
delayed or inhibited grief
overreaction to another person’s loss maybe one manifestation of
delayed grief.q
most affliated with the Baptist and Methodist denominations. “falling-out” hearing about a death. sudden collapse or paralysis. and inability to see or speak.
- hearing intact (severe emotional response)
- Burial rather than cremation usually chosen.
African Americans; concepts of death
Death and bereavement in the Chinese tradition are centered on ancestor worship.
- intuitive fear of death and avoid references to it.
- won’t purchase life insurance b/c of fear its inviting death.
- Black is also bad luck.
- Don’t openly express their emotions.
- Wear black armbands and white strips of cloth tied around their heads.
- Dead honored by placing food, $ for the persons spirit or articles made of paper around the coffin.
Chinese Americans concepts of death
Buddism.
_Death, body prepared by close family members. Followed by a 2 day pd. of visitation by family and friends. ; prayer, burning of insense and presentation of gifts.
-Cremation is common; mourning period is 49 days; end marked by family prayer. and special rice dishes.
Japanese Americans concepts of death
Buddism; predominant religion; cyclic continuity and reincarnation. Birth and death are predestined. Perfer to die @ home. Most do not approve of autopsy. Cremation is common.
-Final moments before funeral are a time for prayer with family. Mourners wear white. -14 days During the following year men wear black armbands and women wear white head bands
1 year anniversary of one death is commemorated.
Last rites with priest. receiving flowers are distressing. (for dead)
Vietnamese Americans
wake held by family and friends. in home of deceased and lasts up to a week before funeral.
Catholic.
-9 days. of novenas; held in home or church. Special prayers asks for Gods; blessing for the deceased. Last day turns into a fiesta. ; Wear dark clothing; black armbands for men and black dresses for women.
-After 1 year of ritualistic mourning emotional outburst of crying are common expressions of grief. Burial of body; but cremation acceptable.
Filipino Americans
believes in the afterlife. Soul cont. to flourish, (most show little concern about death after life).
Taking one’s own life is Forebidden.
Denial with person who commits suicide.
Dying person left alone. Face covered with a cloth and body is treated with respect.
-Autopsy allowed if required by law, deceased has requested or may save another life.
-Funeral; wrapped in shroud, and placed in wooden coffin. Cremation prohibited.
Jewish American concepts of death
“meal of condolence” or “meal of consolation”, provided by neighbors and friends.
-7 day Shiva; beginning with the burial
during this time mourners don’t work and no activity permitted that attracts attention from deceased.
-Mourning last 30 days for relative.
-1 year for parent @ which tombstone erected and a graveside service held.
Jewish American concepts of death; con’t.
Catholics.
Death practices reflection of religion;
Vigil by family members kept over sick or dying person.
After death; Velorio; festive watch over body.
Novenario; 9 days following burial.
Luto; mourning, symbolized by wearing black, black & white, or dark clothing and subdued behavior.
-refrain from social events, no tv or radio.
-bereavement may last 2 years older adults
-burial, more common than creation.
Mexican Americans concepts of death
Do not bury the body of a deceased person for 4 days after death.
- cleansing ceremony takes place before burial to prevent the spirit of the dead person from trying to assume control of someone else’s spirit.
- buried with their shoes on the wrong feet and rings on their index fingers.
- talking to one about death is taboo with client concerning fatal disease/ illness. Must talk in 3rd person about disease. (to do so; implicates provider wishes client was dead)
Native American concepts of death.
The individual openly expresses anger.
Normal grieving
Anhedonia is prevalent (inability to feel pleasure)
Clinical depression
A persistent state of dysphoria exists
Clinical depression
Feels more depressed on some days than others
Normal grieving
Self-esteem seems unaffected
Normal grieving
Expresses chronic physical complaints
Clinical depression
Feelings of depression are related to a specific loss
Normal grieving
Holds anger inside
Clinical depression
Generalized feelings of guilt
Clinical depression
Able to experience some moments of pleasure
Normal grieving
