Grief, Loss, Behavior Change

Question 1

1. Pre-contemplative-

definition

Answer 1

• dont see a prob
• denial
• dont want to change in next 6 mo

Question 2

Pre-contemplative - how to assess if pt at this level

Answer 2

• no knowledge of prob
• surprised about prob
• possibly resistant

Question 3

Pre-contemplative - what to do w/ this pt

Answer 3

Tell me about __
Educate, address denial
Don’t push to action

Question 4

Contemplation - definition

Answer 4

• knows there is a prob but ambivalent

- no plan to change in near future

Question 5

Contemplation - signs a pt is at this level

Answer 5

I know I should but ___

Concerned but prefers status quo

Question 6

Contemplation - what to do w this pt

Answer 6

Focus on benefits+ barriers
Explore fears
Still no push for action

Question 7

Preparation - definition

Answer 7

Plan to do something in next 6 mo

Question 8

Preparation - how to assess if pt at this level

Answer 8

“I can(must) do it”

Question 9

Preparation - what to do with this pt

Answer 9

Tips, techniques, referral to groups/programs

Question 10

Action - definition

Answer 10

Taking steps to change

Question 11

Action - how to tell if pt at this level

Answer 11

They have made some changes already

Question 12

Action - what to do with this patient

Answer 12

Praise
Encourage self-efficacy
Measurable results
Role-play

Question 13

Maintenance - definition

Answer 13

Sustaining change

Question 14

Maintenance - how to tell if pt at this level

Answer 14

Behaviors routine

Question 15

Maintenance - what to do with this pt

Answer 15

Check-in
ID any barriers
Want to be a role model?

Question 16

Relapse - definition

Answer 16

Pt demoralized, shame, decreased self-efficacy

Question 17

Relapse - what to say

Answer 17

Re-energize

“those who try the most are more sucessful than those who dont”

Question 18

3 tenants of motivational interviewing

Answer 18

collaborative
evocative (evoke strengths they have)
honor (choice not to change)

Question 19

Principles of MI

Answer 19

• avoid righting reflex
• ID pt motivation
• listen > inform
• empower (pt is expert on their behavior)

Question 20

Complicated grief “persistent complex bereavement d/o”

Answer 20

-death of someone close to you

For 12mo (6mo kids)
has 1/4:
-long for deceased
-emotional pain
-preocc w deceased
-preocc w circumstnce of death

and

For 12mo (6mo kids)
has 6
- diff accepting death
- disbelief/emo numb
- can't (+)ly reminisce
- bitter/angry
- self-blame
-avoid loss-reminders
-want to die (w them)
-diff trusting
-feel detached
-life's meaningless
-what my role in life?
-can't plan for future
**causes impairment/ distress**

Question 21

Grief stages (list)
5 (DABDA)

Answer 21

Denial
Anger
Bargaining
Depression
Acceptance

Question 22

Denial

Answer 22

refuse to admit its true

• be specific and have pt report back
• ask fam to verify truth

Question 23

Anger

Answer 23

Place blame (act out physically or emotionally)

• ensure pt knows about big picture
• ID anger root cause

Question 24

Bargaining

Answer 24

Postpone/distance oneself from reality by negotiating w/ God, PA

• be firm and don’t negotiate

Question 25

Depression

Answer 25

Loss of control/helplessness

• Screen for dpn
• Remind pt they have control

Question 26

Acceptance

Answer 26

Stability/resignation “pt becomes active participant in their life”

• Support them in time of adjustment

Question 27

Factors improving adjustment

Answer 27

• give time
• social support
• optimistic personality
• • self image
• coping strategies that enforce self-worth