Grief, Loss, Behavior change ID Flashcards
Pre-contemplation
Define
- No recognition of a problem. Lack of concern, ignorance, or denial.
- No intention to change in next 6 months.
Pre-contemplation
Assessing
- Assess knowledge of the problem
- Pt may be surprised about the problem
- May be resistant to you
Pre-contemplation
Intervention
- Tell me in your own words about your understanding and concerns about ______.
- Raising concern: Educate or address denial.
- Don’t push for action yet.
Contemplation
Define
- Recognition of a problem.
- Ambivalence
- No plans to change in the near future.
Contemplation
Assessing
“Yes I know I should, but—(excuses)“
Contemplation
Intervention
- Move from ambivalence toward change.
- Focus on benefits and barriers
- Explore fears and concerns
Preparation
Define
- Decision resolution.
* Making plans to change in the near future (6 months)
Preparation
Assessment
The New Year’s Resolution phase.
“I can do it.”
“I must do it.”
Preparation
Interventions
Transform into action:
- What concerns do you have? How ready are you to start?
- Encourage patient to set a date
- Be a resource for specific tips, techniques, groups/programs
Action
Define
Taking steps to change
Action
Assessment
Patient reports having made some changes already
“I started walking up the stairs”
“I stopped adding salt”
Action
Intervention
- PRAISE patient for actions taken.
- Help organize activity and measure/provide results
- Encourage self-efficacy
- Role play difficult situations to prevent relaps
Maintenance
Define
Sustaining change
Maintenance
Assessing
Behaviors are a routine part of life now.
Maintenance
Intervention
- Periodically check-in
- Identify barriers and create solutions
- Return to prior stages if there is a relapse
- Encourage them to model for others
Relapse
Define
Demoralized, shame, decreased or loss of self-efficacy
Relapse
Intervention
Re-energize behavior change. Educate that those who try more, even if they don’t succeed, are more successful in the end
Complicated grief = now in DSM-5 as “Persistent Complex Bereavement Disorder”
Criteria
Individual has death of person close to him/her
1+ of the following, more days than not, min 12 months (6 months = children):
*Persistent yearning/longing for the deceased
*Intense sorrow and emotional pain in response to death
*Preoccupation with the deceased
*Preoccupation with circumstances of the death
Since the death, 6+ of the following, on more days than not, min 12 months (6 months = children):
- Difficulty accepting the death
- Disbelief or emotional numbness
- Difficulty with positive reminiscing of the deceased
- Bitterness or anger
- Maladaptive appraisals of oneself in relation to the death (self-blame)
- Excessive avoidance of reminders of the loss
- Desire to die in order to be with deceased
- Difficulty trusting others
- Feeling alone or detached
- Feeling that life is meaningless or empty, or that one is unable to function without the deceased
- Confusion about one’s role in life
- Difficulty to pursue interests or to plan for the future
Stages of Grief
Denial
*a conscious or unconscious decision to refuse to admit that something is true
What can we do?
- Be as specific and explicit as possible with respect to the diagnosis and treatment recommendation
- Repeat and reinforce the diagnosis with second opinions, family meetings
- Have the patient repeat it back to you
Stages of Grief
Anger
*An emotional or physical act in which the patient attempts to place blame
What can we do?
- Be open and honest about the expected medical course and potential long-term complications
- Make sure the patient feels and is as informed as possible
- Give extra time to identify root cause of the anger
- Try to channel the energy from anger into something productive
Stages of Grief
Bargaining
*a negotiative process in which patients attempt to postpone or distance themselves from the reality of a situation
What can we do?
- Remain firm regarding treatment recommendations
- Do not participate in turning your recommendation into a negotiation
Stages of Grief
Depression
*a feeling of loss of control or hopelessness with a situation
What can we do?
- Increase the control the patient feels in their life
- Actively screen/recognize depression and refer to mental health pr
Stages of Grief
Acceptance
*a feeling of stability or resignation as the patient becomes an active participant in their life
What can we do?
*Suggest/arrange factors that support adjustment = Time, High levels of social support, Optimistic personality, Positive self-image, Coping strategies associated with self-worth
