Week 11 Grief, Loss, and Dying Flashcards

1
Q

What are the key points to remember with the psychosocial theory

A
  • the physical body is only one dimension of a person; what clients are thinking and feeling is equally important to their healing process
  • Psychosocial theory definition: understanding people as a combination of psychological and social events
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2
Q

Explain Self-concept: overall view of oneself

A

Self concept forms out of a person’s evaluation of her or his;

  • physical appearance
  • sexual performance
  • intellectual abilities
  • success in the workplace
  • friendships
  • problem solving and coping abilities
  • unique talents

A person with a healthy self concept has a mostly positive perception of these evaluations of self

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3
Q

What are the factors affecting self concept

A
  • gender
  • developmental level
  • socioeconomic status
  • family
  • peer relationships
  • locus of control: internal (people feel they can exert control over their lives) or external (people attribute control of their situation to external factors)
  • illness
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4
Q

What are the components of self concept

A

Body image: defined as your mental image of your physical self

  • ideal
  • perceived
  • actual

Role performance
- actions a person takes and the behaviors he/she demonstrates in fulfilling a role instead of expectations

Personal identity
- your view of yourself as a unique human begin, different and separate from all others; develops over time

Self esteem:
- how well a person likes him/herself

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5
Q

What are the psychosocial assessments key points

A
  • Functional abilities: day to day ability to contend with environmental and social tasks; includes ADLs and IADLs
  • Self Efficacy: degree of confidence persons have in their ability to successfully perform specific behaviors (Bandura)
  • Family relationships
  • Relationships with the wider social environment
  • interpersonal communication
  • understanding current illness
  • usual coping mechanisms
  • health priorities
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6
Q

Name and explain the different psychosocial diagnoses

A

Interrupted family processes:
- change in family relationships or functioning; or a family that normally functions effectively then experiences dysfunction

Family coping:
- usual support from a significant other is either compromised or disabled casing a significant health problem

Parental role conflict:
- parent shows significant role confusion and/or conflict in response to crises

Ineffective individual coping:
- client fails to comprehend and effectively judge stressors when he/she perceives incorrect or dangerous life choices as normal, and when there is an inability to use available resources

Post trauma syndrome:
- maladaptive learned response to a traumatic and distressing event

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7
Q

What are the psychosocial diagnoses (continued slide)

A
  • Risk for loneliness
  • Social isolation
  • Risk for violence; directed at others
  • impaired social interaction
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8
Q

What are the self concept diagnoses

A
  • Chronic low self-esteem
  • Situational low self-esteem
  • Disturbed personal identity
  • Ineffective role performance
  • Disturbed body image
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9
Q

Explain the stages of Anxiety

A

Mild:
- normal anxiety in response to the events of day to day living; perception is heightened

Moderate:
- the perceptual field narrows; person begins to focus on self and the need to relieve discomfort

Severe:
- focus is totally on self and the need to relieve the anxiety

Panic:
- becomes unreasonable and irrational

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10
Q

What are the defense mechanisms for anxiety

A
  • denial: refusing to acknowledge existence of a real situation or associated feelings
  • displacement: transferring feeling from one target to another that seems less threatening
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11
Q

What is the focus of nursing care for clients with anxiety

A
  • differentiate: between mild anxiety and that which is severe enough to require referral to a mental health professional
  • provide interventions to relieve anxiety
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12
Q

Explain the key points related to depression

A
  • the nurse should encourage the client to discuss feelings
  • IN RED Unlike the feeling of true sadness, such as feelings that may accompany a divorce, death, or other loss, the depressed mood is typically marked by a sense of emptiness; the client in most need of a mental health referral is the client who verbalizes the feeling of loneliness and emptiness
  • Consider suicide prevention strategies
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13
Q

What are the cues indicating a possible risk for suicide

A
  • alcohol or substance abuse
  • family hx of mental disorders or substance abuse
  • family hx of suicide
  • firearms in the home
  • family violence, including physical or sexual abuse
  • a significant medical illness, such as cancer or chronic pain
  • compulsive gambling
  • recent losses: physical, financial, personal
  • Age, gender, race (elderly or young adult, unmarried, white, male, living alone)
  • recent discharge from an inpatient psychiatry unit
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14
Q

What are the warning signs of possible risk of suicide

A
  • Withdrawal from social contact
  • Desire to be left alone
  • Preoccupation with death and dying, or violence
  • risky or self destructive behavior, such as drug use or unsafe driving
  • changes in routine, sleeping patterns
  • changes in eating habits
  • giving away belongings or getting affairs in order
  • personality changes, such as becoming very outgoing after being shy
  • saying goodbye to people as if they won’t be seen again
  • talking about suicide (I’m going to kill myself, I wish I were dead, or I wish I hadn’t been born)
  • you need to ask: Have you had thoughts of hurting yourself? Has there been previous suicide attempt? When? Do you have a plan to commit suicide? Is there a means to carry out the plan?
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15
Q

Name and explain the categories of loss

A

Actual loss:
- death of a loved one, theft, deterioration, destruction, and natural disaster

Perceived loss:
- internal; it is identified only by the person experiencing it

Physical loss:
- includes injuries. organ removal, loss of function

Psychological (internal) losses:
- commonly seen in the areas of sexuality, control, fairness, meaning, and or trust; loss of youth, limbs, body disfigurement, or body functions

External losses:
- actual losses of objects with sentimental or monetary value

Environmental loss:
- involves a change in the familiar, even if the change is perceived as positive

Loss of significant relationships:
- actual loss of spouses, siblings, family members, or significant others through death, divorce, or separation

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16
Q

Explain the Kubler Ross theory

A
  • popular in health care (five stages of grieving)
  • individuals may not experience every stage or go through the stages in a linear order; also individuals may experience two or more stages simultaneously
  • she felt that if people understood what dying clients are experiencing, they would be more competent in caring for them
17
Q

What are all of the major theorists of grief

A
  • Engel
  • Bowlby
  • Rando
  • Worden
  • Kubler ross
  • Stroebe and Schut
  • Klass, Silverman, and Nickman
  • Neimeyer
18
Q

What are the factors affecting grief part one

A

Significance of the loss

Support system:
- amount of support for the bereaved; people with more emotional and psychosocial support typically have less complicated grief

Unresolved conflict:
- a conflict left unresolves may cause prolonged grief

Circumstances of the loss:
- if the circumstances of the loss leave the bereaved feeling guilty or responsible, his or her healing process may be impeded

19
Q

What are the factors affecting grief part 2

A

Previous loss

Spiritual/cultural beliefs and practices

Timeliness of death

20
Q

What are the four types of grief

A
  • Uncomplicated (normal) grief
  • Dysfunctional/complicated grief
  • disenfranchised grief
  • anticipatory grief
21
Q

Explain DNR/AND

A

an order to not attempt resuscitation of the client in the event of cardiac or respiratory failure; the ANA recommends allow natural death (AND)

22
Q

What are the diagnosis for terminally ill client and family

A
  • Situational or chronic low self esteem
  • Anxiety related to possible inability to cope with the loss
  • Fear or anxiety related to impending death
  • decisional conflict related to end of life treatment measures
  • fatigue related to demands of caring for a dying loved one
  • Spiritual distress related to loss of trust in a loving God
23
Q

What are the planning outcomes for terminally ill clients and families

A
  • grief resolutions (resolves feelings about loss)
  • coping
  • progresses through stages of grief
  • expresses positive expectations about the future
  • seeks social support
24
Q

What are the interventions for terminally ill clients and families

A
  • emotional support: support family through stages of grief
  • encourage discussions of previous loss
  • include significant others in discussions and decisions, as appropriate
  • therapeutic play: encourage children to express their feelings
  • active listening: listen to expressions of grief
  • support group: identify sources of community support
  • Crisis intervention
  • Spiritual support
25
Q

Explain the therapeutic communication for terminally ill clients and families

A
  • Key point: your ability to help someone who is grieving or dying is largely determined by your attitude
  • perfect your listening skills
  • encourage and accept expression of feelings
  • reassure it is not wrong to feel anger, relief, or other unacceptable feelings
  • respond to nonverbal cues with touch and eye contact
  • increase your self awareness
  • continue to communicate, even in case of coma
26
Q

How can you facilitate grief

A
  • encourage questions, and respond to them within a reasonable time
  • sit beside the head of the bed; do not appear rushed
  • when you observe the client or family member expressing feelings, either verbally or nonverbally, encourage him or her to continue
  • expect and accept a wide range of feelings, including anger, fear, and loneliness
  • ask “how would you like me to help?” or what do you need?
  • be sure that everyone on the health care team understands and follows the care plan
  • ask yourself what you would do if this were your family member
  • do not compare another persons loss to your own experience. Do not say “I know how you feel” instead say, “tell me how you feel”
27
Q

How can you help families of dying clients

A
  • when a client is dying, it is important to view the family as your unit of care
  • if the client is unresponsive, you may find yourself spending most of your care time with the family providing education, support, and a listening ear
  • have family help with care, if able
  • encourage questions
  • provide follow up for referrals as needed
  • encourage visit to chapel or to talk with clergy
  • provide anticipatory guidance
  • acknowledge feelings of family
  • Explore coping mechanisms
  • remind family members and significant others to take care of themselves
  • teach what to expect and provide reassurance
  • ask directly if family wants to be present at time of death
  • at the moment of death, do not intrude
28
Q

How can you help families after the death

A
  • emotional support
  • provide grief education: also assure him or her that although the grief process takes time, the symptoms will not last forever
  • Help children deal with loss: you may need to explain that children perceive death differently from adults