Week 11 Grief, Loss, and Dying Flashcards
What are the key points to remember with the psychosocial theory
- 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
Explain Self-concept: overall view of oneself
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
What are the factors affecting self concept
- 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
What are the components of self concept
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
What are the psychosocial assessments key points
- 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
Name and explain the different psychosocial diagnoses
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
What are the psychosocial diagnoses (continued slide)
- Risk for loneliness
- Social isolation
- Risk for violence; directed at others
- impaired social interaction
What are the self concept diagnoses
- Chronic low self-esteem
- Situational low self-esteem
- Disturbed personal identity
- Ineffective role performance
- Disturbed body image
Explain the stages of Anxiety
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
What are the defense mechanisms for anxiety
- denial: refusing to acknowledge existence of a real situation or associated feelings
- displacement: transferring feeling from one target to another that seems less threatening
What is the focus of nursing care for clients with anxiety
- differentiate: between mild anxiety and that which is severe enough to require referral to a mental health professional
- provide interventions to relieve anxiety
Explain the key points related to depression
- 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
What are the cues indicating a possible risk for suicide
- 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
What are the warning signs of possible risk of suicide
- 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?
Name and explain the categories of loss
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
Explain the Kubler Ross theory
- 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
What are all of the major theorists of grief
- Engel
- Bowlby
- Rando
- Worden
- Kubler ross
- Stroebe and Schut
- Klass, Silverman, and Nickman
- Neimeyer
What are the factors affecting grief part one
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
What are the factors affecting grief part 2
Previous loss
Spiritual/cultural beliefs and practices
Timeliness of death
What are the four types of grief
- Uncomplicated (normal) grief
- Dysfunctional/complicated grief
- disenfranchised grief
- anticipatory grief
Explain DNR/AND
an order to not attempt resuscitation of the client in the event of cardiac or respiratory failure; the ANA recommends allow natural death (AND)
What are the diagnosis for terminally ill client and family
- 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
What are the planning outcomes for terminally ill clients and families
- grief resolutions (resolves feelings about loss)
- coping
- progresses through stages of grief
- expresses positive expectations about the future
- seeks social support
What are the interventions for terminally ill clients and families
- 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
