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
Explain the therapeutic communication for terminally ill clients and families
- 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
How can you facilitate grief
- 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”
How can you help families of dying clients
- 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
How can you help families after the death
- 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
