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NURS 3510 - Supportive and Palliative Care > Week 3 > Flashcards

Week 3 Flashcards

1
Q

define loss

A
  • occurs when something or someone of value becomes inaccessible or drastically changed
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2
Q

what are the 3 main types of losses

A
  • actual
  • anticipatory
  • perceived
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3
Q

what is actual loss

A
  • loss that is identified and recognized by others
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4
Q

what are some examples of actual losses (5)

A

loss of:

  • limb
  • death of someone
  • loss of job
  • loss of relationship
  • loss of voice
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5
Q

what is anticipatory loss

A
  • occurs when an individual knows a loss is coming
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6
Q

what are some examples of anticipatory losses (3)

A
  • time leading up to a mastectomy
  • time leading up to deat
  • time leading up to a move
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7
Q

what is perceived loss

A
  • loss which is felt by an individual but cannot be verified as a loss from outside
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8
Q

what are some examples of perceived losses (5)

A

loss of:

  • joy
  • body image
  • confidence
  • mental health
  • hidden relationship
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9
Q

describe how illness trajectory varies between illnesses

A
  • the illness can impact the trajectory

- but, even if multiple individuals have the same illness, the trajectory varies between everyone

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10
Q

how does loss impact an individual

A
  • impacts all 4 domains of a person
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11
Q

what is dignity

A
  • an individuals sense of self worth

- derived from state of spiritual, social, physical, and emotional comfort

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12
Q

how can loss impact dignity

A
  • loss impacts all 4 domains of a person = loss of dignity
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13
Q

know the different losses associated w diff conditions? als, copd, etc???

A

…

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14
Q

what are the 4 categories of responses to loss

A
  • psychological/emotional
  • physical/biological
  • social/behavioral
  • spiritual
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15
Q

what are some examples of psychological/emotional responses to loss (4)

A
  • sadness
  • guilt
  • anger
  • difficulty concentrating
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16
Q

what are some examples of physical/biological responses to loss (3)

A
  • sleep disturbances
  • changes in appetite (+weight loss/gain)
  • aches and pains
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17
Q

what are some examples of social/behavioral responses to loss (3)

A
  • changes in activity lvl
  • decreased socialization
  • avoidance and/or focus on reminders of loss
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18
Q

what are some examples of spiritual responses to loss (2)

A
  • questioning meaning of life/purpose

- asking “why”

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19
Q

what is grief

A
  • the combo of various responses to a loss
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20
Q

describe the early thinking regarding grief

A
  • sigmund freud says that the person experiencing the loss suffers, bc of their attachment to that person or object that was lost
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21
Q

according to freud, what was the goal of processing grief

A
  • involves “letting go” of that which has been lost in order to build new relationships or circumstances
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22
Q

what was the next stage of thinking, after freud. regarding the process of griefing

A
  • the suggestion that we move through 4 general phases of grief
  • where we complete tasks to meet the goal of “recover” and adjust to new reality
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23
Q

what were the 4 stages of grief

A
  • numbing
  • yearning and searching
  • disorganization
  • reorganization to recover from the loss and adjust to new reality
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24
Q

what were the 5 stages of grief outlined by cooper ross

A
  • denial
  • anger
  • bargaining
  • depression
  • acceptance
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25
Q

what was the main idea associated w the 5 stages of grief

A
  • that individuals work thru these stages to a place of fully ackowledging and making peace w the loss
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26
Q

what was the issue associated w theory of the stages of grief

A
  • stages are not an accurate depiction of how grief actually works
  • grief is not a linear process, it is much more complex than that
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27
Q

describe the current thinking of the process of griefing

A
  • proposes that grief is a dual process model

- grief is a process of oscillation (moving back and forth) between 2 modes: loss orientation and restoration

28
Q

what is loss orientation mode

A
  • focuses on emotion focused coping
  • contains things that make you think abt your loss
  • thoughts, feelings, and actions that make you focus on ur grief and pain
29
Q

what is restoration mode

A
  • focuses on problem focused coping

- things that let you get on ur faily life and distract you from ur pain

30
Q

what are some examples of restoration orientated coping (5)

A
  • working
  • cleaning
  • going out w friends
  • TV
  • exercise
31
Q

what is the goal of the current process of thinking

A
  • finding meaning and growth
32
Q

describe “normal grief”

A
  • difficult to define
  • grief is individualized
  • many define it as the ability to move towards acceptance of the loss, which comes w a gradual decrease in the intensity of emotions & responses to loss
33
Q

in general, during grief it is normal to experience… (7)

A
  • sadness
  • anxiety
  • guilt
  • anger
  • sleep disturbances
  • difficulty concentrating
  • loss of appetite
34
Q

in general, during grief, normal processes involve: (4)

A
  • disbelief and non-acceptance that loss has occurred
  • gradual accpetance of reality and permanence of loss
  • gradual reinvestment in life & loving
  • not necessarily a linear process
35
Q

list 6 common alterations in grief

A
  • anticipatory
  • delayed
  • complicated
  • disenfranchised
  • cumulative
  • inhibited
36
Q

what is anticipatory grief

A
  • grief that occurs before the loss

- responses related to the loss of what was or what was hoped for or supposed to be

37
Q

what is delayed grief

A
  • responses to a loss that are postponed until a later time
38
Q

what might initiate delayed grief

A
  • by another major life event
39
Q

what is disenfranchised grief

A
  • grief that occurs when someone experiences a loss, but others do not acknowledge the loss in the person’s life
  • the loss may be minimized or not understoof by others
40
Q

what are some example situations where someone may experience disenfranchised grief (3)

A
  • loss of ex
  • loss of pet
  • loss of home
41
Q

what are some warning signs of delayed grief (3)

A
  • self destructive behavior
  • radical lifestyle changes
  • outbursts
42
Q

what is cumulative grief

A
  • grief that occurs when multiple losses are experienced, often within a short period of time
43
Q

what is inhibited grief

A
  • when someone does not outwardly show any typical signs of grief –> expressed somatically (physical symptoms)
  • often occurs consciously in an attempt to keep grieve private
44
Q

list 6 factors that may affect grief

A
  • nature of loss
  • relationship
  • age
  • gender
  • culture
  • ability to cope
45
Q

what can impact the nature of loss (3)

A
  • if recognized by others
  • if sudden death (type of death)
  • if have multiple concurrent losses
46
Q

how does age impact grief

A
  • determines how grief is manifested & how they understand loss
47
Q

describe 2 examples of how age can impact grief

A
  • young children’s ability to understand the loss varies depending on their development stage
  • older adults have increased risk of cumulative loss
48
Q

describe how gender can impact grief

A
  • women are more likely to express feelings, seek help
49
Q

describe how culture can impact grief (3)

A
  • some cultures expect a dignified and quiet response
  • some expect to openly express
  • emotions vary: some expect you to feel lonely, others angry
50
Q

what can impact the ability to cope r/t grief (4)

A
  • personality traits
  • previous experiences
  • belief system
  • support & resources
51
Q

describe the process of appraisal of an event and stress

A
  • a loss occurs
  • after first appraisal (assessment) of the situation, determine if perceived threat or not
  • if not, then the individual will experience no stress
  • if is perceived threat, it will undergo second appraisal
  • after 2nd appraisal, either have perceived ability or inability to cope
  • if percieved ability to = positive stress
  • if perceieved inability = negative stress
52
Q

list how to asses loss and grief (10)

A
  • get to know the whole person
  • understand the current experience of loss
  • distinguish behaviors indicative of grief response
  • consider age, gender, culture
  • determine potential for an alteration in grief
  • determine past signif lossess
  • explore ways of coping
  • know availability to support systems for pt
  • evaluate need for referrals to address needs in various domains
  • remember the family –> assess them too
53
Q

how can we support those experiencing loss and grief (7)

A
  • be present
  • engage the individual as a whole person
  • acknowledge their losses (focus on solutions later)
  • actively listen
  • demonstrate empathic communication
  • support pt and family to share mutual fears, concerns, and hopes for each other
  • initiate additional support and resources
54
Q

what are some “dont’s” for supporting those experiencing loss and grief (8)

A

dont:

  • compare griefs
  • fact check or correct
  • minimize
  • give compliments
  • be a cheerleader
  • talk abt it later
  • evangelize
  • start w solutions
55
Q

what are some “do’s” for supporting those experiencing loss and grief (7)

A
  • ask questions
  • respect their experience
  • remember this grief is theirs
  • trust them
  • stay in the present moment
  • trust their self cae
  • get consent
56
Q

how can we help ourselves and support other nurses in grief (9)

A
  • identify the loss
  • reflect on loss & grief, and deal w our own “stuff”
  • acknowledge relationships w pts and families
  • acknowledge grief responses
  • seek help from others
  • leave work at work
  • prioritize self-care strategies
  • be present
  • engage in active listening
57
Q

Chochinov et al., did a study that looked at the physical, psychosocial, emotional, and spiritual aspects of pts illness experiences in relation to their dignity. what was the takeaway message of this study (4)

A
  • living with a chronic progressive illness is not 1-size fits all
  • different losses associated with different illnesses
  • within a particular illness, each individual has unique experiences depending on who they are and various factors
    = imp to get to know pts, and consider what losses they may be experiencing and how they are impacted by illness
58
Q

in chochinov’s study, what 4 chronic populations did he consider

A
  • ALS
  • COPD
  • ESRD
  • frail elderly
59
Q

in pts with ALS, dignity was decreased r/t.. (7) what % (idk what the percents mean in the chart lol)

A
  • feeling like not able to fulfill imp roles, tasks, or faily routines
  • feeling like a burden
  • feeling loss of control
  • not feeling valued or worth while
  • weakness & fatigue
  • depression
  • worried about future

11%

60
Q

in pts with COPD, dignity was decreased r/t… (3)

A
  • physical distress
  • most SOB & anxiety out of all groups
  • lowest mortality but most uncertain about health
61
Q

describe what findings were found in individuals with ESRD (3)

A
  • only group with suicidal ideation
  • highest # of comorbidities
  • prominent symptom burden
62
Q

describe what findings were found in the “frail elderly” group (5)

A
  • most isolated relative to other groups
  • lowest social support
  • felt least amt of hope
  • not significally worried abt future
  • although not typically described as terminally ill, 42% of individuals died over the course of the study
63
Q

what is complicated grief

A
  • being “stuck” in acute grief

- responses to loss are debilitating and do not lessen or improve over time

64
Q

what impact does complicated grief have

A
  • significantly impairs ability to fnxn `
65
Q

what are some warning signs of complicated grief (5)

A
  • self destructive behaviors
  • consistent feelings of guilt
  • lowered self esteem
  • radical lifestyle changes
  • outbursts

NURS 3510 - Supportive and Palliative Care (11 decks)

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