Week 3 Flashcards
define loss
- occurs when something or someone of value becomes inaccessible or drastically changed
what are the 3 main types of losses
- actual
- anticipatory
- perceived
what is actual loss
- loss that is identified and recognized by others
what are some examples of actual losses (5)
loss of:
- limb
- death of someone
- loss of job
- loss of relationship
- loss of voice
what is anticipatory loss
- occurs when an individual knows a loss is coming
what are some examples of anticipatory losses (3)
- time leading up to a mastectomy
- time leading up to deat
- time leading up to a move
what is perceived loss
- loss which is felt by an individual but cannot be verified as a loss from outside
what are some examples of perceived losses (5)
loss of:
- joy
- body image
- confidence
- mental health
- hidden relationship
describe how illness trajectory varies between illnesses
- the illness can impact the trajectory
- but, even if multiple individuals have the same illness, the trajectory varies between everyone
how does loss impact an individual
- impacts all 4 domains of a person
what is dignity
- an individuals sense of self worth
- derived from state of spiritual, social, physical, and emotional comfort
how can loss impact dignity
- loss impacts all 4 domains of a person = loss of dignity
know the different losses associated w diff conditions? als, copd, etc???
…
what are the 4 categories of responses to loss
- psychological/emotional
- physical/biological
- social/behavioral
- spiritual
what are some examples of psychological/emotional responses to loss (4)
- sadness
- guilt
- anger
- difficulty concentrating
what are some examples of physical/biological responses to loss (3)
- sleep disturbances
- changes in appetite (+weight loss/gain)
- aches and pains
what are some examples of social/behavioral responses to loss (3)
- changes in activity lvl
- decreased socialization
- avoidance and/or focus on reminders of loss
what are some examples of spiritual responses to loss (2)
- questioning meaning of life/purpose
- asking “why”
what is grief
- the combo of various responses to a loss
describe the early thinking regarding grief
- sigmund freud says that the person experiencing the loss suffers, bc of their attachment to that person or object that was lost
according to freud, what was the goal of processing grief
- involves “letting go” of that which has been lost in order to build new relationships or circumstances
what was the next stage of thinking, after freud. regarding the process of griefing
- 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
what were the 4 stages of grief
- numbing
- yearning and searching
- disorganization
- reorganization to recover from the loss and adjust to new reality
what were the 5 stages of grief outlined by cooper ross
- denial
- anger
- bargaining
- depression
- acceptance
what was the main idea associated w the 5 stages of grief
- that individuals work thru these stages to a place of fully ackowledging and making peace w the loss
what was the issue associated w theory of the stages of grief
- stages are not an accurate depiction of how grief actually works
- grief is not a linear process, it is much more complex than that
describe the current thinking of the process of griefing
- 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
what is loss orientation mode
- 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
what is restoration mode
- focuses on problem focused coping
- things that let you get on ur faily life and distract you from ur pain
what are some examples of restoration orientated coping (5)
- working
- cleaning
- going out w friends
- TV
- exercise
what is the goal of the current process of thinking
- finding meaning and growth
describe “normal grief”
- 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
in general, during grief it is normal to experience… (7)
- sadness
- anxiety
- guilt
- anger
- sleep disturbances
- difficulty concentrating
- loss of appetite
in general, during grief, normal processes involve: (4)
- 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
list 6 common alterations in grief
- anticipatory
- delayed
- complicated
- disenfranchised
- cumulative
- inhibited
what is anticipatory grief
- grief that occurs before the loss
- responses related to the loss of what was or what was hoped for or supposed to be
what is delayed grief
- responses to a loss that are postponed until a later time
what might initiate delayed grief
- by another major life event
what is disenfranchised grief
- 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
what are some example situations where someone may experience disenfranchised grief (3)
- loss of ex
- loss of pet
- loss of home
what are some warning signs of delayed grief (3)
- self destructive behavior
- radical lifestyle changes
- outbursts
what is cumulative grief
- grief that occurs when multiple losses are experienced, often within a short period of time
what is inhibited grief
- 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
list 6 factors that may affect grief
- nature of loss
- relationship
- age
- gender
- culture
- ability to cope
what can impact the nature of loss (3)
- if recognized by others
- if sudden death (type of death)
- if have multiple concurrent losses
how does age impact grief
- determines how grief is manifested & how they understand loss
describe 2 examples of how age can impact grief
- young children’s ability to understand the loss varies depending on their development stage
- older adults have increased risk of cumulative loss
describe how gender can impact grief
- women are more likely to express feelings, seek help
describe how culture can impact grief (3)
- some cultures expect a dignified and quiet response
- some expect to openly express
- emotions vary: some expect you to feel lonely, others angry
what can impact the ability to cope r/t grief (4)
- personality traits
- previous experiences
- belief system
- support & resources
describe the process of appraisal of an event and stress
- 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
list how to asses loss and grief (10)
- 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
how can we support those experiencing loss and grief (7)
- 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
what are some “dont’s” for supporting those experiencing loss and grief (8)
dont:
- compare griefs
- fact check or correct
- minimize
- give compliments
- be a cheerleader
- talk abt it later
- evangelize
- start w solutions
what are some “do’s” for supporting those experiencing loss and grief (7)
- ask questions
- respect their experience
- remember this grief is theirs
- trust them
- stay in the present moment
- trust their self cae
- get consent
how can we help ourselves and support other nurses in grief (9)
- 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
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)
- 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
in chochinov’s study, what 4 chronic populations did he consider
- ALS
- COPD
- ESRD
- frail elderly
in pts with ALS, dignity was decreased r/t.. (7) what % (idk what the percents mean in the chart lol)
- 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%
in pts with COPD, dignity was decreased r/t… (3)
- physical distress
- most SOB & anxiety out of all groups
- lowest mortality but most uncertain about health
describe what findings were found in individuals with ESRD (3)
- only group with suicidal ideation
- highest # of comorbidities
- prominent symptom burden
describe what findings were found in the “frail elderly” group (5)
- 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
what is complicated grief
- being “stuck” in acute grief
- responses to loss are debilitating and do not lessen or improve over time
what impact does complicated grief have
- significantly impairs ability to fnxn `
what are some warning signs of complicated grief (5)
- self destructive behaviors
- consistent feelings of guilt
- lowered self esteem
- radical lifestyle changes
- outbursts
