Week 3- loss, grief, mourning and bereavement

Question 1

4 key elements of how PC can be used in practice

Answer 1

1 .Decreasing suffering and increasing QOL
2. Holistic care (spiritual, cultural, mental, social, physical)
3. Team based
4. Person and family centered care

Question 2

Loss=

Answer 2

To be deprived of someone or something important.

Question 3

anticipatory loss (grief)

- an _______ response to
- can be based on

Answer 3

• An emotional response to expected or impending future losses
• Can be based on the dying person’s or family’s previous losses

Ex. Loss of a long retirement or grandchildren

Question 4

ambiguous loss

- difficult to
- may be

Answer 4

• difficult to identify, often not tangible
• might be more challenging for family

ex. gradual loss of cognitive function with dementia. person is still alive but not the same

Question 5

need to support people through loss so they _____

how (3)

Answer 5

don’t develop complicated grief

how: providing support throughout, prepare for loss, open conversations

Question 6

grief (4)
not necessary to

Answer 6

• natural, healthy response to loss
• whole body experience
• does not end, intensity decreases over time
• everyone grieves differently
• not necessary to alter normal grieving, provide a listening ear, be supportive, provide information

Question 7

as nurses we can

Answer 7

Acknowledge loss
Assess loss and grief
Education
Leave room for silence
Make space for tears
Lifestyle management
Resources

Question 8

AAG

Answer 8

Adult attitudes to Grief scale
- assess grief
ask more questions on the areas that scored high

Question 9

age: 2-4
concept of death (2)
grief response (2)

Answer 9

• seen as abandonment
• seen as reversible
• intensive but brief
• very present oriented

Question 10

Age 4-7
concept of death
grief response

Answer 10

death is still seen as reversible
A great personification of death
feelings of responsibility because of wishes or thoughts

verbalization
great concerns with person
how, why

Question 11

7-11
concept of death (3)
grief response (3)

Answer 11

punishment
fear of bodily harm
difficult transition period- still wants to see as reversible

specific questioning
concerned how others are responding (what is the right way)
starting to have ability to mourn

Question 12

11- 18
concept of death
grief response

Answer 12

• adult approach
  ability to abstract
  beginning to conceptualize death truly

depression
denial
regression
talk to people outside family
traditional mourning

Question 13

social, educational, and family factors to help determine grief/bereavement preferences

questions you can ask

Answer 13

• tell me about your family.
• have you or your family had significant experience with someone who has had a serious illness or who has died?, how did that affect you?

Question 14

cultural, religious and spiritual factors questions to help determine preferences in grief/bereavement discussions

Answer 14

• is there anything I should know about your cultural, religious, or spiritual views about illness or life and death?

Question 15

freud theory of grief (2)

Answer 15

• The starting point for theories on grief
  loss-mourning
• Is complete when attachment is severed

Question 16

bowlby theory on grief (2)

Answer 16

Attachment-based theory
need to detach & sever relationships to complete mourning

Question 17

Kubler- Ross theory on grief (2)

Answer 17

Proposed stages of grief
-shock and disbelief, anger, bargaining, depression & acceptance

Question 18

Parkes theory of grief

Answer 18

Healthy grieving includes changing one’s worldview and the way they have dealt with life previously

Question 19

Klass, Silverman and Nickman theory on grief

Answer 19

Continued bonds
-the ongoing relationship between the bereaved and the deceased is healthy and normal

Question 20

common normal manifestations of grief
- physical
- social
- emotional
- spiritual
- mental

Answer 20

(sleep, personal hygiene)
(isolate, unable to focus on work, distracting, delaying, denying)
(laughing, crying)
(questioning, strengthening)
( disassociate, anger)

Question 21

prolonged grief disorder (complicated grief) occurs when

Answer 21

there is a debilitating intensity or duration of “normal” grief responses that adversely affect the ability to cope with normal life events.

Question 22

vulnerable groups for grief (6)

Answer 22

elderly
children
socially isolated
mentally ill
disenfranchised
culturally diverse groups (new immigrants and the Indigenous)

Question 23

Risk factors for complicated grief (7)

Answer 23

1. Co-morbidities: mental illness; cognitive impairment; substance abuse
2. Concurrent stressors: significant other with a life-threatening illness
3. Circumstances around the death: perceived as preventable, sudden, unexpected, violent, traumatic or untimely; suicide; found/saw/identified the body; issues with death notification
4. Lack of support: social isolation, disenfranchised grief; cultural or language barriers;
5. Relationships: anger, ambivalence, resentment; attachment insecurity; high marital dependency;
6. Low social support
7. Being a spouse or parent of the deceased.

Question 24

Bereavement:

Answer 24

The state where, following death, the family creates meaning and sense out of the new reality of life without their loved one/person who died.

Question 25

Bereavement includes the period of

Answer 25

adjustment following a person’s death and it encompasses many elements of grief, including prolonged grief disorder (complicated grief).

Question 26

___% of grief in bereavement is normal grief, not requiring pharmacological management

Answer 26

85

Question 27

Management of Bereavement
- at the time of death

Answer 27

• personally contact person/family
• acknowledge the death and reactions including feelings such as guilt, relief or shock
• ascertain and address immediate concerns about care, the death or funeral
• arrange for follow up

Question 28

After death
self management (3)

Answer 28

• provide info about grief
• provide info about local resources and online resources
• share be gentle with yourself pt handout

Question 29

after death
- ongoing care contact

Answer 29

• within 2 weeks, acknowledge or contact family
• contact again at 1-2 months, 6 months and 11-12 months (anniversary of the death)
• recognize holidays, birthdays and wedding anniversaries are tough
• be aware that the second year can also be difficult

Question 30

benzos have a

Answer 30

very limited role in the management of acute grief

Question 31

melatonin

Answer 31

• non addictive may be helpful sleep aid
• (0.1-10mg)
• 3-10mg hs is commonly used in PC and geriatric settings

Question 32

treating grief related major depression: antidepressants

Answer 32

treat once you are confident it is pathological
start recommending exercise, counselling, and supports

if symptoms are worse or not improving by 8 weeks post death, start antidepressant medication

Question 33

treating prolonged grief disorder

Answer 33

• assess in the context of the persons life, personality, culture, and nature of death/illness
• refer to bereavement counsellor, psychologist or psychiatrist who will provide targeted psychotherapy