Stages of Grief
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Questions and Answers

Which statement best describes maladaptive grief in relation to the loss of a child?

  • It typically leads to a quicker resolution of grief.
  • It is easier to cope with than the loss of an elderly person.
  • It only affects fathers more than mothers.
  • It is likely intensified by the violent nature of the child's death. (correct)

What is a primary characteristic of delayed or inhibited grief?

  • Rapid adjustment to normal life
  • A strong desire to talk about the loss with others
  • Prolonged fixation in the denial stage of grief (correct)
  • Immediate acceptance of the loss

Which of the following is NOT associated with distorted grief response?

  • Exaggerated depressive mood
  • Acceptance of the loss (correct)
  • Feelings of hopelessness and powerlessness
  • Fixation on anger towards the situation

In the context of grief, what might lead to chronic or prolonged grieving?

<p>Inadequate support systems and resources (A)</p> Signup and view all the answers

What is one potential outcome when someone experiences delayed grieving?

<p>They may experience compounded issues with subsequent losses. (B)</p> Signup and view all the answers

Which age group begins to understand the finality of death and considers their own death?

<p>Age 6-9 (B)</p> Signup and view all the answers

What may indicate a maladaptive mourning process in a bereaved individual?

<p>Avoiding social interactions for an extended period (C)</p> Signup and view all the answers

What common reactions might a child aged 10-12 display upon experiencing the death of someone close?

<p>Feelings of anger, guilt, and depression (A)</p> Signup and view all the answers

What is a key aspect of understanding an individual's beliefs about death and grief?

<p>Encouraging individuals to describe their own rituals and mourning practices (C)</p> Signup and view all the answers

Which nursing diagnosis is associated with the risk of complicated grieving?

<p>Risk for complicated grieving related to loss of a valued entity (C)</p> Signup and view all the answers

What is the primary emotional response associated with the denial stage of grief?

<p>Difficulty believing the loss has occurred (A)</p> Signup and view all the answers

During which stage of grief do individuals often experience elevated anxiety and confusion?

<p>Anger (A)</p> Signup and view all the answers

Which stage of grief involves individuals attempting to negotiate for more time or a second chance?

<p>Bargaining (D)</p> Signup and view all the answers

Which behavior might be observed during the depression stage of grief?

<p>Social isolation (A)</p> Signup and view all the answers

What term describes the overwhelming feelings due to the reality of the loss in the depression stage?

<p>Reactive depression (B)</p> Signup and view all the answers

What is a key characteristic of the anger stage of grief?

<p>Self-blame or blaming others (B)</p> Signup and view all the answers

In the bargaining stage of grief, what kind of statements might individuals make?

<p>Asking for time in exchange for change (A)</p> Signup and view all the answers

What could potentially improve the grieving process during the depression stage?

<p>Individual readiness for support (A)</p> Signup and view all the answers

What characterizes maladaptive grieving compared to normal grief?

<p>Presence of self-esteem issues (B)</p> Signup and view all the answers

Which stage of grief involves accepting the reality of the loss?

<p>Resolution of loss (A)</p> Signup and view all the answers

Which of the following is NOT a symptom of maladaptive grieving?

<p>Feeling relaxed when reminded of the lost entity (B)</p> Signup and view all the answers

What is one of Worden's tasks in the grieving process?

<p>Accepting the reality of loss (C)</p> Signup and view all the answers

Which factor can interfere with the grief process?

<p>Feeling guilty about having a mixed relationship (C)</p> Signup and view all the answers

Which symptom is specifically absent in bereaved populations associated with depression?

<p>Suicidal thoughts (D)</p> Signup and view all the answers

How can previous unresolved losses impact new grief responses?

<p>They cumulatively complicate each new loss (D)</p> Signup and view all the answers

What is a key indicator of normal grieving compared to maladaptive grieving?

<p>Increased resilience and adaptation (B)</p> Signup and view all the answers

What characterizes Stage V: Acceptance in the grieving process?

<p>Gradual acceptance and engagement with the environment (D)</p> Signup and view all the answers

Which stage is marked by profound feelings of despair and aimlessness?

<p>Stage III: Disorganization and despair (D)</p> Signup and view all the answers

How does an individual in Stage II typically behave?

<p>They experience feelings of ambivalence and guilt (C)</p> Signup and view all the answers

What is a key feature of Stage IV: Reorganization?

<p>Establishment of new goals and relationships (C)</p> Signup and view all the answers

Which behavior is NOT typically associated with Stage III: Disorganization and despair?

<p>Attempts to re-engage with lost relationships (A)</p> Signup and view all the answers

What emotional state characterizes individuals in Stage I: Numbness or protest?

<p>Shock and disbelief (B)</p> Signup and view all the answers

In the grieving process, what does a person who is ready to die exhibit in Stage V?

<p>Quietness and withdrawal from the environment (A)</p> Signup and view all the answers

What process occurs during the transition from Stage II to Stage III?

<p>Heightened feelings of despair and disorganization (B)</p> Signup and view all the answers

What is the primary goal of hospice care?

<p>To offer palliative and supportive care for individuals who are dying. (C)</p> Signup and view all the answers

Which of the following behaviors is NOT associated with the stages of grief?

<p>Engaging in aggressive physical exercise. (C)</p> Signup and view all the answers

Which statement best describes the focus of the interdisciplinary treatment team approach in hospice care?

<p>It unifies various professionals to enhance the quality of life for patients. (B)</p> Signup and view all the answers

What is a key intervention to assist a patient in the grieving process?

<p>Fostering trust and showing empathy and unconditional positive regard. (A)</p> Signup and view all the answers

How should healthcare providers assist patients in expressing their feelings related to grief?

<p>By facilitating the identification of emotions and encouraging expression. (C)</p> Signup and view all the answers

Which component is NOT included in the seven components of hospice care?

<p>Emergency medical treatment options. (C)</p> Signup and view all the answers

What should be evaluated to assess a patient's coping with loss?

<p>Their obsession with the lost entity. (A)</p> Signup and view all the answers

What emotion should healthcare providers help patients express during the grieving process?

<p>Anger. (A)</p> Signup and view all the answers

Flashcards

Loss (in bereavement)

Significant loss of a person, pet, or due to illness or a debilitating condition, or developmental/maturational changes, resulting in decreased self-esteem or loss of possessions.

Kubler-Ross stages of grief

A model of grief that describes a five-stage process: denial, anger, bargaining, depression, and acceptance.

Denial (Kubler-Ross)

The first stage of grief, characterized by difficulty accepting the loss, often expressed by phrases like "No, it can't be true!"

Anger (Kubler-Ross)

The stage of grief where individuals experience feelings of sadness, guilt, shame, and anger directed at self or others.

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Bargaining (Kubler-Ross)

Individuals attempt to negotiate with a higher power for a second chance or more time.

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Depression (Kubler-Ross)

A stage of grief involving mourning for the loss experienced.

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Reactive depression

Mourning for what has been lost

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Preparatory depression

Mourning for an impending loss.

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Stage V: Acceptance

Individuals accept or resign to a loss. Anxiety decreases, and coping mechanisms are established.

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Stage I: Numbness/Protest

Shock and disbelief that a loss has occurred, not acknowledging reality.

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Stage II: Disequilibrium

Individual wants to recover the loss, preoccupied with the loss, intense emotions, and guilt.

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Stage III: Disorganization/Despair

Realization of loss leads to despair, disorganized activities, restlessness, and hopelessness. Somatic complaints are common.

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Stage IV: Reorganization

Acceptance of loss, new goals, reinvestment in relationships, and moving forward.

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Loss and Impending Death

Individual may become quiet and withdrawn, disengaging from the environment to facilitate passage when impending death of self is present.

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Coping Mechanisms

Methods developed to handle a loss, crucial in the acceptance stage.

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Grief Stages

A model of emotional responses to loss, encompassing various stages from shock to acceptance, such as numbness/protest and despair.

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Maladaptive Grief

A prolonged or intense grieving process that interferes with daily life, characterized by symptoms like loss of self-esteem, and anger; it is more symptomatic of clinical depression than simple grief.

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Normal Grief

A natural response to loss that leads to resolution and recovery, distinct from a clinical disorder like depression, in which self-esteem is maintained.

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Loss of Self-Esteem (Grief)

A symptom of maladaptive grief, characterized by feelings of worthlessness and low self-image, which often isn't found in normal bereavement but can occur in depression.

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Grief Tasks (Worden)

Stages of grief according to J. William Worden, emphasizing the tasks of accepting reality, processing/managing pain, adjusting to the world without the lost entity, and finding enduring connection.

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Grief Stages (Engel)

Stages of grief according to George Engel, encompassing shock/disbelief, developing awareness, restitution, resolution, and recovery of a sense of well-being.

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Factors of Grief Process

Factors that influence the process, like strong dependency on the lost entity, ambivalent relationships (love/hate), multiple recent losses, or age of the lost entity.

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Suicidal Thoughts (Grief)

A symptom that often marks a difference between normal grief and maladaptive grief, present in clinical depression but not typically in normal or uncomplicated bereavement.

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Psychomotor Retardation (Grief)

A symptom of clinical depression, marked by slowing down of movements or thoughts, a key indicator differentiating from typical grieving and pointing to maladaptive grief or depression

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Death understanding (3-5 years)

Children at this age may understand death, but believe it's reversible. They might think the deceased person will come back.

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Death understanding (10-12 years)

Children understand death is final and affects everyone. They may experience anger, guilt, and depression.

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Cultural considerations in grief

Understanding how different cultures approach death, rituals, and mourning practices is important.

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Nursing diagnosis for grief

Two common nursing diagnoses associated with grief are 'Risk for complicated grieving' and 'Risk for spiritual distress.'

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Delayed grief

A type of grief where a person avoids facing the reality of their loss, often denying it for years. They may overreact to others' grief and struggle to cope with subsequent losses.

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Chronic grief

Grief that persists for a long time, often involving difficulty accepting the loss and moving on. This is a spectrum, and some chronic grief can be adaptive.

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What are some factors that may lead to maladaptive grief?

Factors that increase the likelihood of unhealthy grieving include: traumatic death, especially of a child, the bereaved person's unstable physical or psychological health, perceived responsibility for the loss, loss due to suicide, and loss by murder.

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What is the main characteristic of distorted grief?

Distorted grief is characterized by exaggerated grief reactions, intense negative emotions, and a fixation on anger.

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Stages of Grief

Distinct emotional responses to loss, often described in stages like denial, anger, bargaining, depression, and acceptance.

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Empathy in Grief Support

Understanding and sharing the feelings of someone experiencing loss, showing genuine concern and acceptance without judgment.

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Actualizing the Loss

Helping someone process the reality of a loss by asking questions about the event, like 'When did it happen?' or 'How did it happen?'

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Expressing Grief Emotions

Encouraging someone to express their feelings, like anger, guilt, anxiety, or helplessness, to work through them healthily.

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Hospice Care

A program providing palliative and supportive care for terminally ill individuals and their families, focusing on pain management and quality of life.

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Interdisciplinary Hospice Team

A group of healthcare professionals, including nurses, doctors, social workers, counselors, and therapists, working together to provide holistic hospice care.

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Spiritual Support in Grief

Providing comfort and guidance through religious practices or belief systems, connecting individuals with spiritual leaders upon request.

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Grief Resolution

The long process of healing and adapting to life without the lost person or thing, often requiring time, support, and self-care

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Study Notes

Bereavement

  • Loss: Significant person or pet, illness, or debilitating condition
  • Developmental/maturational changes: Decrease in self-esteem, personal possessions
  • Theoretical perspectives: Stages of grief (Table 27-1)

Stages of Grief

  • Stage 1: Denial: Difficulty believing the loss occurred ("No, it can't be true"). This stage protects from psychological pain.
  • Stage 2: Anger: Reality sets in, leading to feelings like sadness, guilt, shame, helplessness, hopelessness. Anger can be directed at self or others, and anxiety is often heightened. Preoccupation with an idealized version of what was lost is common. Somatic complaints are also frequent.
  • Stage 3: Bargaining: Individuals attempt to negotiate with a higher power for a second chance or more time. This might involve statements like, "If only I could..." or "If only I had...".
  • Stage 4: Depression: Individuals mourn the loss and confront feelings of loss. This stage is marked by pain. Reactive depression involves loss of something or someone of value. Preparatory depression involves anticipating a loss. Examples include regression, withdrawal and social isolation.
  • Stage 5: Acceptance: Individuals have processed the loss. Anxiety decreases, and new coping mechanisms are developed. Individuals focus on other aspects of life. If the loss is impending death, the individual may become quiet and withdrawn, seemingly devoid of feelings.

Kubler-Ross's Grief Process

  • Stage 1: Numbness or Protest: Shock and disbelief that the loss occurred. Reality of the loss is not acknowledged.
  • Stage 2: Disequilibrium: Individuals strongly desire to recover what was lost. Behaviors include preoccupation with the loss, intense weeping, and anger toward the deceased.

Maladaptive Grieving

  • Maladaptive: Loss of self-esteem and feelings of worthlessness. This contrasts with normal bereavement.
  • Clinical depression: Episodes of rage, unresolved anger, difficulty accepting loss and self-destructive behavior are symptoms.

Chronic or Prolonged Grieving

  • Prolonged process: Thoughts, emotions, and behaviors prevent the bereaved from adapting and functioning normally. Individuals may linger on the "anger" stage.

Concepts of Death by Developmental Age

  • Birth-2 years: Loss and separation experienced
  • 3-5 years: Understanding of death; belief death is reversible
  • 6-9 years: Begin to understand finality
  • 10-12 years: Understanding that death is final and affects everyone

Cultural Considerations

  • Death rituals: Vary across cultures
  • Mourning practices: Vary across cultures
  • Burial practices: Vary across cultures

Nursing Interventions

  • Identify values and beliefs: about death, dying, and the afterlife.
  • Assess stages: of grief.
  • Assess emotional state: of patient and family.
  • Encourage expression: of feelings and provide empathy, concern, and unconditional positive regard.
  • Assist in actualizing loss: by asking about the loss.

Patient Outcomes

  • Loss awareness: Patient acknowledges awareness of the loss and expresses feelings.
  • Grief stages: Patient verbalizes stages and associated behaviors.
  • Self-satisfaction: Patient experiences personal satisfaction.
  • Spiritual support: Patients gain support from spiritual practices.

Advance Directives

  • Allows patients to be in control of their end-of-life decision.
  • Patients should be advised of their right to refuse treatment and make advance directives. Advance directives may be not honored (due to vague language, inconsistencies with the current situation, etc.).

Hospice Care

  • Palliative and supportive care: For dying individuals and their families. Includes pain and symptom management, physical, psychological, spiritual and social care.
  • Aggressive treatment: Not appropriate for hospice patients.

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Chapter 27: Bereavement PDF

Description

Explore the emotional journey of grieving through the stages of denial, anger, bargaining, and depression. This quiz covers the key theoretical perspectives and developmental changes associated with bereavement. Understand the psychological responses and transformative processes individuals experience in the face of loss.

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