Chapter10-Grief & Loss.pptx

Chapter 10 Grief and Loss Learning Objectives  1. Identify the types of losses for which people may grieve.  2. Discuss various theories related to understanding the grief process.  3. Describe five dimensions of grieving.  4. Discuss universal and culturally specific mourning rituals.  5. Disc...

Chapter 10 Grief and Loss Learning Objectives  1. Identify the types of losses for which people may grieve.  2. Discuss various theories related to understanding the grief process.  3. Describe five dimensions of grieving.  4. Discuss universal and culturally specific mourning rituals.  5. Discuss disenfranchised grief.  6. Identify factors that increase a person’s susceptibility to complications related to grieving.  7. Discuss factors that are critical to integrating loss into life.  8. Identify priority cues and essential actions to facilitate grieving for clients and families. Copyright © 2023 Wolters Kluwer All Rights Reserved Grief  Subjective emotions and affect; normal response to loss  Grieving/bereavement: process by which person experiences grief o Content o Process  Anticipatory grieving: persons facing an imminent loss begin to deal with possibility of loss or death in near future  Mourning: outward expression of grief, including rituals Copyright © 2023 Wolters Kluwer All Rights Reserved Types of Losses Physiologic loss o Amputation, mastectomy Safety loss o Domestic violence, child abuse, Loss of security and a sense of belonging o Loss of a loved one Loss of self-esteem o Change in how a person is valued Loss related to self-actualization o Internal or external crisis that blocks self-actualization Copyright © 2023 Wolters Kluwer All Rights Reserved Theories of Grieving #1 (See Table 10.1) Kübler-Ross’s five stages of grieving o Denial o Anger o Bargaining o Depression o Acceptance Copyright © 2023 Wolters Kluwer All Rights Reserved Theories of Grieving #2 Theory that humans instinctively attain and retain affectional bonds with significant others through attachment behavior Bowlby’s phases of grieving o Numbness and denial of loss o Emotional yearning for the lost loved one and protesting permanence of loss o Cognitive disorganization and emotional despair with difficulty functioning o Reorganization and reintegration Copyright © 2023 Wolters Kluwer All Rights Reserved Theories of Grieving #3 Engel’s stages of grieving o Shock and disbelief  Numbness feeling to the loss accompanied by refusal o Developing awareness  Accept the loss, crying, helplessness, frustration at others o Restitution  Funeral, wake, family gatherings o Resolution of the loss  Preoccupied with the loss, deceased is idolized, (lasts about a year) o Recovery  Previous preoccupation Copyright © 2023 Wolters and Kluwer obsession All Rights Reserved ends, go on with life Theories of Grieving #4 Horowitz’s stages of loss and adaptation o Outcry  Realization of loss, yelling, crying, collapse o Denial and intrusion  denial-become too distracted forget about the loss  Intrusion- the loss is involved in everything the person does and thinks o Working through  Person spends less time between denial and intrusion, emotions not as overwhelming o Completion  Life begins to feel normal, memories are less painful Copyright © 2023 Wolters Kluwer All Rights Reserved Tasks of Grieving (Mourning) Involves active participation  Rando’s “six Rs” o o Accept reality of the loss Recognize  Experience the loss o React  o o Emotional response to loss Recollect and reexperience  Memories are reviewed and relived Relinquish  Accept world has changed o Readjust  o o Work through pain of grief  Accept the grief in order to move forward o Adjust to changed environment due to loss  Develop new coping skills, find new meaning in life o Emotionally relocate loss and move on Return to daily life Reinvest  Worden’s tasks Accept changes, return to world  The lost person is not forgotten but rather is relocated in their life Copyright © 2023 Wolters Kluwer All Rights Reserved Dimensions of Grieving  Cognitive responses o Questioning, trying to make sense of loss  o Question life being fair, searching for answers Attempting to keep lost one present  Belief in afterlife, loved one is watching over them now  Emotional responses (anger, sadness, anxiety)  Spiritual responses (angry with god, loss of hope)  Behavioral responses(easiest to observe) o  Tearful, sobbing, crying, restlessness) Physiologic responses (anxiety, insomnia, palpitations) Copyright © 2023 Wolters Kluwer All Rights Reserved Cultural Considerations #1  Universal reactions to loss o Initial response of shock and social disorientation o Attempts to continue relationship with deceased o Anger with those perceived as responsible for death o Time for mourning  Culture-specific rituals o Expressions of grieving defined by each culture o Acculturation: altering values/behaviors to adapt to another culture o Cultural rituals with roots in major religions o Various mourning rituals and practices in the United States Copyright © 2023 Wolters Kluwer All Rights Reserved Culture-Specific Rituals  African Americans o Hyms may be sung, poetry rad, deceased viewed in church before burial  Muslim o Do not permit cremation, 5 steps of burial process, traditional first step of washing of the deceased body by someone of same sex  Haitan Americans o Some practice voodoo, calling on spirits with whom one makes peace  Chinese o Strict practices for announcing the death and preparing the body, burning incense and reading scriptures. If Buddhist, meditate before a shrine is important.  Filipino o Customary to wear black clothes and armbands during mourning, wreath on casket and drape on the home of deceased Vietnamese o Bath and dress the deceased and dress in black clothes, grains of rice in mouth and money in deceased pocket, may display body in home before burial Copyright © 2023 Wolters Kluwer All Rights Reserved Cultural Considerations #2 Nurse’s role o Individualize care o Encourage patients to discover and use grieving behaviors that are effective and meaningful to them Copyright © 2023 Wolters Kluwer All Rights Reserved Disenfranchised Grief #1 Grief over loss that is not or cannot be acknowledged openly, mourned publicly, or supported socially: o A relationship that has no legitimacy  Same sex relationships, extra marital affair o The loss itself is not recognized.  Prenatal death, abortions o The griever is not recognized.  Older adults and children o The loss involves social stigma.  Grieving death of a criminal family member Copyright © 2023 Wolters Kluwer All Rights Reserved Disenfranchised Grief #2 Grief process more complex due to the absence of usual supports for grieving, healing In the U.S. culture, kin-based relationships receive most attention in cases of death. Experienced by nurses when their need to grieve is not recognized Can also be experienced by other “helping” professionals, such as chaplains and clergy Copyright © 2023 Wolters Kluwer All Rights Reserved Complicated Grieving #1  Person void of emotion; grieving for prolonged periods; expressing grief disproportionate to event  Previously existing psychiatric disorders may complicate process.  Clients can experience grief when change encountered. Copyright © 2023 Wolters Kluwer All Rights Reserved Complicated Grieving #2 Characteristics of susceptibility o Low self-esteem o Low trust in others o Previous psychiatric disorder o Previous suicide threats or attempts o Absent or unhelpful family members o Ambivalent, dependent, insecure attachment to deceased person Copyright © 2023 Wolters Kluwer All Rights Reserved Complicated Grieving #3  Risk factors leading to vulnerability o Death of spouse or a child o Death of parent (particularly in early childhood or adolescence) o Sudden, unexpected, untimely death o Multiple deaths o Death by suicide or murder  Unique, varied experience (physical, emotional reactions) o Maladaptive thoughts o Dysfunctional behaviors o Inadequate emotional regulation Copyright © 2023 Wolters Kluwer All Rights Reserved The Nursing Process: Assessment All dimensions of human response (see Box 10.1) Three critical components Adequate perception regarding the loss What does the lose mean to the client Adequate support while grieving for the loss Who can meet their emotional or spiritual needs Adequate coping behaviors during process Carefully observe client’s behavior, use effective communiation skills Copyright © 2023 Wolters Kluwer All Rights Reserved The Nursing Process: Data Analysis and Priorities Anticipated vs. actual loss Problems with eating and sleeping Negative effects on physical health requiring followup Copyright © 2023 Wolters Kluwer All Rights Reserved The Nursing Process: Outcomes Examples: Client will: o Identify effects of loss o Seek adequate support o Develop plan for coping with the loss o Apply effective coping strategies o Recognize negative effects of the loss on life o Seek or accept professional assistance if needed Copyright © 2023 Wolters Kluwer All Rights Reserved The Nursing Process: Actions Exploring perception of loss o Cognitive responses o Adaptive denial Obtaining support Promoting coping behaviors (see Nursing Actions) o Reviewing strengths of past coping o Encouraging self-care o Using communication, interpersonal skills Copyright © 2023 Wolters Kluwer All Rights Reserved The Nursing Process: Evaluation Review of tasks and phases of grieving can be helpful in making statements about client’s status. Clients need support of trusted person. Nurse must examine personal attitudes. Copyright © 2023 Wolters Kluwer All Rights Reserved Self-Awareness Issues Examine one’s own experiences with grief and loss. o Pt’s experiencing loss needs more than a nurse with basic knowledge and skills, they need support and trustful nurse Take self-awareness inventory, reflecting on results. o “How have I hoped with mu losses?”, “Am I capable of facilitating my client’s grief?” Perform ongoing self-evaluation. o Effective method of keeping the therapeutic relationship goal-oriented and attentive to client’s needs. Copyright © 2023 Wolters Kluwer All Rights Reserved