EF - GRIEF Flashcards
Grief can be defined as
eelings or reactions that an individual has to a loss in ir life
loss that an individual faces is not always related to a
death
grief can be experienced w/ many
types of loss
every person experiences grief in ir
own unique way
Most individuals, if not all, will
experience grief at some point in ir life
American Psychological Association defines grief as
“ anguish experienced after significant loss, usually death of a beloved person”
Grief can occur after
eceiving bad news about one’s health or from many life situations
C. may experience grief due to
loss of a loved one such as a spouse, a parent, a sibling, a child, or a close friend
divorce,
retirement,
loss of a job,
loss of friendship,
loss of financial stability,
a miscarriage, or
moving to a new city
Grief can include both
emotional and physical manifestations,
grief is usually accompanied by
physiological stress
C.s may exhibit
anxiety,
difficulties in concentrating,
thinking about past excessively, and
agitation
Grief is body’s way of
healing after one has suffered a loss
Types of Grief
Normal
Anticipatory
Prolonged Grief Disorder
Disenfranchised Grief
Normal grief, also known
uncomplicated grief
Normal grief, also known as uncomplicated grief, is caused by
loss of a loved one, through death or ending of a relationship
grief can be triggered by or
experiences that are considered to be painful or traumatic to C.
period of time for which an individual grieves a loss will
differ for every person, most people will experience grief after a loss for several months to a year
normal grief is different for
everyone
individual’s sense of loss is
unique to that person, and people’s feelings regarding loss reflect ir own unique make-up
Feelings experienced during grief often include
sadness, guilt, yearning, anger, and regret
no timeline for how long
an individual will experience grief,
nor is re an ordinary degree or severity to which
an individual will experience grief
Grief typically lessens
over time as feelings decrease in intensity, and person experiencing grief simultaneously moves forward in ir acceptance of loss
Grief is primarily thought of as being caused by death of a loved one, but it has many or causes—for example
loss of identity, loss of safety, loss of autonomy, and loss of dreams or expectations
Loss of identity can be experienced when
a C. faces loss of a role or relationship,
Exs of loss of role or relationship
such as after divorce, when one is no longer considered a spouse; or when a child goes off to college, leaving parent as an empty nester; or after having undergone a double mastectomy, when a C. might feel a loss of femininity
Loss of safety (think of Maslow’s hierarchy of needs) is experienced when
C.s perceive that y have lost physical, emotional, and mental happiness
Loss of security can be experienced when
C.s find mselves evicted or have erratic housing arrangements, among children of divorced parents, or when a survivor of physical abuse fears for ir safety on a daily basis
Loss of autonomy is experienced
as a result of older adults’ inability to take care of mselves and belief that y can no longer contribute to society, or when individuals have a worsening condition that affects ir physical or cognitive capability
Loss of dreams and expectations is experienced when
an individual’s hopes and dreams remain unfulfilled
Exs of lost of dreams/expectations
C.s whose career path fails to mirror ir expectations; students struggling to find where y belong in real world; and a couple who are coming to terms w/ infertility
Common manifestations of normal grief include
sadness, guilt, yearning, anger, and regret
Anticipatory grief is defined as
grief that is experienced before loss of someone or something
anticipatory grief arises when
a loss is expected
Anticipatory grief commonly occurs when
C. has been identified as having a terminal illness or has been suffering from a chronic disease over an extended period of time
anticipatory grief can be experience by
C.s who have a connection w/ dying person or are dying person mselves
re is no exact amount of time over which
a person may experience anticipatory grief
Even though a person has experienced anticipatory grief previously, prior experience will
not affect present grief experience or degree of grief an individual experiences after a loss
C.s who suffer anticipatory grief can display both
mental and physical manifestations
According to Metzger, common findings of anticipatory grief include
sadness, anger, loneliness, guilt, anxiety, fear, fatigue, and poor concentration
normal to have anticipatory grief when
someone or something that a C. loves is expected to be lost, and C.s can experience anticipatory grief when y face a looming crisis or end of life
Prolonged grief disorder (PGD), previously known as
complicated grief,
Prolonged grief disorder (PGD)
grief that lasts longer than 6 months and can be so significant that it affects C.’s ability to function
C.s who are experiencing prolonged grief are unable to
accept death of loved one
behavior is marked by a persistent need to
find deceased person, and y are preoccupied w/ thoughts of deceased person
Or manifestations of prolonged grief disorder include
feelings of guilt (self-blame), anger, and difficulty participating in new and different activities
It is not unusual for C.s experiencing prolonged grief to
detach mselves from ir friends or family, making it harder for m to recover as y become isolated and lonely
Nursing interventions for PGD include
showing concern, allowing C.s to voice ir feelings, and providing emotional support and guidance
If a nurse becomes concerned that a C. has potential for self-harm, nurse has an ethical responsibility to
notify provider immediately to get mental health services for C.
Health care providers can diagnose complicated grief as a
medical disorder and can provide C. w/ most appropriate treatment available, including support and rapy
Disenfranchised grief is grief related to
a relationship that does not coincide w/ what is considered by society to be a recognized or justified loss
Disenfranchised grief loss is considered by society to
be one of shame or socially uncomfortable and, refore, not worthy of grief
Because loss is not regarded as worthy of grief,
social support is not provided to grieving individual
C.s who are experiencing disenfranchised grief are left to
grieve alone and in silence, as compared to C.s experiencing normal grief, for whom rituals are routinely utilized to lessen burden after a loss
isenfranchised grief can occur as a result of
a loss being unrecognized as significant (eg, loss of a pet or miscarriage),
an unrecognized relationship (eg, an extramarital affair),
an unrecognized griever (eg, a young child),
or loss itself being disenfranchised (eg, suicide)
C.s experiencing disenfranchised grief can suffer from
depression, unstable emotions, social isolation, physical symptoms, insomnia, and low self-esteem
Kubler-Ross Five Stages of Grief
named after psychiatrist Elizabeth Kubler-Ross, who initially developed ory for dying in 1969
Kubler-Ross model identifies five stages in grieving process:
denial, anger, bargaining, depression, and acceptance
Originally it was believed that those who were grieving had to go
through all five stages in a precise, sequential order
revised ory,
stating that five stages were not sequential, and an individual may not necessarily experience all of m; also may bounce back and forth between stages
Denial
C. refuses to believe reality,
is first stage in Kubler-Ross ory and is an
attempt to lessen pain of loss
not uncommon for C. to have a feeling of
numbness and shock
mind is trying to adjust to a loss of someone or something and wonders how life will continue in this altered state
C. is trying to understand what has happened and deal w/ feelings of losing someone or something
Denial is a time in which C.
reflects on and relives time spent w/ person, and questions how life can move forward w/out person
Denial is bodys way of
slowing things down and giving time to adjust to loss, so that C. will not become emotionally overwhelmed
Anger is
second stage, in which C. is trying to adjust to loss and is feeling severe emotional distress
C. thinks, “Why me?” and “It’s not fair”
During anger stage, If C.s have a strong religious faith, y may
question ir belief in deity
Anger provides a means of
releasing emotional discomfort
During anger stage ir may also be blaming
Blaming of ors for loss can also occur, w/ anger being targeted at loved ones such as family and close friends
Anger is a necessary and healthy stage of grief It will
eventually dissolve,
and more anger that is felt,
faster a person will heal
After a loss, many people feel
abandoned and left alone
feeling of anger connects C. to
reality, and it is something that will connect C. to people once again
Bargaining is
third stage
In bargaining, C. tries
different approach - attempt to relieve /minimize / pain felt from /loss
/try bargaining w/ higher power (iemaking promise to do something in exchange for different / better outcome
ex: “I promise I will be a better person if you let this person live”
bargaining response is an attempt to
avoid grief through act of negotiating
In bargaining stage, this is also commonly expereienced
guilt
Ex; If only I had driven m to work that day, y would still be here today”
Depression is which stage of kubler ross model
4th stage
What happens in depression stage
reality sets in,
loss of loved one / thing - deeply felt
realization loved one is gone or situation is over becomes real
in depressions tage, C. feels
numbness and a sense of immense loss,
mourns loss,
wonders if it is worth continuing in life alone
Some C.s might w/draw, not wanting to be around ors as y try to deal w/ loss
It is natural and appropriate to have feelings of _________ during grieving process
depression
what is last stage of kubler ross model
acceptance
acceptance stage
person still feels pain of loss
realizes that all will eventually be well
acknowledges new reality, such as a spouse or child who is never coming back or a job that y will never return to
in what stage are re Some days better than ors, w/ a higher number of good days versus bad days
acceptance stage
in what stage does person begins to connect w/ friends again, and may perhaps make new friendships
acceptance stage
person recognizes that nothing will take place of loss, but that life goes on
Dual Process Model of Grief
suggests that process of grieving oscillates (shifts back and forth) between two types of responses: loss-oriented and restoration grief
During loss-oriented process
grief is conveyed through intense thoughts / feelings
person feels sad,
longs for person who has died,
feels sad about how person died
believes it is unfair person will not be part of griever’s future
restoration grief process involves
coping w/ or losses that come w/ death of a loved one (secondary losses)
rebuilding one’s life w/out loved one
loss of a loved one brings about not only feelings of grief, but also
changes that are a result of loss
restoration process is a time of
thinking about future, filled w/ new tasks and obligations
secondary losses
or losses that come w/ death of a loved one
undamental aspect of Dual Process Model is process of
going back and forth between loss-oriented responses and restoration-oriented responses
C.s shift between se responses over and over again
For example, when a C. becomes tired of focusing on feeling sad and longing for person who has died, C. will
switch to focus on ir new roles and responsibilities
Concentrating on one process too much can be
detrimental, especially if C. uses this approach to avoid dealing w/ emotions of losing a loved one
Dr J William Worden developed Four Tasks of Grieving model as an alternative to
Kubler-Ross’s Five Stages of Grief ory
Worden’s ory suggests that a grieving C. commonly engages in
four tasks as part of grieving process
In Wordens ory, key idea is that
grieving C.s can involve mselves in grieving process, permitting mselves to acknowledge loss and adjust to life after loss
In Wordens ory, 4 tasks of grieving are
(1) accept reality of loss,
(2) experience pain of grief,
(3) adjust to an environment w/out deceased, and
(4) find an enduring connection while embarking on a new life
first taks in Wordens model
Accept Reality of Loss
overcoming denial of loss and accepting loss that has occurred
accepting loss as reality versus believing that it never happened
Denying loss does not
make it go away
Grief is a natural way of
mourning that body and mind must be permitted to go through
first step in grieving is
acceptance,
accepting loss allows
mourner to move forward in grieving process
second task in Wordens model
be aware of emotion and to experience pain of grief
In today’s culture, many people are fearful of feeling strong emotions y may do everything in ir power to avoid feeling, yet preventing feeling of strong emotions only
makes pain worse
Coping w/ emotions can be handled through
writing, creating songs, or whatever works best for C.
important thing is that feelings are dealt w/ and not
suppressed
Third stage in Wordens model
Adjust to an Environment w/out Deceased
get used to living w/out loved one being around
