Loss, Grieving, and Death

Question 1

An actual or potential situation in which something that is valued is changed or no longer available.

Answer 1

LOSS

Question 2

TYPES/ CLASSIFICATIONS OF LOSS

1. _____ loss which can be recognized by others.
2. _____ loss that is experienced by one person but cannot be verified by others.
3. _____ not directly verifiable.
4. _____ experienced before the loss actually occurs.

Answer 2

Actual loss
Perceived loss
Psychological loss
Anticipatory loss

Question 3

SOURCES OF LOSS

Answer 3

1. Loss of an aspect of oneself
2. Loss of an object external to oneself
3. Separation from an accustomed environment
4. Loss of a loved or valued person

Question 4

Sources of loss

1. _____ May be a loss of a body part, a physiological function, or a psychological attribute.
2. _____ Loss of inanimate objects that have importance to the person, and Loss of animate (live) objects.
3. _____ Separation from an environment and people who provide security can cause a sense of loss.
4. _____ Loss through illness, divorce, separation or death.

Answer 4

1. Loss of an aspect of oneself
2. Loss of an object external to oneself
3. Separation from an accustomed environment
4. Loss of a loved or valued person

Question 5

The total response to the emotional experience related to loss. It is manifested in thoughts, feelings, and behaviors associated with overwhelming distress or sorrow.

Answer 5

GRIEF

Question 6

The subjective response experienced by the surviving loved ones.

Answer 6

BEREAVEMENT

Question 7

The behavioral process through which grief is eventually resolved or altered. It is often influenced by culture, spiritual beliefs, and custom.

Answer 7

MOURNING

Question 8

_____ and _____ are experienced not only by the person who faces the death of a loved one but also by the person who suffers other kinds of losses.

_____ permits the individual to cope with the loss gradually and to accept it as part of reality.

_____ is a social process; it is best shared and carried out with the assistance of others

Answer 8

GRIEF AND MOURNING
GRIEVING
GRIEF

Question 9

TYPES OF GRIEF RESPONSES (NDU)

Answer 9

Normal Grief
Disenfranchised Grief
Unhealthy Grief (Pathologic or Complicated Grief)

Question 10

TYPES OF NORMAL GRIEF

_____ Brief but genuinely felt
_____ Experienced in advance of the event

Answer 10

ABBREVIATED GRIEF
ANTICIPATORY GRIEF

Question 11

It is a type of grief responses that occurs when a person is unable to acknowledge the loss to other people. Often relate to socially unacceptable loss that cannot be spoken about.

Ex: Suicide, abortion, or giving a child up for adoption

Answer 11

DISENFRANCHISED GRIEF

Question 12

It is a type of grief responses that exists when the strategies to cope with the loss are maladaptive and out of proportion or inconsistent with cultural, religious, or age-appropriate norms.

Answer 12

UNHEALTHY GRIEF (PATHOLOGIC OR COMPLICATED GRIEF)

Question 13

The preoccupation lasts for more than 6 months and leads to reduced ability to function formally.

Answer 13

Persistent Complex Bereavement Disorder

Question 14

Forms of Complicated Grief (UIDE)

Answer 14

Unresolved or chronic grief
Inhibited grief
Delayed grief
Exaggerated grief

Question 15

Forms of Complicated Grief

Extended in length and severity _____

Many of the normal symptoms of grief are suppressed and other effects, including
somatic, are experienced instead _____

Occurs when feelings are purposely or subconsciously suppressed until a much
later time _____

The survivor appears to be using dangerous activities as a method to lessen the
pain of grieving _____

Answer 15

Unresolved or chronic grief
Inhibited grief
Delayed grief
Exaggerated grief

Question 16

STAGES OF GRIEVING (KEMS)

Answer 16

1. Client Responses and Nursing Implications in Kübler-Ross’ Stages of Grieving
2. Engel’s Stages of Grieving
3. Martocchio’s Five Cluster’s of Grief
4. Sander’s Phases of Bereavement

Question 17

Client Responses and Nursing Implications in Kübler-Ross’ Stages of Grieving. (DABDA)

_____ Refuses to believe that loss is happening.
_____ Client or family may direct anger at nurse or staff about matters that normally would not bother them.
_____ Seeks to bargain to avoid loss.
_____ Grieves over what has happened and what cannot be.
_____ Comes to terms with loss.

Answer 17

Denial
Anger
Bargaining
Depression
Acceptance

Question 18

Engel’s Stages of Grieving (SDRRIO)

_____ Refuses to accept loss. Accepts the situation intellectually, but denies it emotionally.
_____ Reality of loss begins to penetrate consciousness.
_____ Conducts rituals of mourning
_____ Attempts to deal with painful void.
_____ Produces image of lost object that is almost devoid of undesirable features.
_____ Behavior influenced by several factors: importance of lost object as source of support, degree of dependence on relationship, degree of ambivalence toward lost object, number and nature of other relationships, and number and nature of previous grief experiences (which tend to be cumulative).

Answer 18

Shock and Disbelief
Developing awareness
Restitution
Resolving the loss
Idealization
Outcome

Question 19

Martocchio’s Five Cluster’s of Grief (SYAIR)

Answer 19

1. Shock and disbelief
2. Yearning and protest
3. Anguish, disorganization, and despair
4. Identification in bereavement
5. Reorganization and restitution

Question 20

Martocchio’s Five Cluster’s of Grief

1. _____ May feel numb, sadness, anger, guilt and may deny loss.
2. ______ Anger and withdrawal
3. ______ Decreased interest in future, difficult in decision making, may feel lack purpose of living, crying is common.
4. _____ May imitate deceased’s habits, traits and goals
5. _____ Grieving does not stop at once, typical patterns of life return no timetable can be set.

Answer 20

1. Shock and disbelief
2. Yearning and protest
3. Anguish, disorganization, and despair
4. Identification in bereavement
5. Reorganization and restitution

Question 21

Sander’s Phases of Bereavement (SACHR)

Answer 21

Shock
Awareness of loss
Conversation/Withdrawal
Healing: The Turning Point
Renewal

Question 22

Sander’s Phases of Bereavement

1. _____ Often unable to process normal thought sequences.
2. _____ The bereaved experience the full significance of their loss.
3. _____ During this phase, survivors feel a need to be alone to conserve and replenish both physical and emotional energy.
4. _____ During this phase, the bereaved move from distress about living without their loved one to learning to live more independently.
   5._____ In this phase, survivors move on to a new self-awareness, an acceptance of responsibility for self, and learning to live without the loved one.

Answer 22

Shock
Awareness of loss
Conversation/Withdrawal
Healing: The Turning Point
Renewal

Question 23

2 types of MANIFESTATIONS OF GRIEF

Answer 23

Normal Grief
Complicated Grief

Question 24

FACTORS INFLUENCING THE LOSS AND GRIEF RESPONSES

Answer 24

AGE
SIGNIFICANCE OF THE LOSS
CULTURE
SPIRITUAL BELIEFS
GENDER
SOCIOECONOMIC STATUS
SUPPORT SYSTEM
CAUSE OF LOSS OR DEATH

Question 25

NURSING MANAGEMENT

Answer 25

ADPIE

Question 26

DIAGNOSING A normal complex process that includes emotional, physical, spiritual, social, and intellectual responses and behaviors by which individuals, families, and communities incorporate an actual, anticipated, or perceived loss into their daily lives.

Answer 26

GRIEVING

Question 27

DIAGNOSING A disorder that occurs after the death of a significant other, in which the experience of distress accompanying bereavement fails to follow normative expectations and manifests in functional impairment.

Answer 27

Complicated grieving/ risk for complicated grieving

Question 28

DIAGNOSING _____ Losses have such impact on the individual and family that usual effective roles and interactions are negatively affected. _____ The client has great difficulty placing the loss in appropriate perspective to his or her other life activities. _____ Related to the loss of relationships with others.

Answer 28

Interrupted family process Risk-Prone health behavior Risk for loneliness

Question 29

PLANNING Overall Goals - Grieving the loss of body function or a body part: To adjust to the changed ability and to redirect both physical and emotional energy into rehabilitation. - Grieving the loss of a loved one or thing  To remember them without feeling intense pain.  To redirect emotional energy into one’s own life and adjust to the actual or impending loss.

Question 30

IMPLEMENTING 1. Using effective communication skills 2. Facilitating grief work 3. Providing emotional support 4. Providing physical comfort 5. Maintaining privacy/ dignity 6. Promoting independence

Question 31

People may use a variety of terms instead of the word DIED. Serious examples include passed away, gone to a better place, lost, or free from suffering. Humorous examples include bought the farm, kicked the bucket, or croaked.

Question 32

RESPONSES TO DYING AND DEATH

Answer 32

Grieving Fear Hopelessness Powerlessness

Question 33

RESPONSES TO DYING AND DEATH _____ Denial, guilt, anger, despair, feelings of worthlessness, crying, and inability to concentrate. _____ The feeling of disruption related to an identifiable source (in this case someone’s death). _____ Occurs when the person perceives no solutions to a problem—when the death becomes inevitable and the person cannot see how to move beyond the death. _____ This loss of control may be manifested by anger, violence, acting out, or depression and passive behavior.

Answer 33

Grieving Fear Hopelessness Powerlessness

Question 34

NURSING MANAGEMENT

Answer 34

ADPIE

Question 35

The client is not made aware of the impending death. The family may choose this because they do not completely understand why the client is ill or they believe the client will recover.

Answer 35

CLOSED AWARENESS

Question 36

The client, family and health care personnel know that the prognosis is terminal but do not talk about it and make an effort not to raise the subject. Sometimes the client refrains from discussing death to protect the family from distress.

Answer 36

MUTUAL PRETENSE

Question 37

The client and others know about the impending death and feel comfortable discussing it, even though it is difficult. This awareness provides the client an opportunity to finalize affairs and even participate in planning funeral arrangements.

Answer 37

OPEN AWARENESS

Question 38

NURSING MANAGEMENT: DIAGNOSING 1. Fear 2. Hopelessness 3. Powerlessness 4. Risk for Caregiver Role Strain 5. Interrupted Family Process

Question 39

NURSING MANAGEMENT: IMPLEMENTING

Answer 39

1. Helping Clients Die with Dignity 2. Hospice and Palliative Care 3. Meeting the physiological needs of the dying client 4. Providing spiritual support 5. Supporting the family

Question 40

2 TYPES OF CARE IN IMPLEMENTATION ____ focuses on support and care of the dying person and family, with the goal of facilitating a peaceful and dignified death. _____ an approach that improves the quality of life of clients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.

Answer 40

HOSPICE CARE PALLIATIVE CARE