Week 3 Flashcards
(65 cards)
1
Q
define loss
A
- occurs when something or someone of value becomes inaccessible or drastically changed
2
Q
what are the 3 main types of losses
A
- actual
- anticipatory
- perceived
3
Q
what is actual loss
A
- loss that is identified and recognized by others
4
Q
what are some examples of actual losses (5)
A
loss of:
- limb
- death of someone
- loss of job
- loss of relationship
- loss of voice
5
Q
what is anticipatory loss
A
- occurs when an individual knows a loss is coming
6
Q
what are some examples of anticipatory losses (3)
A
- time leading up to a mastectomy
- time leading up to deat
- time leading up to a move
7
Q
what is perceived loss
A
- loss which is felt by an individual but cannot be verified as a loss from outside
8
Q
what are some examples of perceived losses (5)
A
loss of:
- joy
- body image
- confidence
- mental health
- hidden relationship
9
Q
describe how illness trajectory varies between illnesses
A
- the illness can impact the trajectory
- but, even if multiple individuals have the same illness, the trajectory varies between everyone
10
Q
how does loss impact an individual
A
- impacts all 4 domains of a person
11
Q
what is dignity
A
- an individuals sense of self worth
- derived from state of spiritual, social, physical, and emotional comfort
12
Q
how can loss impact dignity
A
- loss impacts all 4 domains of a person = loss of dignity
13
Q
know the different losses associated w diff conditions? als, copd, etc???
A
…
14
Q
what are the 4 categories of responses to loss
A
- psychological/emotional
- physical/biological
- social/behavioral
- spiritual
15
Q
what are some examples of psychological/emotional responses to loss (4)
A
- sadness
- guilt
- anger
- difficulty concentrating
16
Q
what are some examples of physical/biological responses to loss (3)
A
- sleep disturbances
- changes in appetite (+weight loss/gain)
- aches and pains
17
Q
what are some examples of social/behavioral responses to loss (3)
A
- changes in activity lvl
- decreased socialization
- avoidance and/or focus on reminders of loss
18
Q
what are some examples of spiritual responses to loss (2)
A
- questioning meaning of life/purpose
- asking “why”
19
Q
what is grief
A
- the combo of various responses to a loss
20
Q
describe the early thinking regarding grief
A
- sigmund freud says that the person experiencing the loss suffers, bc of their attachment to that person or object that was lost
21
Q
according to freud, what was the goal of processing grief
A
- involves “letting go” of that which has been lost in order to build new relationships or circumstances
22
Q
what was the next stage of thinking, after freud. regarding the process of griefing
A
- the suggestion that we move through 4 general phases of grief
- where we complete tasks to meet the goal of “recover” and adjust to new reality
23
Q
what were the 4 stages of grief
A
- numbing
- yearning and searching
- disorganization
- reorganization to recover from the loss and adjust to new reality
24
Q
what were the 5 stages of grief outlined by cooper ross
A
- denial
- anger
- bargaining
- depression
- acceptance
25
what was the main idea associated w the 5 stages of grief
- that individuals work thru these stages to a place of fully ackowledging and making peace w the loss
26
what was the issue associated w theory of the stages of grief
- stages are not an accurate depiction of how grief actually works
- grief is not a linear process, it is much more complex than that
27
describe the current thinking of the process of griefing
- proposes that grief is a dual process model
| - grief is a process of oscillation (moving back and forth) between 2 modes: loss orientation and restoration
28
what is loss orientation mode
- focuses on emotion focused coping
- contains things that make you think abt your loss
- thoughts, feelings, and actions that make you focus on ur grief and pain
29
what is restoration mode
- focuses on problem focused coping
| - things that let you get on ur faily life and distract you from ur pain
30
what are some examples of restoration orientated coping (5)
- working
- cleaning
- going out w friends
- TV
- exercise
31
what is the goal of the current process of thinking
- finding meaning and growth
32
describe "normal grief"
- difficult to define
- grief is individualized
- many define it as the ability to move towards acceptance of the loss, which comes w a gradual decrease in the intensity of emotions & responses to loss
33
in general, during grief it is normal to experience... (7)
- sadness
- anxiety
- guilt
- anger
- sleep disturbances
- difficulty concentrating
- loss of appetite
34
in general, during grief, normal processes involve: (4)
- disbelief and non-acceptance that loss has occurred
- gradual accpetance of reality and permanence of loss
- gradual reinvestment in life & loving
- not necessarily a linear process
35
list 6 common alterations in grief
- anticipatory
- delayed
- complicated
- disenfranchised
- cumulative
- inhibited
36
what is anticipatory grief
- grief that occurs before the loss
| - responses related to the loss of what was or what was hoped for or supposed to be
37
what is delayed grief
- responses to a loss that are postponed until a later time
38
what might initiate delayed grief
- by another major life event
39
what is disenfranchised grief
- grief that occurs when someone experiences a loss, but others do not acknowledge the loss in the person's life
- the loss may be minimized or not understoof by others
40
what are some example situations where someone may experience disenfranchised grief (3)
- loss of ex
- loss of pet
- loss of home
41
what are some warning signs of delayed grief (3)
- self destructive behavior
- radical lifestyle changes
- outbursts
42
what is cumulative grief
- grief that occurs when multiple losses are experienced, often within a short period of time
43
what is inhibited grief
- when someone does not outwardly show any typical signs of grief --> expressed somatically (physical symptoms)
- often occurs consciously in an attempt to keep grieve private
44
list 6 factors that may affect grief
- nature of loss
- relationship
- age
- gender
- culture
- ability to cope
45
what can impact the nature of loss (3)
- if recognized by others
- if sudden death (type of death)
- if have multiple concurrent losses
46
how does age impact grief
- determines how grief is manifested & how they understand loss
47
describe 2 examples of how age can impact grief
- young children's ability to understand the loss varies depending on their development stage
- older adults have increased risk of cumulative loss
48
describe how gender can impact grief
- women are more likely to express feelings, seek help
49
describe how culture can impact grief (3)
- some cultures expect a dignified and quiet response
- some expect to openly express
- emotions vary: some expect you to feel lonely, others angry
50
what can impact the ability to cope r/t grief (4)
- personality traits
- previous experiences
- belief system
- support & resources
51
describe the process of appraisal of an event and stress
- a loss occurs
- after first appraisal (assessment) of the situation, determine if perceived threat or not
- if not, then the individual will experience no stress
- if is perceived threat, it will undergo second appraisal
- after 2nd appraisal, either have perceived ability or inability to cope
- if percieved ability to = positive stress
- if perceieved inability = negative stress
52
list how to asses loss and grief (10)
- get to know the whole person
- understand the current experience of loss
- distinguish behaviors indicative of grief response
- consider age, gender, culture
- determine potential for an alteration in grief
- determine past signif lossess
- explore ways of coping
- know availability to support systems for pt
- evaluate need for referrals to address needs in various domains
- remember the family --> assess them too
53
how can we support those experiencing loss and grief (7)
- be present
- engage the individual as a whole person
- acknowledge their losses (focus on solutions later)
- actively listen
- demonstrate empathic communication
- support pt and family to share mutual fears, concerns, and hopes for each other
- initiate additional support and resources
54
what are some "dont's" for supporting those experiencing loss and grief (8)
dont:
- compare griefs
- fact check or correct
- minimize
- give compliments
- be a cheerleader
- talk abt it later
- evangelize
- start w solutions
55
what are some "do's" for supporting those experiencing loss and grief (7)
- ask questions
- respect their experience
- remember this grief is theirs
- trust them
- stay in the present moment
- trust their self cae
- get consent
56
how can we help ourselves and support other nurses in grief (9)
- identify the loss
- reflect on loss & grief, and deal w our own "stuff"
- acknowledge relationships w pts and families
- acknowledge grief responses
- seek help from others
- leave work at work
- prioritize self-care strategies
- be present
- engage in active listening
57
Chochinov et al., did a study that looked at the physical, psychosocial, emotional, and spiritual aspects of pts illness experiences in relation to their dignity. what was the takeaway message of this study (4)
- living with a chronic progressive illness is not 1-size fits all
- different losses associated with different illnesses
- within a particular illness, each individual has unique experiences depending on who they are and various factors
= imp to get to know pts, and consider what losses they may be experiencing and how they are impacted by illness
58
in chochinov's study, what 4 chronic populations did he consider
- ALS
- COPD
- ESRD
- frail elderly
59
in pts with ALS, dignity was decreased r/t.. (7) what % (idk what the percents mean in the chart lol)
- feeling like not able to fulfill imp roles, tasks, or faily routines
- feeling like a burden
- feeling loss of control
- not feeling valued or worth while
- weakness & fatigue
- depression
- worried about future
11%
60
in pts with COPD, dignity was decreased r/t... (3)
- physical distress
- most SOB & anxiety out of all groups
- lowest mortality but most uncertain about health
61
describe what findings were found in individuals with ESRD (3)
- only group with suicidal ideation
- highest # of comorbidities
- prominent symptom burden
62
describe what findings were found in the "frail elderly" group (5)
- most isolated relative to other groups
- lowest social support
- felt least amt of hope
- not significally worried abt future
- although not typically described as terminally ill, 42% of individuals died over the course of the study
63
what is complicated grief
- being "stuck" in acute grief
| - responses to loss are debilitating and do not lessen or improve over time
64
what impact does complicated grief have
- significantly impairs ability to fnxn `
65
what are some warning signs of complicated grief (5)
- self destructive behaviors
- consistent feelings of guilt
- lowered self esteem
- radical lifestyle changes
- outbursts
