Chapter 10 MH

subjective emotions and affect; normal response to loss

process by which person experiences grief
- content
- process

persons facing an imminent loss begin to deal with possibility of loss or death in near future
ex: cancer that will end in loss

outward expression of grief, including rituals
ex: a wake, sitting shiva, religious ceremonies and arranging funerals

physiologic loss -> loss of limb, mastectomy, hysterectomy
safety loss -> domestic violence, childhood abuse, robbed in home
loss of security and sense of belonging -> divorce, change in relationship, loss of role
loss of self-esteem -> loss of job, death of loved one can threaten, retirement
loss related to self-actualization -> wanting to have children but never being able to, someone wanting to go to college realizes they can't

cognitive response
emotional responses
spiritual responses
behavioral responses
physiologic responses

questioning, trying to make sense of loss -> questions belief that 'life is fair'
attempting to keep lost on present -> talking ot the dead, "I wish you were here"

being stunned is the first most common reaction
anger, sadness, anxiety -> "it took the doctor too long to diagnose him"

comfort or anger
emotional and spiritual responses become intertwined

how you act
easiest to see

sleep disturbances is the most common grieving physiological symptom -> too much or too little sleep
headaches, loss of appetite, weight loss, palpitations

initial response of shock and social disorientation
attempts to continue relationship with deceased
anger with those percieved as responsible for death
time for mourning -> variable, different lenghts of time

expressions of grieving defined by each culture
acculturation: altering values/ behaviors to adapt to another culture
cultural rituals with roots in major religions
various mourning rituals and practices in the US

individualize care
encourage pt to discover and use grieving behaviors that are effective and meaningful to them

grief over loss that is not or cannot be acknowledged openly, mourned publicly, or supported socially:
a relationship that has no legitimacy
- the loss iteself is not recognized
- the griever is not recognized
- the loss invovles social stigma

process is more complex due to absence of usual supports for grieving, healing
US culture -> kin-based relationships receive most attention in cases of death
experienced by nurses hwen their need to grieve is not recognized
can be experience by other "helping" professionals -> chaplains and clergy

loss of a baby
extramarital affair -> gf not allowed to go to fuenral since scoeity foeesn't think valid in grieving
same-sex marriages
death of a pet
children leaving home

response outside the norm
person void of emotion; grieving for prolonged periods; expressing grief disproportionate to event
obsesively preoccupied with deceased
unable to process the death

previously existing psychiatric disorders may complicate process
clients can experience grief when change encountered

low self-esteem
low trust in others
previous psychiatric disorders
previous sucide threats or attempts
absent or unhelpful family members
ambivalent, dependent, insecure attachment to deceased person -> comflicting emotions about a person

death of spouse or a child
death of parent (early childhood or adolescence)
sudden, unexpected, untimely death
multiple deaths
death by suicide or murder

maladaptive thoughts -> rumination, catastrophizing
dysfunctional behaviors -> avoiding all reminders of the deceased person or immersing self into lost loved one's possessions, daydreaming about being together
inadequate emotional regulation -> focusing on negative emotions; not breaking for more soothing or calming pursuits; ignoring regular routines for eating, sleeping, activities, and social contact

adequate perception regarding the loss -> what does the loss mean to the client
adequate support while grieving for the loss -> who would you want to share the info youjust recieved
adequate coping behaviors during process

anticipated vs actual loss
problems with eating and sleeping
negative effects on physical health requiring follow-up

client will:
identify effects of loss
seek adequate support
develop plan for coping with the loss
apply effective coping strategies
recognize negative effects of the loss on life
seek or accept professional assistance if needed

ezploring perception of loss
- cognitive responses
- adaptive denial -> loss too big to deal with all at once, accept it in tiny its
obtaining support
promoting coping behaviors
- reviewing strengths of past coping
- enocuraging self-care
- using communicationm interpersonal skills

review of tasks and phases of grieving can be helpful in making statements about client's statu
client need support of trusted person
nurse must examine personal attitudes

examine one's own experiences with grief and loss
take self-awareness inventory, reflecting on results
perform ongoing self-evaluation