1. Mental Health Nursing II NURS 2310 Unit 5 The Bereaved Individual

2. Key Terms Loss = the experience of separation from something of personal importance Grief = deep mental and emotional anguish that is a response to the subjective experience of loss of something significant Mourning = psychological process through which the individual passes on the way to successful adaptation to the loss of a valued object Denial = refusal to acknowledge a loss; serves to protect individual from the reality of the loss

3. Key Terms (cont’d) Hospice = provides palliative and supportive care to meet the special needs of people who are dying and their families

4. Objective 1 Exploring the types of loss

5. Significant others – –Related to death, divorce, or separation Illness or debilitating condition – –Loss of physical and/or emotional wellness – –Loss of personal independence Developmental or maturational changes Decrease in self-esteem – –Related to inability to meet own expectations or those of others (whether real or perceived) Personal possessions – –Symbolizes familiarity and security – –Represents loss of material extension of self

6. Objective 2 Recalling the stages of grief as outlined by Kubler/Ross

7. Stage 1: Denial – –Shock and disbelief Stage 2: Anger – –Envy and resentment Stage 3: Bargaining – –Not usually visible or evident to others Stage 4: Depression – –Full impact of loss is experienced Stage 5: Acceptance – –Feelings of peace regarding loss 5 Stages Video

8. Objective 3 Identifying behaviors noted in each of the Kubler/Ross stages of grief

9. Denial  The reality of the loss is not acknowledged; individual can not believe loss has occurred Anger  Anger may be directed toward self or displaced on loved ones, caregivers, or God Bargaining  Individual makes a “bargain” with higher power in attempt to reverse or postpone the loss Depression  Feelings of sadness prevail; desperation; disengagement from lost entity Acceptance  Resignation; the focus is on the reality of the loss

10. Objectives 4 and 5 Reviewing specified types of grief and Identifying the behaviors representative of anticipatory, resolved, and maladaptive grief

11. Anticipatory grief = the occurrence of grief work before an expected loss Facilitates process of mourning Decreases length and intensity of response Emotional disengagement from the entity Resolved grief = completion of the process of mourning Individual can look back on relationship with lost entity and accept both pleasures and disappointments Increased energy and desire to pursue new situations and relationships

12. Maladaptive grief = inability to progress satisfactorily through the stages of grieving to achieve resolution Individual usually fixed in the denial or anger stage of the grief process May involve pathological grief responses – –chronic or prolonged response = intense preoccupation with memories of lost entity for many years after loss has occurred – –delayed/inhibited response = continued denial of loss; may manifest through anxiety disorders – –distorted response = continued anger related to loss; behaviors exaggerated out of proportion

13. Objective 6 Applying the nursing process to the client experiencing bereavement

14. Assessment  Abbreviated (limit to essential data); specific to culture, age Diagnosis  Grieving R/T actual or perceived loss; anticipatory grieving R/T terminal illness Planning  Clarify own feelings; watch for overburdening/transference of feelings; referral to outside resources Implementation  Open discussion of feelings; nonjudgmental listening; demonstrate respect for need to talk or not to talk; encourage realistic hope Evaluation  Review of completed grief work