Mental Health Mental Health Nursing IINursing II

NURS 2310NURS 2310

Unit 5Unit 5

The Bereaved The Bereaved IndividualIndividual

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

Key Terms (cont’d) Hospice = provides palliative and

supportive care to meet the special needs of people who are dying and their families

Objective 1Objective 1

Exploring the types of loss

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

Objective 2Objective 2

Recalling the stages of grief as outlined by Kubler/Ross

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

Objective 3Objective 3

Identifying behaviors noted in each of the Kubler/Ross stages

of grief

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

ObjectivesObjectives4 and 54 and 5

Reviewing specified types of grief

and Identifying the behaviors representative of anticipatory,resolved, and maladaptive grief

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 entityResolved 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

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

Objective 6Objective 6

Applying the nursing process to the client experiencing

bereavement

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