Mental Health Nursing II NURS 2310

1. Mental Health Nursing IINURS 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. Objectives4 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