Chapter 37. The Experience of Loss, Death, and Grief – Loss and Grief EAQ – Flashcards

2 In masked grief, the patient's disruptive behavior interferes with normal functioning. The patient is unaware that the behavior is a result of loss and ineffective grief resolution. In chronic grief, the patient may experience a normal grief response that extends for an extended period of time. A person's grief response may be delayed because the loss is so overwhelming that the person must avoid the full realization of the loss. In exaggerated grief, the person may exhibit self-destructive or maladaptive behavior, obsessions, or psychiatric disorders.

4 Trajectories of bereavement explains common grief, chronic grief, and chronic depression. In the grief tasks model the patient accepts the reality of loss and experiences the pain of grief. Attachment theory explains denial, anger, bargaining, depression, and acceptance. Rando's "R" process model explains recognizing, reacting, reminiscing, relinquishing, readjusting, and reminiscence.

4 The Kübler-Ross theory of grief and mourning consists of five stages of dying. When the patient accepts the death of the partner, it indicates acceptance. When the patient expresses anger or resistance towards God or others, it indicates anger. When the patient cannot accept the loss, it indicates denial. When the patient postpones awareness of the loss by trying to prevent it from happening, it indicates bargaining.

4 According to attachment theory, endless examination of how and why the loss has occurred represents disorganization and despair. Feeling lethargic, loss of appetite and emotional outbursts of tearful sobbing represents yearning and searching. In a stage of reorganization, person separates himself or herself from the lost relationship.

2 The patient is experiencing complicated grief. In complicated grief, a person has a difficult time moving forward after a loss. The patient experiences a chronic and disruptive yearning for the deceased; has trouble accepting the death and trusting others; and/or feels excessively bitter, emotionally numb, or anxious about the future. In normal grief, the person shows a common reaction characterized by complex emotional, cognitive, social, and spiritual responses to loss and death. In anticipatory grief, the grief extends over a long period of time, beginning before the actual loss occurs; the person absorbs loss gradually and prepares for its inevitability. Disenfranchised grief occurs when the relationship of the person with the deceased is not socially sanctioned, cannot be openly shared, or seems to be of lesser significance.

4 Normal grief is a common and universal reaction and the patient may have feelings such as disbelief, yearning, anger, and depression. The patient may experience anticipatory grief before the actual loss or death occurs. In complicated grief, a person has a prolonged or significantly difficult time moving forward after a loss.

2 When experiencing anticipatory grief, family members grieve the impending loss of companionship, control, sense of freedom, and the mental and physical changes the loved one will experience. Normal grief is a common and universal reaction to loss or death that may be unexpected or traumatic. In complicated grief, a patient has a prolonged or significantly difficult time moving forward after a loss. Disenfranchised grief is experienced by a patient when the relationship to the deceased person is not socially sanctioned, cannot be shared openly, or seems of lesser significance.

1 Older adults have usually sustained more losses because they have lived longer. For people at any age, each loss influences the way one responds to subsequent losses. The loss of a social network makes it more important to find resources and sources of social support for grieving older adults. Sometimes many losses overpower a person's coping resources instead of making the person stronger.

1, 3, 4 The nursing care plan should focus on providing comfort, preserving dignity, and maintaining quality of life for the dying patient. Terminally ill patients should be allowed to spend the rest of their days in as much comfort and peace as is possible given the patient's condition. The plan should also include providing social support to family members to prepare to grieve their loss. Euthanasia is a controversial issue, and nurses do not take part in that decision. The nurse should not provide economical support to family members.

4 Ambiguous loss is a type of disenfranchised grief which occurs when the person is physically present but psychologically unavailable. Actual loss occurs when a person no longer can see, feel, or hear a person or object. Perceived loss is uniquely defined by the person experiencing loss that is less obvious to other people. Unpredictable external events result in situational loss such as leading to loss of function due to an accident.

3 The patient is experiencing exaggerated grief. In exaggerated grief, people blame themselves for a loss. The person with exaggerated grief is at a high risk of suicide and should be constantly monitored. In certain situations, a loss is so overwhelming that the person takes time to realize and react to it. This is referred to as delayed grief. In masked grief, the person shows disruptive behavior but is unaware that the disruptive behavior is a result of the loss. Uncomplicated grief is a common reaction characterized by complex emotional, cognitive, social, and spiritual responses to loss.

3 The patient is experiencing situational loss due to a sudden and unpredictable external event such as an accident. The economic status of the patient is affected due to the physical disability caused as a result of the accident. An actual loss is a loss in which a person can no longer feel, hear, see, or know a person or object. Perceived loss is a loss in which a person is experiencing a loss, but the loss is less obvious to other people. Maturational loss is a form of necessary loss that includes all normally expected life changes across the life span.

4 The patient expresses a willingness to do anything if the nurse helps to relieve the patient of the illness. This indicates that the patient is in the bargaining stage. In this stage the patient makes promises to self or significant others to behave differently in exchange for relief from the illness. In the anger stage, the patient expresses resistance and sometimes feels intense anger at another person or the situation. In the denial stage, the patient may not accept the truth. Denial provides psychological protection to the patient who cannot yet bear a loss. In the depression stage, the patient realizes the whole impact of the loss. In this stage the patient feels overwhelmingly sad, hopeless, and lonely.

3 The attachment theory of grief and mourning was proposed by Bowlby in 1980. The yearning and searching stage of attachment theory is characterized by emotional outbursts of tearful sobbing. Numbing involves protecting the person from the full impact of the loss. Reorganization involves accepting the change and assuming unfamiliar loses. Disorganization and despair is characterized by endless examination of how and why the loss occurred.

3 Self-esteem, confidence, or dreams are considered intangible loss. Therefore, a patient lacking confidence is experiencing intangible loss. A body part or body function, relationship, or possessions are considered tangible things. Therefore, a patient who lost a body part such as a hand; a patient who lost parent-child relationship due to death of parents; and a patient who lost use of a body part is experiencing tangible loss.

4 Trajectories of bereavement theory for grief and mourning describe common grief, chronic grief, chronic depression, depression followed by improvement, and resilience. The grief tasks model for grief and mourning by Worden (2008) describes accepting the reality of the loss, experiencing the pain of grief, adjusting to the world in which the deceased is missing, emotionally relocating the deceased and moving on with life. The attachment theory of grief and mourning by Bowlby (1980) explains numbing, yearning and searching, disorganization and despair, and reorganization. The dual process model theory for grief and mourning by Stroebe and Schut (1999) explains loss-oriented activities and restoration-oriented activities.

2 In the reorganization stage of mourning, the person accepts change, acquires new skills, and builds new relationships. In this stage the person is trying to create separation from a lost relationship. In the numbing stage, the person feels unreal. In the yearning and searching stage, the person experiences an inner and intense yearning for the lost person. In this stage the person also shows some physical symptoms. In the disorganization and despair stage, the person extends blame and expresses anger towards anyone who is responsible for the loss.

2 The Kübler-Ross theory of grief and mourning (1969) consists of five stages. When the patient is unable to accept the fact that he or she is in the terminal stage of cancer, it indicates denial. As a result, the patient wants to perform the tests again in another hospital. Anger is the expression of resistance or anger towards God or other people. Bargaining is characterized by postponing awareness of the loss by trying to prevent it from happening. Depression is characterized by the individual realizing the full impact of the loss.

4 This woman's friends are not fully acknowledging the value of her pregnancy because of the short length of time the woman was pregnant or because, by comparison, the loss seems less than losing a child after birth. The loss does not seem "legitimate." Thus the woman does not experience sympathy from others and feels disenfranchised. Delayed grief is a type of complicated grief in which the person's response is unusually delayed or postponed because the loss is so overwhelming. Anticipated grief occurs before the actual loss or death occurs. Exaggerated grief is also a type of complicated grief in which the person often exhibits self-destructive or maladaptive behaviors.

3 In the depression stage, the patient realizes the whole impact of the loss. At this stage the patient feels hopeless and lonely. In the anger stage, the patient expresses resistance and intense anger at God, other people, or the situation itself. In the denial stage, the patient is psychologically not ready to accept the loss. In the bargaining stage, the patient postpones awareness of the loss. In this stage the person makes promises to self, God, or loved ones to live or believe differently to try to prevent the loss from taking place. In this stage the patient does not accept the truth.

1 The young adult has suffered an actual loss, because the patient can no longer feel, see, or know the lost limb. A perceived loss is experienced by the person only and is less obvious to other people. Necessary losses are natural and positive; they occur due to normal life changes. A necessary loss is replaced by something different or better. A maturational loss is a form of loss secondary to normally expected life changes across the life span.

1, 3, 5 Suicide is a risk for people who experience exaggerated grief in which self-destructive or maladaptive behaviors are present. Exaggerated grief is not usually delayed. If a person's grief response is delayed, it is called delayed grief and it is often triggered by a second loss.

3 A loss that occurs when a person can no longer feel, hear, see, or know a person or object is an actual loss. A situational loss brought on by sudden and unpredictable external events. A maturational loss includes all normally expected life changes across a patient's life span. A perceived loss is uniquely defined by the one experiencing the loss and is less obvious to others.

2 Perceived loss is defined as person experiencing loss that is less obvious to other people. A person who lost confidence due to rejection by a friend may experience perceived loss. Actual loss occurs when a person can no longer see, feel, or hear a person or object. It occurs when there is a loss of body part or job. A person who meets unexpected external events such as sustaining an injury with physical changes in an automobile accident experiences situational loss. Maturational loss is a form of necessary loss that includes all expected normal life changes across the life span.

4 Exaggerated grief is a type of complicated grief that involves maladaptive behaviors and obsessions in the patient. Chronic grief is a normal grief response, which lasts a long time. It is characterized by disbelief, yearning, anger, and depression. Masked grief interferes with normal functioning and it does not involve maladaptive behaviors and obsessions. Delayed grief is a delayed response to grief and does not involve maladaptive behaviors and obsessions.

1, 2, 5 Kübler-Ross describes five stages of dying, including anger, denial, and depression. In the anger stage, the person expresses resistance and intense anger toward God or other people for the loss. Denial is the stage wherein the person is not able to accept the loss. In the depression stage, the person realizes the full impact of the loss. Anxiety and yearning are not stages of dying in this theory.

1 Delayed grief is characterized by two losses. One loss may be less important than the other, causing a delay in the response to one of the losses. The loss of the job is less important than the loss of the sibling, so the person shows a delayed response to the second loss. Masked grief is the grieving response wherein a person's normal functioning is disrupted, but the person does not realize that the disruption in functioning is due to the loss. In exaggerated grief, the person blames self for the loss. Disenfranchised grief is a loss that is not socially sanctioned, cannot be openly shared, or seems to be of lesser significance to others.

2 A person who has been anticipating a loss for some time may have already experienced many of the emotions (e.g., sadness, shock) commonly associated with death. Denial is a stage of dying that a patient would experience. Yearning and searching are aspects of Bowlby's Attachment Theory.

3 The anger stage is characterized by expressing anger or resistance at God, the situation, or others. When the patient searches for new, better doctors, it indicates anger at physicians. When the patient believes sickness is inevitable, it indicates depression. When the patient admits that someday we all have to die, it indicates acceptance. When the patient accepts the loss and decides to go for the best treatment, it indicates acceptance.

2 Anticipatory grief is a forewarning or cushion that gives people time to prepare or complete the tasks related to the impending death. Normal grief is a common and universal reaction to loss or death that may be unexpected or traumatic. In complicated grief, a person has a prolonged or significantly difficult time moving forward after a loss. People experience disenfranchised grief when their relationship to the deceased person is not socially sanctioned, cannot be shared openly, or seems of lesser significance.

3 The Kübler-Ross theory of grief and mourning includes five stages of dying. The bargaining stage is characterized by postponing awareness of the loss by trying to prevent it from happening. When the patient tries to postpone death by planning to go to church every day to be cured, it indicates bargaining. When the patient accepts whatever comes, it indicates the acceptance stage. When the patient questions or blames God, it indicates anger. When the patient denies the results of test reports, it indicates denial.

2 Chronic grief may last for years or decades. Patients who experience exaggerated grief have a risk of suicide. A person experiencing exaggerated grief may exhibit obsessions. A person with masked grief is unaware that the disruptive behavior is due to loss.

4 A maturational loss is a form of necessary loss that includes all normally expected life changes across a patient's life span. When a toddler experiences separation anxiety from mom when starting preschool, it is a maturational loss. An actual loss is the loss of a body part, or death of a family member. Perceived loss is perceiving rejection by a friend as a loss. A situational loss is brought on by sudden and unpredictable events such as an auto accident.

2 Giving people options in caregiving allows them to honor their cultural beliefs. Although Western health care practices place a high value on honesty, people from some cultural backgrounds regard being told the truth as harmful. In some cultures self-determination may not be a given right for every person.

3, 4, 5 According to Worden's Grief Tasks Model, it takes about a year to come to terms with the loss experienced, although this may differ from person to person. Once a person accepts the reality of the loss, the person may experience the pain of grief. Grief is manifested by loneliness, sadness, or despair. This stage is followed by adjustments to the world in which the deceased is missing. Family members may start performing roles of the deceased even if they don't like to. The final stage is to emotionally relocate the deceased and move on with life. Blocking the pain and denying the loss does not help one to move on.

3 Postmodern grief interventions focus on the uniqueness of the patient's story that unfolds and writes itself as the person lives through the experience of loss.

4, 5 Because the parent has a terminal illness, the patient will eventually prepare for the inevitability that the parent will die. Grief cannot be controlled by willpower, because it is an unconscious process. High-dose sedation should be advised only after obtaining the opinion of the health care provider and only for severe grief. Avoiding the parents is not a justifiable way of escaping grief. Grief does not last long and the patient may even experience relief once the parent passes away.

2 A person who is caring for a patient with severe dementia experiences anticipatory grief. In this grief, people predict loss and begin to prepare for it. A person whose former spouse is dead experiences disenfranchised grief. A person who has a conflicted relationship with the deceased experiences complicated grief. A person whose husband's body is not found after a terrorist attack may experience disenfranchised grief.

2, 4, 5 The death of a pet, an ex-spouse, or a married lover can cause disenfranchised grief due to the perception that these relationships are less significant or are socially unacceptable, compared with relationships with parents and siblings, which are socially sanctioned.

3, 4, 5 Bowlby's attachment theory describes the experience of mourning based on his studies of children separated from their parents during World War II. There are four stages of mourning: numbing, yearning and searching, disorganization and despair, and reorganization. In the reorganization stage, the last stage of mourning, a person accepts the loss and starts living with it. Yearning and searching is the second stage of bereavement, in which a person is in acute distress. This stage is characterized by emotional outbursts such as crying. In the stage of disorganization and despair, a person endlessly tries to find out how and why the loss occurred. Depression and bargaining are stages of dying in Kübler-Ross's classic behavioral theory.

3 In delayed grief, the person may postpone the grief response because the loss is so overwhelming that the person must avoid the full realization of the loss. A patient who is exhibiting psychosis may be experiencing exaggerated grief. A patient who is depressed due to the death of a child may be experiencing normal grief. A patient who is unaware of behaving disruptively as a result of grief may be experiencing masked grief.