Unit 14 Study Guide

Grieving Behaviors of Children: Adolescents

- May withdraw into themselves or attempt to go about usual activities in an effort to avoid dealing with the pain of the loss - Some exhibit acting our behaviors, such as aggression or defiance - Some show regressive behaviors, whereas others react by trying to take care of their loved ones who are also grieving

Grieving Behaviors of Children: Ages 10-12

- able to understand that death is final and eventually affects everyone, including themselves - feelings of anger, guilt, and depression are common - peer relationships and school performance may be disrupted - there may be a preoccupation with the loss and a withdrawal into the self

Grieving Behaviors of Children: Ages 6-9

- beginning to understand the finality of death - may believe that death is contagious - regressive and aggressive behaviors, withdrawal, school phobias, somatic symptoms (c/o upset tummy), and clinging behaviors

Grieving Behaviors of Children: Ages 3-5

- believe death is reversible, thoughts about death may include magical thinking - become frightened if they feel a threat to themselves or their loved ones - concerned with safety issues and require a great deal of personal reassurance that they are safe - regressive behaviors include loss of bowel/bladder control, thumb sucking, and temper tantrums. Changes in eating and sleep patterns may also occur.

Grieving Behaviors of Children: Birth to Age 2

- unable to recognize/understand death - infants who are separated from mom may become quiet, lose weight, and sleep less - they often react to the emotions of adults by becoming irritable and crying more than usual

Can you differentiate between various perceptions of death and the associated developmental level (children, adolescent, adult/older adult) based on each statement? 1. Bereavement overload 2. Regressive, aggressive, and clinging behaviors 3. Difficulty tolerating feelings of loss 4. Feelings of anger, guilt, depression and hopelessness 5. Increased risk for mortality

1. Adult/Older Adult 2. Children 3. Adolescents 4. Children 5. Adult/Older Adult

Can you differentiate between the types of maladaptive grieving (chronic or prolonged, delayed or inhibited, or distorted [exaggerated]) based on each statement? 1. Inability to perform normal activities after an extended period of time 2. Absence of evidence of grief 3. Failure of mourning process 4. Feeling trapped in grief 5. Fixed in anger stage

1. chronic or prolonged 2. delayed or inhibited 3. delayed or inhibited 4. distorted (exaggerated) 5. distorted (exaggerated)

Definition of Hospice and Four Components

A program that provides palliative and supportive care to meet the special needs of people who are dying and their families. Hospice care provides physical, psychological, spiritual, and social care for the person for whom aggressive treatment is no longer appropriate.

The 5 Stages of Grief from Kubler-Ross

Denial Anger Bargaining Depression Acceptance

Purpose of Rituals in Grieving (According to George Engel)

In Stage III, Engel says that Participation in these rituals is thought to assist the individual to accept the reality of the loss and to facilitate the recovery process.

Long-Term Outcomes for Complicated Grieving (According to Bowlby)

In stage IV, Bowlby says that new goals and patterns of reorganization are developed. The individual begins a reinvestment in new relationships and indicates a readiness to move forward within the environment.

Patients at High Risk for Complicated Grieving

Older adults d/t bereavement overload ???

Types of Care Provided by a Hospice Interdisciplinary Team: Rehab Therapists

PT and OT help with minimizing physical disability, aid in strengthening exercises, provide help with equipment, OT may help with performing ADLs as independently as possible, speech therapists may also be called to help

Definition of an Advanced Directive

Refers to either a living will or a durable power of attorney for healthcare (also called a healthcare proxy)

Description of Dysfunctional Grieving

Represents a failure to follow the predictable course of normal grieving to a resolution. When the process deviates from the norm, the individual becomes overwhelmed and resorts to maladaptive coping.

Examples of Situations Representing the Anger Stage of the Grieving Process

Self-blame or blaming others may lead to feelings of anger toward the self and others. The anxiety level may be elevated, and the individual may experience confusion and a decreased ability to function independently. He or she may be preoccupied with an idealized image of what has been lost. Numerous somatic complaints are common.

Bowlby's Grieving Stages

Stage I: Numbness or Protest Stage II: Disequilibrium Stage III: Disorganization & Despair Stage IV: Reorganization

Worden's Task Completion in Grieving

Task I: Accepting the Reality of the Loss Task II: Processing the Pain of Grief Task III: Adjusting to a World Without the Lost Entity Task IV: Finding an Enduring Connection with the Lost Entity in the Midst of Embarking on a New Life

In which situation would the grief response be most difficult for the bereaved individual? a. The individual has experienced a number of recent losses. b. The individual knew beforehand that the loss was going to occur. c. The individual lost an elderly person who was close to him or her. d. The individual participated in the rituals associated with loss within e. his or her culture.

a

In which stage of grief outlined by Elizabeth Kübler-Ross does a client acknowledge the loss but hold out hope for additional alternatives? a. Stage III b. Stage V c. Stage II d. Stage I

a

When Frank's wife of 34 years dies, he is very stoic, handles all the funeral arrangements, doesn't cry or appear sad, and comforts all of the other family members in their grief. Two years later, when Frank's best friend dies, Frank has sleep disturbances, difficulty concentrating, loss of weight, and difficulty performing on his job. This is an example of which of the following maladaptive responses to loss? a. delayed grieving b. distorted grieving c. prolonged grieving d. exaggerated grieving

a

Which behavior is exhibited by a bereaved individual in stage II of the grief process outlined by George Engel? a. Regressing to a state of helplessness b. Feeling numb c. Participating in the funeral d. Imitating admired qualities of the lost entity

a

Which is an example of delayed grief? a. Overreaction to another person's loss b. Detachment from a dying family member even before the death has occurred c. Depressive mood disorder as a reaction to loss d. Extreme feelings of powerlessness

a

Which of the following is a correct statement when attempting to distinguish normal grief from clinical depression? a. In clinical depression, anhedonia is prevalent b. In normal grieving, the person has generalized feelings of guilt c. The person who is clinically depressed relates feelings of depression to a specific loss d. In normal grieving, there is a persistent state of dysphoria

a

Which of the following is thought to facilitate the grief process? a. The ability to grieve in anticipation of the loss b. The ability to grieve alone without interference from others c. Having recently grieved for another loss d. Taking personal responsibility for the loss

a

Which are the most likely characteristics of the disorganization and despair stage in the grief process as hypothesized by John Bowlby? Select all that apply. a. Perceptions of visualizing the lost person or object b. Restless behavior c. Resignation to the loss d. Intense weeping e. Anger toward the self

a, b

Which are the characteristic features of a distorted grief response? Select all that apply. a. Anger toward the environment b. Anger toward the self c. Depressive mood d. Overreaction to another person's loss e. Keeping a "stiff upper lip"

a, b, c

Which behaviors are associated with the second stage of grief hypothesized by John Bowlby? Select all that apply. a. Preoccupation with the loss b. Intense weeping c. Feelings of ambivalence d. Restlessness and aimlessness e. Somatic complaints

a, b, c

Which behaviors are most likely to be observed in a client who is mourning the loss of a loved one, according to Elizabeth Kübler-Ross's stages of grief? Select all that apply. a. Regression b. Withdrawal c. Social isolation d. Decreased ability to function independently e. Resignation to the loss

a, b, c

Which behaviors exhibited by bereaved individuals are examples of chronic grieving? Select all that apply. a. Maintaining personal possessions aimed at keeping a lost loved one alive b. Refusing to attend family gatherings after the loss of a spouse c. Setting a place at the table for the deceased loved one d. Overreacting to another person's loss e. Refusing to grieve in the belief that one must be stoic in the face of adversity

a, b, c

Which are the most common reasons for delayed grieving in a bereaved individual? Select all that apply. a. The bereaved individual feels ambivalence toward the lost entity. b. The bereaved individual feels extreme anger toward the lost entity. c. The bereaved individual experiences social pressure to resume normal functions of daily life. d. The bereaved individual feels a lack of internal and external resources to cope with loss. e. The bereaved individual has had the opportunity to prepare for the loss.

a, b, c, d

Which of the following is most likely to initiate a grief response in an individual? (Select all that apply.) a. Death of a pet dog b. Being told by her doctor that she is beginning menopause c. Failing an examination d. Losing a spouse through divorce

a, b, c, d,

Connor, who is 14, just lost his grandmother to cancer. What behaviors would you expect Connor to exhibit? Select all that apply. a. Acting out b. Clinging c. Crying d. Goes about usual activities e. Withdrawal

a, c, d, e

Irelyn, age 6, has just learned that her aunt passed away. What behaviors would you expect to find Irelyn exhibiting? Select all that apply. a. Difficulty being away from her brother Aidan. b. Saying she can't stop thinking about the death of her aunt. c. Verbalizing chronic complaints of an upset stomach. d. Being afraid to go to school. e. Hitting another child in her kindergarten class.

a, c, d, e

In which situations does the grief response become more difficult? Select all that apply. a. The bereaved individual was strongly dependent on the lost entity. b. The lost entity is an elderly person. c. The bereaved individual believes that he or she bears responsibility for the loss. d. The bereaved individual has the opportunity to prepare for the loss. e. The loss is sudden and unexpected.

a, c, e

Types of Care Provided by a Hospice Interdisciplinary Team: Social Workers

assist the patient and family with psychosocial issues including those associated with the patient's condition, financial issues, legal issues, and bereavement concerns, provides info on community resources

A bereaved individual feels such intense sadness at the passing of the lost entity that the individual is unable to properly manage daily living activities. The individual also experiences chronic somatic symptoms. Which sort of grief response does this individual experience? a. Normal grief b. Distorted grief c. Inhibited grief d. Anticipatory grief

b

A client has recently gone through a mastectomy as a part of her treatment for breast cancer. She requires therapeutic intervention while she works through her feelings of grief regarding the mastectomy. Which stage of the grief response outlined by Elizabeth Kübler-Ross is the client most likely experiencing? a. Acceptance b. Depression c. Bargaining d. Anger

b

A major difference between normal and maladaptive grieving has been identified by which of the following? a. There are no feelings of depression in normal grieving b. There is no loss of self-esteem in normal grieving c. Normal grieving lasts longer than one year d. In normal grief, the person does not show anger toward the loss

b

Children of which age group are most likely to believe that their thoughts or behaviors caused a person to become sick or to die? a. 2 years of age b. 3 to 5 years of age c. 6 to 9 years of age d. 10 to 12 years of age

b

Which stage of the grief process outlined by Elizabeth Kübler-Ross includes feelings of shame, helplessness, and hopelessness? a. Stage I b. Stage II c. Stage III d. Stage IV

b

Which stage of the grief process outlined by Elizabeth Kübler-Ross is characterized by confusion and a decreased ability to function independently? a. Denial b. Anger c. Bargaining d. Acceptance

b

Which statement is true regarding the concept of death held by most children between the ages of 6 and 9 years? a. They believe death is reversible. b. They may believe that death is contagious. c. They are interested in the physical aspects of dying and the final disposition of the body. d. They generally have an attitude of immortality.

b

Which actions are called for to complete the third task of the grief process outlined by J. William Worden? Select all that apply. a. Allowing oneself to experience the intensity of the pain b. Making adaptations to one's environment after the loss results in a change of lifestyle c. Making adjustments to one's sense of self d. Accepting the reality of the loss e. Letting go of past attachments and forming new ones

b, c

Which characteristic features are most likely to be observed in a client who is in Stage V of the grief response outlined by Elizabeth Kübler-Ross? Select all that apply. a. Regression b. Decreased anxiety c. Resignation d. Shame e. Decreased ability to function independently

b, c

A client who is a heavy smoker is informed by the health-care provider that his or her lung cancer has metastasized and he or she has only a few months to live. The individual says, "Please God, if I am spared this time, I will never touch a cigarette again." Which stage of the grief response is the client experiencing, based on the stages of grief outlined by Elizabeth Kübler-Ross? a. Depression b. Acceptance c. Bargaining d. Denial

c

Gloria, a recent widow, states, "I'm going to have to learn to pay all the bills. Hank always did that. I don't know if I can handle all of that." This is an example of which of the tasks described by Worden? a. Task I: accepting the reality of the loss b. Task II: processing the pain of grief c. Task III: adjusting to a world without the lost entity d. Task IV: finding an enduring connection with the lost entity in the midst of embarking on a new life

c

How long does the acute phase of normal grieving last in a 40-year-old adult? a. 2 to 3 weeks b. 4 to 5 weeks c. 6 to 8 weeks d. 12 to 14 weeks

c

Nancy, who is dying of cancer, says to the nurse, "I just want to see my new grandbaby. If only God will let me live until she is born. Then I'll be ready to go." This is an example of which of Kubler-Ross's stages of grief? a. Denial b. Anger c. Bargaining d. Acceptance

c

Which behavior is most likely to be observed in the restitution stage of the grief process as outlined by George Engel? a. Refusal to acknowledge the loss b. Regression to a state of helplessness c. Participation in rituals associated with loss d. Preoccupation with the loss

c

Which grief reaction can the nurse anticipate in a 10 year old child? a. Statements that the deceased person will soon return b. Regressive behaviors such as loss of bladder control c. A preoccupation with the loss d. Thinking that he or she may have done something to cause the death

c

Which of the following is not true regarding grieving by an adolescent? a. Adolescents may not show their true feelings about death b. Adolescents tend to have an immortal attitude c. Adolescence do not perceive death as inevitable d. Adolescents may exhibit acting out behaviors as part of their grief

c

Which of the following theories are appropriately matched with the stage of grief? Select all that apply. a. George Engel: Stage I: Awareness b. John Bowlby: Stage III: Disequilibrium c. J. William Worden: Task III: Adjusting to a world without the lost entity d. Elizabeth Kubler-Ross: Stage V: Acceptance e. Elizabeth Kubler-Ross: Stage IV: Depression

c, d, e

Types of Care Provided by a Hospice Interdisciplinary Team: Nurses

care manager, assesses patient and family needs, establishes goals of care, supervises/assists caregivers, evaluates care, advocates for patient, and provides educational info as needed, physical care when needed such as IV therapy

Children of which age are most likely to personify death in their minds in the form of a monster? a. 10-year-olds b. 2-year-olds c. 4-year-olds d. 7-year-olds

d

Engel identifies which of the following as successful resolution of the grief process? a. When the bereaved person can talk about the loss without crying b. When the bereaved person no longer talks about the lost entity c. When the bereaved person puts all remembrances of the lost out of sight d. When the bereaved person can discuss both positive and negative aspects about the lost entity

d

In which situation is the grief response facilitated? a. The individual was strongly dependent on the lost entity. b. The individual had a love-hate relationship with the lost entity. c. The individual's physical health was unstable at the time of the loss. d. The individual knew that the loss was imminent.

d

In which stage of the grief response outlined by George Engel does the bereaved individual idealize the concept of the loss? a. Stage V b. Stage II c. Stage III d. Stage IV

d

Types of Care Provided by a Hospice Interdisciplinary Team: Physicians

input into the care of the patient, orders may come from the PCP while pain/symptom management may come from the hospice agent

Types of Care Provided by a Hospice Interdisciplinary Team: Dietician

may be helpful with patients who have n/v, diarrhea, anorexia, and weight loss, ensure patient is receiving proper nutrition

Types of Care Provided by a Hospice Interdisciplinary Team: Trained Volunteers

provide services that may otherwise be non-affordable, provide services such as transportation, companionship, respite care, recreational activities, and light housekeeping, they are sensitive to family and patient needs

Types of Care Provided by a Hospice Interdisciplinary Team: Counseling Services

psychiatrist or psychologist if there is a history of mental illness or neurocognitive disorder or if depression has become a problem

Types of Care Provided by a Hospice Interdisciplinary Team: Attendants

spend the most time with the patient, can be licensed or not, assist with personal care, ADLs, LPNs for advanced care like tube feedings and dressing changes

Definition of Anticipatory Grieving

the experiencing of the feelings and emotions associated with the normal grief response before the loss actually occurs