(3) Chapter 28: The Bereaved Individual **

5. What term should a nurse use when assessing a response to grieving that includes a sudden physical collapse and paralysis, and which cultural group would be associated with this behavior? 1. "Falling out" in the African American culture 2. "Body rocking" in the Vietnamese American culture 3. "Conversion disorder" in the Jewish American culture 4. "Spirit possession" in the Native American culture

1. "Falling out" in the African American culture Rationale: The nurse should use the term falling out to describe a sudden physical collapse and paralysis in the African American culture. The individuals may also experience an inability to see or speak yet maintain hearing and understanding.

7. A nursing instructor is teaching about the typical grieving behaviors of Chinese Americans. Which student statement would indicate that more instruction is necessary? 1. "In this culture, the color red is associated with death and is considered bad luck." 2. "In this culture, there is an innate fear of death." 3. "In this culture, emotions are not expressed openly." 4. "In this culture, death and bereavement are centered on ancestor worship."

1. "In this culture, the color red is associated with death and is considered bad luck." Rationale: The nursing instructor should evaluate that more instruction is needed if a student states that the color red is associated with death and bad luck in the Chinese culture. Chinese Americans consider the color white as associated with death and is considered bad luck. Red is the ultimate color of luck in this culture. Chinese Americans also avoid purchasing insurance because of the fear that they may be inviting death.

11. A nurse is leading a bereavement group. Which of following members of the group should the nurse identify as being at high risk for complicated grieving? (Select all that apply.) 1. A widower who has recently experienced the death of two good friends 2. A man whose wife died suddenly after a cerebrovascular accident 3. A widow who removed life support after her husband was in a vegetative state for a year 4. A woman who had a competitive relationship with her recently deceased brother 5. A young couple whose child recently died of a genetic disorder

1. A widower who has recently experienced the death of two good friends 2. A man whose wife died suddenly after a cerebrovascular accident 4. A woman who had a competitive relationship with her recently deceased brother 5. A young couple whose child recently died of a genetic disorder Rationale: The nurse should identify that individuals are at a high risk for complicated grieving when the bereaved person was strongly dependent on the lost entity, the relationship with the lost entity was highly ambivalent, the individual experienced a number of recent losses, the loss is that of a young person, the individual's physical or psychological health is unstable, and the bereaved person perceived responsibility for the loss. Having a year to process grief while her husband was in a vegetative state would reduce the widow's risk for the problem of complicated grieving.

13. Which of the following types of care should the interdisciplinary team of hospice provide? (Select all that apply.) 1. Physical care available on a 24/7 basis 2. Counseling on the addictive properties of pain-management medications 3. Discussions related to death and dying 4. Explorations of new aggressive treatments 5. Assistance with obtaining spiritual support and guidance

1. Physical care available on a 24/7 basis 3. Discussions related to death and dying 5. Assistance with obtaining spiritual support and guidance Rationale: The nurse should identify that the interdisciplinary team of hospice provides physical care available on a 24/7 basis, discussions related to death and dying, and assistance with obtaining spiritual support and guidance. Hospice is a program that provides palliative and supportive care to meet the needs of people who are dying and their families.

12. An instructor is teaching nursing students about Worden's grief process. According to Worden, which of the following client behaviors would delay or prolong the grieving process? (Select all that apply.) 1. Refusing to allow oneself to think painful thoughts 2. Indulging in the pain of loss 3. Using alcohol and drugs 4. Idealizing the object of loss 5. Recognizing that time will heal

1. Refusing to allow oneself to think painful thoughts 3. Using alcohol and drugs 4. Idealizing the object of loss Rationale: The nurse should identify that refusing to allow oneself to think painful thoughts, using alcohol and drugs, and idealizing the object of loss will delay or prolong the grieving process. Task II of Worden's grief process is working through the pain or grief. Pain must be acknowledged and processed in order to move on.

3. A nurse discharges a female client to home after delivering a stillborn infant. The client finds that neighbors have dismantled the nursery that she and her husband planned. According to Worden, how could this intervention affect the woman's grieving task completion? 1. This intervention may hamper the woman from continuing a relationship with her infant. 2. This intervention would help the woman forget the sorrow and move on with life. 3. This intervention communicates full support from her neighbors. 4. This intervention would motivate the woman to look to the future and not the past.

1. This intervention may hamper the woman from continuing a relationship with her infant. Rationale: The nurse should anticipate that this intervention could hinder the woman from continuing a relationship with her infant. The first task in Worden's grief process is to accept the reality of the loss. It is common for individuals to refuse to believe that the loss has occurred. Behaviors may include misidentifying an individual in the environment as their loved one, retaining possessions of the lost loved one, and removing all reminders of the loved one in order to avoid reality.

6. Which grieving behaviors should a nurse anticipate when caring for a Navajo client who recently lost a child? 1. Celebrating the life of a deceased person with festivities and revelry 2. Not expressing grief openly and reluctance to touch the dead body 3. Holding a prayerful vigil for a week following the person's death 4. Expressing grief openly and publicly and erecting an altar in the home to honor the dead

2. Not expressing grief openly and reluctance to touch the dead body Rationale: The nurse should identify that a Navajo client who recently lost a child would not express grief openly and would be reluctant to touch the dead body. Navajo Indians do not bury the body of a deceased person for four days after death, and they conduct a cleaning ceremony prior to burial. The dead are buried with their shoes on the wrong feet and rings on their index fingers.

1. A client is diagnosed with terminal cancer. Which situation represents Kübler-Ross's grief stage of "anger"? 1. The client registers for an iron-man marathon to be held in 9 months. 2. The client is a devout Catholic but refuses to attend church and states that his faith has failed him. 3. The client promises God to give up smoking if allowed to live long enough to witness a grandchild's birth. 4. The client gathers family in order to plan a funeral and make last wishes known.

2. The client is a devout Catholic but refuses to attend church and states that his faith has failed him. Rationale: The nurse should assess that the client is in the "anger" stage of grieving when the client refuses to attend church and states that his faith has failed him. Anger is the second stage of Kübler-Ross's grief process, in which the reality of the situation is realized, and the individual has feelings of sadness, guilt, shame, helplessness, and hopelessness.

10. Which is the most accurate description of the nursing diagnosis of dysfunctional grieving? 1. Inability to form a valid appraisal of a loss and to use available resources 2. The experience of distress, with accompanying sadness, which fails to follow norms 3. A perceived lack of control over a current loss situation 4. Aloneness perceived as imposed by others and as a negative or threatening state

2. The experience of distress, with accompanying sadness, which fails to follow norms Rationale: The nurse should define dysfunctional grieving as the experience of distress, with accompanying sadness, which fails to follow norms. Three types of pathological grief reactions are delayed or inhibited grief, distorted (exaggerated) grief response, and chronic or prolonged grieving. One crucial difference between normal and dysfunctional grieving is the loss of self-esteem marked my feelings of guilt or worthlessness that may precipitate depression.

2. A nurse is caring for an Irish client who has recently lost his wife. The client tells the nurse that he is planning an elaborate wake and funeral. According to George Engel, what purpose would these rituals serve? 1. To delay the recovery process initiated by the loss of the client's wife 2. To facilitate the acceptance of the loss of the client's wife 3. To avoid dealing with grief associated with the loss of the client's wife 4. To eliminate emotional pain related to the loss of the client's wife

2. To facilitate the acceptance of the loss of the client's wife Rationale: The nurse should anticipate that the purpose of these rituals is to facilitate the acceptance of the loss of the client's wife. Resolution of the loss is the fourth stage in Engel's grief process, in which the bereaved experiences a preoccupation with the loss, which gradually decreases over time.

9. A nurse assesses a woman whose husband died 13 months ago. She isolates herself, screams at her deceased spouse, and is increasingly restless. According to Bowlby, this widow is in which stage of the grieving process? 1. Stage I: Numbness or protest 2. Stage II: Disequilibrium 3. Stage III: Disorganization and despair 4. Stage IV: Reorganization

3. Stage III: Disorganization and despair Rationale: The nurse should identify that this client is in the third stage of Bowlby's grief process, called disorganization and despair. This stage is characterized by feelings of despair in response to the realization that the loss has occurred. The individual experiences helplessness, fear, and hopelessness. Perceptions of visualizing or being in the presence of the lost one may occur.

8. A nurse assigns a client the nursing diagnosis of complicated grieving. According to Bowlby, which long-term outcome would be most appropriate for this nursing diagnosis? 1. The client will accomplish the recovery stage of grief by year one. 2. The client will accomplish the acceptance stage of grief by year one. 3. The client will accomplish the reorganization stage of grief by year one. 4. The client will accomplish the emotional relocation stage of grief by year one.

3. The client will accomplish the reorganization stage of grief by year one. Rationale: The nurse should identify that, according to Bowlby, an appropriate long-term outcome for this client is to accomplish the reorganization stage of grief by year one. Until the client can recognize and accept personal feelings regarding the loss, grief work cannot progress. The reorganization stage of grieving is the final stage in which the individual accepts the loss and new goals and patterns are established.

4. A teenager has recently lost a parent. Which grieving behavior should a school nurse expect when assessing this client? 1. Denial of personal mortality 2. Preoccupation with the loss 3. Clinging behaviors and personal insecurity 4. Acting-out behaviors, exhibited in aggression and defiance

4. Acting-out behaviors, exhibited in aggression and defiance Rationale: The school nurse should anticipate that the teenager will exhibit aggression and acting out. Adolescents have the ability to understand death on an adult level yet have difficulty tolerating the intense feelings associated with the death of a loved one. It is often easier for adolescents to talk with peers about feelings than with other adults.

Studies have shown that individuals contemplating end-of-life issues commonly fear A. becoming a burden. B. leaving money unspent. C. being able to direct and control care. D. the inability to display strong feelings toward family.

A. becoming a burden. Individuals typically fear becoming a burden, being abandoned, being in pain, becoming impoverished, and becoming undignified in how they look and smell.

16. ______________________ grieving is the experiencing of the feelings and emotions associated with the normal grief response before the loss actually occurs.

ANS: Anticipatory Rationale: Anticipatory grieving is the experiencing of the feelings and emotions associated with the normal grief response before the loss actually occurs. Anticipatory grieving may serve as a defense for some individuals to ease the burden of loss when it actually occurs.

15. Order the stages of normal grief, according to J. William Worden. ________ Finding an enduring connection with the lost entity in the mist of embarking on a new life ________ Accepting the reality of the loss ________ Adjusting to a world without the lost entity ________ Processing the pain of grief

ANS: The correct order is 4, 1, 3, 2 - Accepting the reality of the loss - Processing the pain of grief - Adjusting to a world without the lost entity - Finding an enduring connection with the lost entity in the mist of embarking on a new life Rationale: Worden views the bereaved person as active and self-determining rather than a passive participant in the grief process. He proposes that bereavement includes a set of tasks that must be reconciled in order to complete the grief process.

14. Order the stages of normal grief, according to John Bowlby. ________ Reorganization ________ Disequilibrium ________ Disorganization and despair ________ Numbness/protest

ANS: The correct order is 4, 2, 3, 1 Numbness/Protest Disequilibrium Disorganization and despair Reorganization Rationale: John Bowlby hypothesized four stages in the grief process. He implies that these behaviors can be observed in all individuals who have experienced the loss of something or someone of value, even in babies as young as 6 months of age.

Additional Assistance: ___________ ____________ A living will or durable power of attorney for health care Allows an individual to provide directions about his or her future medical care Allow the client to be in control of decisions at the end of life

Additional Assistance: Advance directives A living will or durable power of attorney for health care Allows an individual to provide directions about his or her future medical care Allow the client to be in control of decisions at the end of life

Additional Assistance: Advance directives Reasons why advance directives are sometimes not honored 1) 2) 3)

Additional Assistance: Advance directives Reasons why advance directives are sometimes not honored - Not available at the time treatment decisions need to be made - The advance directive is not clear - The health-care proxy is unsure of the client's wishes

Additional Assistance: Spare family and loved ones the burden of making choices without knowing what is most important to the person who is dying by creating a(n) ________ ________

Additional Assistance: Advance directives Spare family and loved ones the burden of making choices without knowing what is most important to the person who is dying

Additional Assistance: _________ A program that provides palliative and supportive care to meet the special needs of people who are dying and their families. Focus of care is on quality of life Provides physical, psychological, spiritual, and social care for the person for whom aggressive treatment is no longer appropriate.

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

Additional Assistance: Hospice Name some of the team members involved in the Interdisciplinary approach to care 1) 2) 3) 4) 5) 6) 7)

Additional Assistance: Hospice Name some of the team members involved in the Interdisciplinary approach to care - Nurses - Attendants - Physicians - Social workers - Volunteers - Dietitian - Counselor

3. With what types of behaviors is grief manifested in school-age children?

Ages 3 to 5 Preschoolers and kindergartners Regressive behaviors, such as loss of bladder or bowel control, thumb sucking, and temper tantrums, are common. Changes in eating and sleeping patterns may also occur. Ages 6 to 9 Normal grief reactions at this age include regressive and aggressive behaviors, withdrawal, school phobias, somatic symptoms, and clinging behaviors. Ages 10 to 12 They may ask questions about how the death will affect them personally. 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. They will require reassurance of their own safety and self-worth. Adolescents They may or may not cry. They may withdraw into themselves or attempt to go about usual activities in an effort to avoid dealing with the pain of the loss. Some teens exhibit acting-out behaviors, such as aggression and defiance. It is often easier for adolescents to discuss their feelings with peers than with their parents or other adults. Some adolescents may show regressive behaviors, whereas others react by trying to take care of their loved ones who are also grieving. In general, individuals of this age group have an attitude of immortality.

Anticipatory Grieving Difficulty arises when family members complete the process of anticipatory grief and __________________________ ____________________ occurs prematurely.

Anticipatory Grieving Difficulty arises when family members complete the process of anticipatory grief and detachment from the dying person occurs prematurely.

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

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

Assessment: Concepts of death: Cultural issues - __________ _____________ --- Similar to those of the dominant American culture of the same religion and social class, with a blending of cultural practices from the African heritage --- Feelings are expressed openly and publicly

Assessment: Concepts of death: Cultural issues - African Americans --- Similar to those of the dominant American culture of the same religion and social class, with a blending of cultural practices from the African heritage --- Feelings are expressed openly and publicly

Assessment: Concepts of death: Cultural issues - Chinese Americans --- Death and bereavement in the Chinese tradition are centered on __________ ____________ --- Chinese people have an intuitive fear of death and avoid references to it --- Do not openly ________ __________ ___________

Assessment: Concepts of death: Cultural issues - Chinese Americans --- Death and bereavement in the Chinese tradition are centered on ancestor worship --- Chinese people have an intuitive fear of death and avoid references to it --- Do not openly express their emotions

Assessment: Concepts of death: Cultural issues - Filipino Americans --- ____________ takes place in home of the deceased --- Among _________ families, 9 days of novenas are held in the home or church, finishing on the last day with a fiesta --- Wear dark clothing for ________ after a death

Assessment: Concepts of death: Cultural issues - Filipino Americans --- Week-long wake takes place in home of the deceased --- Among Catholic families, 9 days of novenas are held in the home or church, finishing on the last day with a fiesta --- Wear dark clothing for 1 year after a death

Assessment: Concepts of death: Cultural issues - Japanese Americans --- Predominant religion is _______ --- Body is prepared by ________________ --- __________ is common

Assessment: Concepts of death: Cultural issues - Japanese Americans --- Predominant religion is Buddhism --- Body is prepared by close family members --- Cremation is common

Assessment: Concepts of death: Cultural issues - Jewish Americans --- Traditional Judaism believes in __________ --- A dying person is __________ --- No _____ and no _______ are part of a Jewish funeral --- ________ is prohibited --- _______ period beginning with the burial is call shiva, during which mourners think only about the deceased

Assessment: Concepts of death: Cultural issues - Jewish Americans --- Cremation is prohibited --- 7-day period beginning with the burial is call shiva, during which mourners think only about the deceased

Assessment: Concepts of death: Cultural issues Vietnamese Americans ---__________ is predominant religion --- Belief that ______ and ________ are predestined --- ________ is common --- The _______ anniversary of an individual's death is commemorated

Assessment: Concepts of death: Cultural issues - Vietnamese Americans --- Cremation is common --- The 1-year anniversary of an individual's death is commemorated

Assessment: Concepts of death: Cultural issues Which Culture __________ ____________ --- The Navajo of the Southwest conduct a cleansing ceremony before burial to prevent the spirit of the dead person from trying to assume control of someone else's spirit --- The dead are buried with their shoes on the wrong feet and rings on their index fingers --- They do not express grief openly and are reluctant to touch the body of a dead person

Assessment: Concepts of death: Cultural issues Which Culture Native Americans --- The Navajo of the Southwest conduct a cleansing ceremony before burial to prevent the spirit of the dead person from trying to assume control of someone else's spirit --- The dead are buried with their shoes on the wrong feet and rings on their index fingers --- They do not express grief openly and are reluctant to touch the body of a dead person- Native Americans --- The dead are buried with their shoes on the wrong feet and rings on their index fingers --- They do not express grief openly and are reluctant to touch the body of a dead person

Assessment: Concepts of death: Developmental issues - Adolescents --- Usually able to view death on __________ --- Have difficulty perceiving ___________ --- May or may not cry; may __________ --- May exhibit ______________

Assessment: Concepts of death: Developmental issues - Adolescents --- Usually able to view death on an adult level --- Have difficulty perceiving their own death --- May or may not cry; may withdraw --- May exhibit acting out behaviors

Assessment: Concepts of death: Developmental issues - Elderly adults --- A time in life of the convergence of _______ ________ --- May lead to "__________ ___________" --- __________ ___________ may result in depression

Assessment: Concepts of death: Developmental issues - Elderly adults --- A time in life of the convergence of many losses --- May lead to "bereavement overload" --- Bereavement overload may result in depression

A client tells the nurse "I am worried about my 70-year-old mother. My father died almost 9 months ago, and she is still not her old self. She says she is lonely, but she doesn't do anything about getting out and being with others." The most helpful remark for the nurse would be A. "I think you are right in being concerned about your mother. Restitution should be taking place." B. "At about this time in the grieving process people experience disorganization and aimlessness." C. "It's odd that she is not talking a lot about your father and the good life they shared as a way of holding on." D. "Because of her age, she may never release from her husband and be ready to take on a new relationship."

B. "At about this time in the grieving process people experience disorganization and aimlessness." Teaching the family about the normal phenomena experienced during bereavement is helpful. This statement is the only option that reflects a fact about the bereavement process. Disorganization, depression, restlessness, and aimlessness precede reorganization of behavior and are generally most pronounced at 6 to 9 months.

Nursing interventions that facilitate the grieving process include A. insisting that the bereaved seek spiritual guidance. B. helping the bereaved suppress strong emotions. C. making eye contact and listening attentively. D. not letting long periods of silence occur.

C. making eye contact and listening attentively. Eye contact lets the bereaved know you are there and share their sadness. Patient listening helps the bereaved express feelings, both positive and negative.

A woman whose mother has just died a painful death from cancer tearfully tells the nurse that she does not think she will ever get over her mother's death. The most appropriate response would be A. "The next few months will be very hard for you, but in a year you will feel fine again." B."It was for the best. She was in such great pain." C. "Time heals all wounds, and yours will heal also." D. "The loss must be very painful for you."

D. "The loss must be very painful for you. The most therapeutic response acknowledges the loss without offering banalities.

A grieving husband tells the nurse "There were so many things I should have told her before she died. How much she meant to me, what a good wife and mother she was." Which of the normal phenomena experienced during the mourning process does this statement exemplify? A. Preoccupation with the deceased B. Disorganization and depression C. Anger D. Guilt

D. Guilt Guilt is exemplified in this statement. The husband blames himself for failing to take specific actions.

1. What type of maladaptive response to loss occurs when an individual becomes fixed in the anger stage of grief? What clinical disorder is associated with this occurrence? _________ (___________) Grief Response When this occurs, __________ is the result. __________ ____ disorder is a type of ___________ grief reaction.

Distorted (Exaggerated) Grief Response When this occurs, depression is the result. Depressive mood disorder is a type of exaggerated grief reaction.

4. According to Engel, when is the grief response thought to be resolved?

Engel (1964) has stated that successful resolution of the grief response is thought to have occurred when a bereaved individual is able "to remember comfortably and realistically both the pleasures and disappointments of [that which is lost]."

True/False The following are all examples of loss: - A significant other (person or pet) - Illness or debilitating conditions - Developmental/maturational changes - Decrease in self-esteem - Personal possessions

Examples of loss include: - A significant other (person or pet) - Illness or debilitating conditions - Developmental/maturational changes - Decrease in self-esteem - Personal possessions

True/False Anticipatory grieving does not promote the grieving process for family members.

False Anticipatory grieving may be positive for some people and less functional for others.

Length of the Grief Process: Acute grief Usually lasts about ___________; longer in older adults

Length of the Grief Process: Acute grief Usually lasts about 6 to 8 weeks; longer in older adults

Length of the Grief Process: Resolution of the grief process Is thought to have occurred when a bereaved individual is able to ________________________________________________________________________________________________________________________

Length of the Grief Process: Resolution of the grief process Is thought to have occurred when a bereaved individual is able to remember comfortably and realistically both the pleasures and disappointments of that which is lost

Length of the Grief Process: The grief process - Is very individual - May last for ______________

Length of the Grief Process: The grief process - Is very individual - May last for many years

Length of the Grief Process: The grief response is more difficult if - The bereaved person was _________ __________ - The relationship was an ____________ one - The individual has experienced a number of _________ _______

Length of the Grief Process: The grief response is more difficult if - The bereaved person was strongly dependent - The relationship was an ambivalent one - The individual has experienced a number of recent losses

Length of the Grief Process: The grief response is more difficult if - The loss is that of a __________ __________ - The bereaved person's health is __________ - The bereaved person perceives some ___________ ____ ____ _______

Length of the Grief Process: The grief response is more difficult if - The loss is that of a young person - The bereaved person's health is unstable - The bereaved person perceives some responsibility for the loss

Length of the Grief Process: The grief response may be facilitated if - The individual has the support of _________ ________ - The individual has the opportunity to _______ ___ ___ ____

Length of the Grief Process: The grief response may be facilitated if - The individual has the support of significant others - The individual has the opportunity to prepare for the loss

True/False Loss is anything that is perceived as such by the individual.

Loss is anything that is perceived as such by the individual.

_______ is the experience of separation from something of personal importance.

Loss is the experience of separation from something of personal importance.

Maladaptive Responses to Loss: _________ or ___________ grieving - A ********* grief process may be considered maladaptive when certain behaviors are exhibited --- Behaviors aimed at keeping the lost loved one alive --- Behaviors that prevent the bereaved from adaptively performing activities of daily living

Maladaptive Responses to Loss: Chronic or prolonged grieving - A ********* grief process may be considered maladaptive when certain behaviors are exhibited --- Behaviors aimed at keeping the lost loved one alive --- Behaviors that prevent the bereaved from adaptively performing activities of daily living

Maladaptive Responses to Loss: ________ or _________ grief - The absence of grief when it ordinarily would be expected - Potentially pathological because the person is not dealing with the reality of the loss - Remains fixed in the denial stage of the grief process - Grief may be triggered much later in response to a subsequent loss

Maladaptive Responses to Loss: Delayed or inhibited grief - The absence of grief when it ordinarily would be expected - Potentially pathological because the person is not dealing with the reality of the loss

Maladaptive Responses to Loss: ___________ (__________) grief - All of the symptoms associated with normal grieving are exaggerated. - The individual becomes incapable of managing activities of daily living. - The individual remains fixed in the anger stage of the grief process. - Depressed mood disorder is a type of distorted grief response.

Maladaptive Responses to Loss: Distorted (exaggerated) grief - All of the symptoms associated with normal grieving are exaggerated. - The individual becomes incapable of managing activities of daily living. - The individual remains fixed in the anger stage of the grief process. - Depressed mood disorder is a type of distorted grief response.

Normal vs. Maladaptive Grieving: One crucial difference between normal and maladaptive grieving - The ______________ does not occur in uncomplicated bereavement --- The ______________ ultimately precipitates depression

Normal vs. Maladaptive Grieving: One crucial difference between normal and maladaptive grieving - The loss of self-esteem does not occur in uncomplicated bereavement --- The loss of self-esteem ultimately precipitates depression

Nursing Diagnosis Risk for __________ ___________ related to loss of a valued concept/object; loss of a loved one

Nursing Diagnosis Risk for complicated grieving related to loss of a valued concept/object; loss of a loved one

Nursing Diagnosis Risk for _________ ___________ related to complicated grief process

Nursing Diagnosis Risk for spiritual distress related to complicated grief process

Planning/Implementation Nursing intervention for the bereaved individual *Provide assistance through the grief process in a healthful manner toward resolution. * Encourage the individual to express feelings about the loss and how the loss will affect his or her life. * Encourage the individual to participate in usual religious practices from which he or she derives support. * Assist the client to identify positive aspects about his or her life, past relationships, and prospects for the future.

Planning/Implementation Nursing intervention for the bereaved individual *Provide assistance through the grief process in a healthful manner toward resolution. * Encourage the individual to express feelings about the loss and how the loss will affect his or her life. * Encourage the individual to participate in usual religious practices from which he or she derives support. * Assist the client to identify positive aspects about his or her life, past relationships, and prospects for the future.

2. Describe the phenomenon of bereavement overload. The aging process comes with a ___________ of losses, the timing of which makes it impossible for the aging individual to ________ the grief process in response to one loss before another occurs. Because grief is __________, this can result in bereavement overload, the person is less able to adapt and reintegrate, and mental and physical health is jeopardized. Bereavement overload has been implicated as a predisposing factor in the development of __________ disorder in _____ adults.

The aging process comes with a convergence of losses, the timing of which makes it impossible for the aging individual to complete the grief process in response to one loss before another occurs. Because grief is cumulative, this can result in bereavement overload, the person is less able to adapt and reintegrate, and mental and physical health is jeopardized. Bereavement overload has been implicated as a predisposing factor in the development of depressive disorder in older adults.

Theoretical Perspectives: Stages of grief Elisabeth Kübler-Ross - Stage I: - Stage II: - Stage III: - Stage IV: - Stage V:

Theoretical Perspectives: Stages of grief Elisabeth Kübler-Ross - Stage I: Denial - Stage II: Anger - Stage III: Bargaining - Stage IV: Depression - Stage V: Acceptance

6. 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. Delayed grieving

9. 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. In clinical depression, anhedonia is prevalent.

5. 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. The ability to grieve in anticipation of the loss

7. 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 no longer than 1 year. d. In normal grief the person does not show anger toward the loss.

b. There is no loss of self-esteem in normal grieving.

8. 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 they may have done something to cause the death

c. A preoccupation with the loss

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

c. Adolescents do not perceive death as inevitable.

2. 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. Bargaining

3. 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. Task III. Adjusting to a world without the lost entity

4. 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 loss out of sight d. When the bereaved person can discuss both positive and negative aspects about the lost entity

d. When the bereaved person can discuss both positive and negative aspects about the lost entity

1. Which of the following is most likely to initiate a grief response in an individual? a. Death of the pet dog b. Being told by her doctor that she has begun menopause c. Failing an examination d. Answer a only e. All of the above.

e. All of the above.