Grieving, Crisis, Therapies

PART III

LOSS & GRIEVING

LOSS AND GRIEVING

GRIEF- refers to the subjective emotions and affect that are a normal response to the experience of loss

ANTICIPATORY GRIEVING- when people facing an imminent loss begin to grapple with the very real possibility of the loss or death in the near future DISENFRANCHISED GRIEF-grief over a loss that is not or cannot be acknowledged openly, mourned publicly or supported socially COMPLICATED GRIEVING-when a person is void of emotion, grieves for prolonged periods, has expressions of grief that seem disproportionate to the event

LOSS
    

Physiologic Loss Safety and Security Loss Love and Belongingness Loss Self-Esteem Loss Self-Actualization Loss

GRIEVING PROCESS

Stages of death and dying according to Kubler-Ross:
    

Denial Anger Bargaining Depression Acceptance

Dysfunctional grieving – extends from 4 to 6 weeks leading to CRISIS

Interventions
   

  

Explore client’s perception and meaning of the loss Allow adaptive denial Assist client to reach out for and accept support Encourage client to examine patterns of coping in past and present situation of loss Encourage client to care for himself Offer client food without pressure to eat Use effective communication

CRISIS AND ITS MANAGEMENT

CRISIS

Situation that occurs when an individual’s habitual coping ability becomes ineffective to merit demands of a situation
TYPES OF CRISES: MATURATIONAL / DEVELOPMENTAL

 1.

Normal expected crisis that runs through age

1.

SITUATIONAL
Unexpected and sudden event in life

1.

ADVENTITIOUS
Calamities, war

Characteristics of a Crisis State
    

Highly individualized Lasts for 4-6 weeks Self-limiting Person affected becomes passive and submissive Affects a person’s support system

PHASES OF A CRISIS
 

 

Pre-crisis: State of equilibrium Initial Impact (may last a few hours to a few days): High level of stress, helplessness, inability to function socially Crisis (may last a brief or prolonged period of time): Inability to cope, projection, denial, rationalization Resolution: attempts to use problem-solving skills Post crisis: may have OLOF or may have symptoms of neurosis, psychosis

CRISIS MANAGEMENT

 

Role of the nurse is to return the client to its pre-crisis state by assisting and guiding them until they achieved their OLOF. Goal: to enable patient to attain an OLOF Nurse’s Primary Role: Active and Directive

Steps in Crisis Intervention
1. 2. 3. 4.

5.

6.

Identify the degree of disruption the client is experiencing Assess the client’s perception of the event Formulate nursing diagnoses Involve the patient and family if applicable with planning Implement interventions- new and old coping mechanisms Evaluate-reassessment, reinforcement

TYPES OF THERAPIES
Treatment Modalities

Individual Psychotherapy

Individual Psychotherapy

 

One to one relationship between therapist and client For dissociative, anorexia, paranoid, narcissistic Change is achieved by the exploration of feelings, attitudes, thinking behavior and conflict

SEVEN SUBTYPES:
1.
 

CLASSICAL PSYCHOANALYSIS
Based on Freud’s theory To uncover unconscious feelings and thoughts that interfere with the client’s living a fuller life
  

Free association -client is encouraged to say anything that comes to mind, without censoring thoughts or feelings Dream analysis Working through (transference) -process of repeated interpretation to the person of his or her unconscious processes has the effect of bringing about change

2.
 

PSYCHOANALYTICAL PSYCHOTHERAPY
Uses dream analysis, transference and free association Therapist is much more involved and interacts with the client more freely Done through intimate professional relationship between the nurse/therapist and the client over a period of time (introductory, working and termination phase)

3.

SHORT TERM DYNAMIC PSYCHOTHERAPY

   

Indication-persons with specific symptom or interpersonal problem that he/she wants to work on Therapist directs the content Use of transference and dream analysis Weekly sessions (total number-12 to 30) Successful for highly motivated individuals who have insight and with positive relationship with the therapist

4.  

TRANSACTIONAL ANALYSIS Eric Berne Each person has three ego states and change from one to another frequently
 

Parent-concepts of standards of behavior and how things should be done e.g. Go and take out the garbage. Adult-rational thinking and data analyzing part of the personality e.g. Would you please take out the garbage Child- feelings associated with persons, things or incidents represent the need-gratifying aspects of the personality. E.g. Is that why you married me? To be your garbage man?

  

For group, family and individual Client to identify ego states for each given situation Rewarding of positive or negative behaviors with strokes Client work through these behaviors

5.

COGNITIVE PSYCHOTHERAPY

Restructuring or changing ways in which people think about themselves through:
  

Thought stopping Positive self-talk Decatastrophizing

Therapists help patients identify these thoughts

6.

BEHAVIORAL THERAPY
    

 

Changes in maladapted behavior can occur without insight into the underlying cause Based on learning theory Modeling Operant conditioning Self-control therapy-combination of cognitive & behavioral approaches “talking to self” Systematic desensitization Aversion therapy

7.

GESTALT THERAPY
   

Emphasis on the “here and now” Only present behavior can be changed, not history Uncover repressed feelings and needs Techniques: have a person behave the opposite of the way he/she feels, presuming that a person can then come in contact with a submerged part of the self; in dreams, person is ask to play the roles of persons in the dream to get in touch with different repressed feelings

Milieu Therapy

Milieu Therapy

Total environment has an effect on the individual’s behavior Components
  

Physical Environment Interpersonal relationships Atmosphere of safety, caring, and mutual respect

For alcoholics

PROGRAMS FOR MILIEU SHOULD HAVE:
   

 

An emphasis on group and social interaction No rules and expectations mediated by peer pressure A view of patients’ roles as responsible human beings An emphasis on patients’ rights for involvement in setting goals Freedom of movement and informality of relationships with staff Emphasis on interdisciplinary participation Goal-oriented, clear communication

Group Therapy

Group Therapy

 

Number of people coming together, sharing a common goal, interest or concern, staying together and developing relationships For PTSD and Alcoholics Phases
  

Orientation-Purpose of the group is stated; objectives and

expectations are laid out Working -Leaders’ role is to keep the group focused, support for each other to attain group goals Termination-Leader acknowledges each member’s contribution and experience as a whole  Members prepare for separation

Characteristics of Group Therapy
  

 

Universality  “You are not alone” Instilling hope and inspiration Developing social skills by interacting with one another Feeling of acceptance and belonging Altruism “Giving of one’s self”

Types:
  

Psychoanalytically oriented group therapy Psychodrama Family therapy

Family Therapy

Assumption of Family Therapy
 

Client: Whole family Concepts:
 

The family is the most fundamental unit of the society. Adaptive or maladaptive patterns of behavior are learned from the family Dysfunction in the family = dysfunction in the individual Improve relationships among family members Promote family function Resolve family problems

Purpose
  

OTHER TYPES OF THERAPIES

SUPPORT GROUPS

For those with AIDS, Mother-Against-Drug Dependence

SELF-HELP GROUPS

Alcoholic Anonymous

   

Provide support, treat patients with respect and dignity Do not place patients in situations wherein they will feel inadequate or embarrassed Treat patients as individuals Provide reality testing Handle hostility therapeutically Provide psychopharmacologic treatment

RULES FOR PSYCHOTHERAPEUTIC MANAGEMENT

BEHAVIORAL THERAPIES
Treatment Modalities

BEHAVIORAL THERAPY

Based on the following theorists:

Pavlov’s Classical Conditioning

All behavior are learned Reinforcements

B.F. Skinner’s Operational Conditioning

BEHAVIORAL THERAPY
Behavioral Modification – Substance Abuse Systematic Desensitization – Phobia Token economy – Schizophrenic, anorexia

1.

2. 3.

ATTITUDE THERAPY
Treatment Modalities

ATTITUDE THERAPY
1. 2. 3. 4. 5. 6.

Paranoid – Passive Friendliness Withdrawn – Active Friendliness Depressed / Anorexia – Kind Firmness Manipulative – Matter of Fact Assaultive – No Demand Anti-social – Firm, consistent

PSYCHOSOMATIC THERAPY
Treatment Modalities

Electroconvulsive Therapy

Electroconvulsive Therapy
 

Effective in most affective disorders The induction of a grandmal seizure in the brain. Abnormal firing of neurons in the brain causes an increase in neurotransmitters Number of Treatments: 6-12, 3 x a week, about 0.5-2seconds Unilateral or bitemporal

Electroconvulsive Therapy
 1. 2.

3.

Indications: Patients who require rapid response Patients who cannot tolerate pharmacotherapy or cannot be exposed to pharmacotherapy Patients who are depressed but have not responded to multiple and adequate trials of medication

Electroconvulsive Therapy
Preparations for ECT:  Pretreatment evaluation and clearance  Consent  NPO from midnight until after the treatment  Meds:
  

Atropine Sulfate-to decrease secretions Succinylcholine (Anectine)- to promote muscle relaxation Methohexital Sodium (Brevital)- anesthethic

   

Empty bladder Remove jewelry, hairpins, dentures and other accessories Check vital signs Attempt to decrease patient’s anxiety

Electroconvulsive Therapy
Care after ECT:  O2 therapy of 100% until patient can breathe unassisted  Monitor for respiratory problems, gag reflex  Reorient patient  Observe until stable  Careful documentation.  Male erectile dysfunction

OTHER THERAPIES

NEUROSURGERY

Sign up to vote on this title
UsefulNot useful