Brandone Dave B.

Paragoso
BSN- 3A

READINGS ON CHAPTER 10 GRIEF AND LOSS

Grief refers to the subjective emotions and affect that are normal responses to
the experience of loss. Grieving is the process by which a person experiences grief.
Types of losses can be identified as unfulfilled or unmet human needs. Maslow’s
hierarchy of human needs is a useful model by which to understand loss as it relates to
unfulfilled human needs. Grief work is one of life’s most difficult challenges.

The challenge of integrating a loss requires all that the person can give of mind,
body, and spirit. Because the nurse constantly interacts with clients at various points on
the health–illness continuum, he or she must understand loss and the grieving process.
Many theorists including Kubler-Ross, Bowlby, Engel, and Horowitz have described the
process of grieving. Dimensions of human response include cognitive, emotional,
spiritual, behavioral, and physiologic.

People may be experiencing more than one phase of the grieving process at a
time. Culturally bound reactions to loss are often lost in the acculturation to dominant
societal norms. Both universal and culture-specific rituals facilitate grieving.
Disenfranchised grief often involves deaths, mourners, or situations that are not socially
supported or sanctioned, or carry a stigma for the mourners. Complicated grieving is a
response that lies outside the norm. The person may be void of emotion, grieve for a
prolonged period, or express feelings that seem out of proportion.

Low self-esteem, distrust of others, a psychiatric disorder, previous suicide

threats or attempts, and absent or unhelpful family members increase the risk for
complicated grieving. Situations considered risk factors for complicated grief in those
already vulnerable include the death of a spouse or child, a sudden unexpected death,
and murder.

During assessment, the nurse observes and listens for cues in what the person
thinks and feels and how he or she behaves and then uses these relevant data to guide
the client in the grieving process. Crisis theory can help the nurse working with a
grieving client. Adequate perception, adequate support, and adequate coping are critical
factors.
Effective communication skills are the key to successful assessment and
interventions. Interventions focused on the perception of loss include exploring the
meaning of the loss and allowing adaptive denial, which is the process of gradually
adjusting to the reality of a loss. Being there to help the client while assisting him or her
to seek other sources of support is an essential intervention. Encouraging the client to
care for himself or herself promotes adequate coping. To earn the client’s trust, the
nurse must examine his or her own attitudes about loss and periodically take a self-
awareness inventory.
Reflection
Sheila Videbeck, a prominent figure in the field of psychology, has contributed
significant insights into the complex dynamics of grief and loss. Reflecting on her work,
it becomes apparent that grief is a multifaceted experience that transcends mere
sadness. Videbeck's exploration of grief delves into its psychological, emotional, and
even physical dimensions, shedding light on its profound impact on individuals and
communities. One key aspect of Videbeck's perspective on grief is its universality. She
emphasizes that grief is a natural response to loss, whether it be the death of a loved
one, the end of a relationship, or any significant change that alters one's sense of
normalcy. This recognition of grief as a universal human experience fosters empathy
and understanding, acknowledging that everyone copes with loss in their own way and
on their own timeline.

Moreover, Videbeck highlights the diversity of grief reactions. She acknowledges

that there is no one-size-fits-all approach to grieving, as individuals may express their
sorrow and pain in varied ways. Some may openly mourn, while others may suppress
their emotions or channel them into different outlets. This diversity underscores the
importance of offering compassion and support without judgment, allowing individuals
the space to navigate their grief authentically. Videbeck also explores the complex
emotions that accompany grief, including anger, guilt, and despair. These emotions may
fluctuate unpredictably, complicating the grieving process and intensifying the sense of
loss. By acknowledging and validating these emotions, Videbeck encourages
individuals to confront their feelings honestly and seek healthy coping mechanisms.

Furthermore, Videbeck emphasizes the importance of social support in navigating grief.

She recognizes that grieving is not a solitary journey but a communal experience that
requires the presence and understanding of others. Family, friends, and support groups
can provide invaluable comfort and validation, helping individuals find solace amidst
their pain. In sum, Sheila Videbeck's reflections on grief and loss offer a nuanced
understanding of this universal human experience. By acknowledging its complexity,
diversity, and profound impact, she underscores the need for empathy, support, and
compassion in helping individuals navigate the turbulent waters of grief. Her insights
remind us of the importance of honoring our emotions, seeking connection with others,
and embracing the healing power of community.

READINGS ON CHAPTER 11 ANGER, HOSTILITY AND AGGRESSION

Anger expressed appropriately, can be a positive force that helps a person solve
problems and make decisions. Hostility, also called verbal aggression, is behavior
meant to intimidate or cause emotional harm to another and can lead to physical
aggression. Physical aggression is behavior meant to harm, punish, or force into
compliance another person. Most clients with psychiatric disorders are not aggressive.
Clients with schizophrenia, bipolar disorder, dementia, head injury, antisocial or
borderline personality disorders, or conduct disorder, and those intoxicated with alcohol
or other drugs, may be aggressive. Rarely, clients may be diagnosed with IED.
Treatment of aggressive clients often involves treating the comorbid psychiatric disorder
with mood stabilizers or antipsychotic medications.

Assessment and effective intervention with angry or hostile clients can often
prevent aggressive episodes. Aggressive behavior is less common and less intense on
units with strong psychiatric leadership, clear staff roles, and planned and adequate
events such as staff–client interaction, group interaction, and activities. The nurse must
be familiar with the signs, symptoms, and behaviors associated with the triggering,
escalation, crisis, recovery, and postcrisis phases of the aggression cycle.

In the triggering phase, nursing interventions include speaking calmly and

nonthreateningly, conveying empathy, listening, offering PRN medication, and
suggesting retreat to a quiet area. In the escalation phase, interventions include using a
directive approach; taking control of the situation; using a calm, firm voice for giving
directions; directing the client to take a time-out in a quiet place; offering PRN
medication; and making a “show of force.” In the crisis phase, experienced, trained staff
can use the techniques of seclusion or restraint to deal quickly with the client’s
aggression. During the recovery phase, interventions include helping clients relax,
assisting them to regain self-control, and discussing the aggressive event rationally. In
the post-crisis phase, the client is reintegrated into the milieu. Important self-awareness
issues include examining how one handles angry feelings and deals with one’s own
reactions to angry clients.

Reflection

Videbeck's chapter on anger, hostility, and aggression is an insightful exploration of

these complex emotions and behaviors that are deeply ingrained in human psychology.
Here are some reflections on the key points and insights from the chapter:

Understanding the Nature of Anger: The chapter begins by delving into the nature of
anger, emphasizing its role as a natural and often adaptive response to perceived
threats or injustices. Anger, when appropriately managed, can serve as a catalyst for
change and assertiveness. However, it can also become problematic when it escalates
into aggression or hostility.

Factors Influencing Anger Expression: Videbeck discusses various factors that influence
how individuals express and manage their anger. These factors include biological
predispositions, environmental stressors, cultural norms, and learned behaviors.
Understanding these influences is crucial for developing effective interventions to
address anger-related issues.

Differentiating Anger, Hostility, and Aggression: The chapter distinguishes between

anger, hostility, and aggression, highlighting their interrelated yet distinct characteristics.
Anger refers to the emotional response to perceived provocation, while hostility involves
a more enduring attitude of cynicism or antagonism towards others. Aggression, on the
other hand, encompasses behaviors intended to cause harm or damage.
Assessment and Evaluation: Videbeck emphasizes the importance of thorough
assessment and evaluation when working with individuals experiencing anger-related
problems. This involves gathering information about the frequency, intensity, triggers,
and consequences of their anger episodes. Additionally, assessing for underlying
mental health conditions, such as depression or trauma, is essential for comprehensive
treatment planning.

Intervention Strategies: The chapter discusses various intervention strategies aimed at

managing and reducing anger, hostility, and aggression. These may include cognitive-
behavioral techniques, such as anger management therapy, relaxation exercises,
assertiveness training, and conflict resolution skills. Pharmacological interventions may
also be considered in cases where underlying psychiatric conditions contribute to anger
dysregulation.

Cultural Considerations: Videbeck acknowledges the importance of cultural factors in

shaping individuals' experiences and expressions of anger. Cultural norms regarding
emotional expression, gender roles, and social hierarchies can significantly influence
how anger is perceived and managed within different cultural contexts. Mental health
professionals must be culturally competent and sensitive to these dynamics when
working with diverse populations.

Prevention and Education: Finally, the chapter emphasizes the role of prevention and
education in addressing anger-related issues. Teaching individuals coping skills, conflict
resolution strategies, and effective communication techniques can empower them to
manage their anger constructively and maintain healthier interpersonal relationships.

In conclusion, Videbeck's chapter offers a comprehensive overview of anger, hostility,

and aggression, highlighting the complex interplay of biological, psychological, social,
and cultural factors that influence these emotions and behaviors. By understanding the
underlying mechanisms and employing evidence-based interventions, mental health
professionals can help individuals effectively manage their anger and improve their
overall well-being.