Endings, Stress & Crisis

Khanhthiloan@hmu.edu.vn
 Objectives
● Compare and contrast the stages of dying
● Discuss various types of grief
● Analyze models of stress
● Discuss coping strategies
● Apply the nursing process to clinical
situations involving loss and stress
● Identify types of crisis
 Outline

● Stages of Dying
● Grief
● Models of Stress
● Coping Strategies
● Crisis
 What is Loss?

● Perceived loss: experienced by one person but

cannot be verified by another.
● Example is a psychologic loss.
● Actual loss: loss that can be recognized by others
● Example: retirement, injury, loss of job, death.
 Kubler-Ross’ Framework
for Dying

● Denial
● Anger
● Bargaining
● Depression
● Acceptance
 Grief
● Total response to the emotional experience related to loss
● Engel's Phases of Grief
● 1. shock and disbelief: refusal to accept the loss
● 2. developing awareness: physical & emotional responses:
anger, crying, empty feeling, loss of energy
● 3. restitution: adaptation to a new life without a decreased
 Types of Grief
● Acute/Normal: is marked by movement towards
acceptance of the loss and a gradual alleviation of the
symptoms, as well as the ability to continue to engage in
basic daily activities.

● Anticipatory: is the reaction to a death you were able to

anticipate such as when an individual dies from a long term
illness
 Types of Grief

● Chronic Sorrow: Strong grief reactions that do not

subside and last over a long period of time. Continually
experiencing extreme distress over the loss with no
progress towards feeling better or improving functioning

● Complicated: Refers to grief reactions and feelings

of loss that are debilitating, long lasting, and/or impair
your ability to engage in daily activities
 Stress & Stressors

● Stress: represents a natural physiologic,

psychological, and spiritual response to the
presence of a stressor ( tension, anger, fear,
hurt, frustration)
● Stress is a state of mental or emotional strain or
tension resulting from adverse or very
demanding circumstances)
● Stressors are the factors that causes stress.
(physical stressors, psychological stressors,
spiritual stressors)
 Models of Stress

● Stress as physiologic response

● Cannon

● General Adaptation Syndrome

● Selye
 General adaptation
syndrome
● Alarm stage:
- Adrenal gland release epirephrine 🡪 stimulate center
nervous system
- Aldosterol: maintain normal blood volume and salt
balance
- Cortizol: increase blood glucose for energy
● Resistance stage: increased heart rate, breath, muscle
activity
● Exhaustion: The nervous system and immune system no
longer has the energy the sustain themselves🡪 fatigue
and other symptoms
 Models of Stress
● Allostasis Sterling & Eyer

● Stress as Stimulus Holmes & Rahe

● Transactional Model Lazarus & Folkman

 Allostasis load
● Homeostasis: Refers to the maintenance of stable constant
bodily conditions through varying influences
Ex: Body temperature
● Allostasis: Refers to the process of achieving homeostasis
through behavioral change (the body is adaptive to the
environment and to change)
Ex: Fight-flight response: increase heart rate and respiratory
● Allostasis load: how we continually deal with stress, get
stressed for so long and so often🡪 allostasis of the body get
to be too much 🡪 end up having health issues
 Stimulus stress model

● Stimulus: Stressful life event (marriage,

divorce…) that threaten or disrupt
homeostasis
● Stressors (cumulative stresses within a
short time) requiring a significant change
in the lifestyle of the individual
● A quantity and severity of stressors
influence a person’s potential for
developing stress-related illness
 Transactional model of
stress

● Stress results from an imbalance between

demands and our coping resources
● Primary appraisal: threat or no threat ( am
I ok,). Coping resources
● Secondary appraisal: Adequate or
inadequate resources (how much control I
has over the stressor)
 Coping strategies

● Take a few deep breathe

● Physical recreation: Regular exercise (yoga,
meditating)
● Problem-solving: determine solutions, plan of action
● Seeking support: Asking for help, finding emotional
support from family members, friends during
stressful period
● Humor: pointing out the amusing aspects of the
problem at hand, is thought to help deal with small
failures
● Relaxation: relaxing activities, calming techniques
Coping strategies

● Problem- focused coping: Cope by

focusing on the problem, focused on the
cause of the stress and fix this
● Emotion-focused coping: Focus on
changing the emotion, changing the way
you feel about it or the way you think
about it (change the perception of
stressful situations)
 Crisis

● A crisis occurs when a stressful life

event overwhelms an individuals
ability to cope effectively in the face
of a perceived challenge or threat.
Types of crisis

● Developmental crisis: Maturational stages

associated with psychological crisis
Ex: marriage, pregnancy, give birth
● Situational crisis: unusually stressful life event that
exceeds a person’s resource and coping skills
Ex: Lose a spouse
● Adventitious crisis: unplanned, unusual, horrific and
beyond anyone’s control
Ex: Natural disasters, crime of violent