Case Study

Nancy is a
59-year-old client who is grieving for her 14-year-old Maltese pet that has recently died of
congestive heart failure. Nancy has experienced fatigue, lack of energy, and mild depression.
She has missed work because of her feelings of sadness related to the death of her pet. Her
coworkers are asking Nancy why she is feeling so tired. Nancy makes excuses for her fatigue
and lack of energy by saying that she “just can’t seem to sleep well at night.” Nancy tells the
nurse that she is reticent to be honest with her colleagues because she thinks that they will not
understand her overwhelming feelings of sadness and grief related to the death of her pet.

A. Cultural Significance of Nancy’s Fear

Nancy's fear of sharing her feelings with her colleagues reflects a common cultural reluctance to
openly discuss grief, especially related to the loss of a pet. In many cultures, the intensity of
grief experienced after the death of a pet may be downplayed or misunderstood, leading
individuals like Nancy to fear judgment or lack of understanding from others.

B. Assessing Grieving Behaviors and Vulnerability

Assessment of Loss: Nancy's loss is tangible, involving the death of her pet due to congestive
heart failure. Her feelings of sadness, depression, and fatigue impact her daily life and work
attendance.

Susceptibility to Complicated Grieving: Nancy may be vulnerable to complicated grieving

due to her strong emotional response and reluctance to seek support.

Disenfranchised Grief: Nancy's grief may be disenfranchised, as society may not fully
recognize the significance of the bond between her and her pet. Nurses may also experience
disenfranchised grief if the emotional impact of pet loss is not acknowledged in their work
environments.

Assessment of Anxiety Levels:

Nurses may experience heightened anxiety, especially when their own family members are
hospitalized. This combines professional expertise with personal emotions, creating a
challenging balance to manage. Hamilton Rating Scale for Anxiety can help nurses objectively
assess their anxiety levels; it can help them to recognize escalating anxiety and take proactive
steps to manage it effectively. Also Seeking support from colleagues and accessing resources
such as counseling services can offer valuable assistance during this challenging time.

A. The cultural significance of Nancy's fear of sharing her feelings with her colleagues can
be attributed to the general societal perception of grief and how different types of losses
are acknowledged and validated. In many cultures, grief is often associated with the loss
of a human being, such as a family member or close friend. The loss of a pet, while
significant to the individual, may not be as widely recognized or understood by others.
This can lead to feelings of isolation and reluctance to share one's grief openly.

1. In Nancy's case, the loss of her Maltese pet can be considered an intangible loss, as it
does not fit the typical categories of loss (e.g., job, home, death, divorce, or end of a
relationship). However, it is crucial to recognize and validate the significance of such
losses for the individual experiencing them.

2. Assessing the client for characteristics of susceptibility and risk factors leading to
vulnerability can help determine if they are at risk for complicated grieving. Factors such
as a history of mental health issues, lack of social support, or a previous traumatic
experience can contribute to a more complex grieving process.

3. The three categories of circumstances that can result in disenfranchised grief are:

a. Losses that are not widely recognized or validated by society (e.g., the loss of a pet, a
relationship that was not socially acknowledged, or a miscarriage).

b. Relationships that are not culturally sanctioned or considered significant (e.g., grief
over the end of a romantic relationship that was not socially accepted).

c. Grief that is experienced in a minority status or stigmatized context (e.g., grief related
to substance abuse, criminal activity, or mental illness)

B. Assessing anxiety levels during clinical experiences can help individuals better understand
their reactions to new situations and discomfort.
a. Anxiety levels may increase when facing new experiences, as the unfamiliarity of the
situation can lead to feelings of uncertainty and apprehension.

b. The Hamilton Rating Scale for Anxiety is a tool that can be used to quantify and
assess anxiety levels. It consists of a 14-item questionnaire that measures the
severity of anxiety symptoms.

c. Reflecting on anxiety levels during clinical experiences can provide insights into
personal coping mechanisms, areas for improvement, and strategies for managing
anxiety in future situations. It is crucial to acknowledge and address anxiety, as it can
impact the quality of care provided and overall well-being.