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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. What is the cultural significance of Nancy’s fear of sharing
her feelings with her colleagues?

Nancy's fear of sharing her feelings with her colleagues stems from a
cultural context that often marginalizes or diminishes the
significance of pet loss and grief. In many cultures, particularly
Western ones, there exists a prevailing attitude that views pet loss as
trivial or less significant compared to the loss of human companions.
This attitude can lead to a lack of understanding and empathy from
others, including colleagues, when someone experiences profound grief
over the death of a pet.

One aspect contributing to this cultural dynamic is the traditional

notion that animals are inferior to humans and therefore their
deaths should not be as impactful. This belief is deeply ingrained in
many societies and can lead to a lack of acknowledgment or
validation of the bond between humans and their pets. Consequently,
individuals like Nancy may feel hesitant or even ashamed to express
their grief openly, fearing judgment or ridicule from others who may
not share the same perspective.

Furthermore, societal norms often dictate that individuals should

quickly move on from the loss of a pet, viewing extended mourning
periods as excessive or unwarranted. This pressure to suppress
emotions and conform to societal expectations can contribute to
feelings of isolation and alienation for those experiencing pet loss
grief.

In Nancy's case, her reticence to share her feelings with her

colleagues reflects a broader cultural reluctance to acknowledge and
validate the depth of grief experienced over the loss of a beloved pet.
She anticipates that her colleagues may not understand or
appreciate the intensity of her sadness, leading her to conceal her
emotions and make excuses for her fatigue. This fear of being
misunderstood or invalidated underscores the need for greater
cultural sensitivity and recognition of the significance of pet loss
grief in society.
Explore losses with assigned clients.

1. Is the loss tangible (loss of job or home, death, divorce, end of a

relationship) or intangible (loss of hope, dreams, independence)?
Assess grieving behaviors.

In Nancy's case, she experiences tangible loss. Tangible

losses, which are tangible or material in nature, include
the loss of a house, property, automobiles, food, and
money. Natural disasters, divorce, bankruptcy, death,
and similar events can all result in actual losses to our
physical and material possessions. Her 14-year-old
Maltese pet has died because of congestive heart failure.
Nancy’s grieving behavior is feelings of sadness, and
withdrawing from others and her work. She also
experiences fatigue, lack of energy, lack of sleep, and
mild depression. Grief is an emotional response to a loss
that has invested emotions, attention, time, energy, or
dreams. It is a normal, appropriate emotional response to
external and consciously recognized loss, involving
psychological, behavioral, social, and physical reactions.
Grief is an emotional pain that needs to be
acknowledged and experienced, usually time-limited, and
subsides gradually.
 2. Assess the assigned client for characteristics of susceptibility
and risk factors leading to vulnerability. Is the client vulnerable
or susceptible to complicated grieving in response to a loss?

Nancy displays several characteristics and risk factors that could make
her vulnerable to experiencing complicated grieving following the loss of
her pet:
Age: Being 59 years old, Nancy may have encountered previous losses,
potentially heightening her susceptibility to complicated grief if past
grief remains unresolved.

Attachment to Pet: Nancy had a significant bond with her pet,

indicating that the loss may trigger profound grief, increasing the
likelihood of experiencing complicated grieving.

Social Isolation: Nancy's hesitance to share her feelings with

colleagues and her avoidance of acknowledging her grief could lead to
isolation. Lack of social support may exacerbate her grief, raising the
risk of complications.

Depressive Symptoms: Nancy's experiences of fatigue, low energy, mild

depression, and disrupted sleep patterns suggest depressive symptoms,
which can complicate the grieving process and heighten vulnerability
to prolonged grief.

Work-related Stress: Nancy's absence from work due to sadness may

introduce additional stressors, potentially leading to feelings of guilt
or inadequacy and further complicating her grieving process.

Fear of Misunderstanding: Nancy's concern that her colleagues won't

comprehend her profound sadness and grief may deter her from
seeking support, increasing her ulnerability to complicated grieving.

Considering these factors, it's evident that Nancy is at risk of

experiencing complicated grieving following her pet's loss. It's essential for
healthcare providers to offer support, validation, and access to resources
to assist Nancy in navigating her grief effectively and preventing further
complications. Encouraging her to consider therapy or joining support
groups tailored to pet loss can be particularly beneficial in addressing her
unique vulnerabilities and needs.
 3. Discuss the three categories of circumstances that can
result in disenfranchised grief. How are nurses vulnerable?

Based from the book of Sheila I. Videbeck Psychiatric Mental

Health Nursing 8th Edition, disenfranchised grief is grief over a loss
that is not or cannot be acknowledged openly, mourned publicly, or
supported socially. Circumstances that can result in
disenfranchised grief include the following:
A relationship that has no legitimacy
The loss itself is not recognized
The griever is not recognized
The loss involves social stigma

Some people who experience a loss may not be recognized or fully

Supported as grievers. Below are the three categories of
circumstances:

1. Societal factors contribute to disenfranchised grief when

society does not recognize the significance of the loss. This
could include losses such as miscarriage, the death of a pet, or
the death of an ex-spouse. These losses may be minimized or
invalidated by societal norms, leaving individuals to grieve in
isolation without the validation and support they need.
2. Relational factors play a role in disenfranchised grief when
the relationship between the griever and the deceased is not
socially sanctioned or acknowledged. This could occur in cases
of LGBTQ+ relationships, where the loss of a partner may not be
recognized or validated by society in the same way as
heterosexual relationships. Similarly, the loss of a close friend or
colleague may not receive the same level of support or
understanding as the loss of a family member.
3. Situational factors contribute to disenfranchised grief when
the circumstances surrounding the loss are stigmatized or
taboo. This could include deaths related to suicide, substance
abuse, or HIV/AIDS. In these cases, individuals may feel unable
to openly express their grief due to fear of judgment or shame
from others.
ADDITIONAL EXAMPLE
Older Adult & Children – For example, older adults and
children experience limited social recognition for their losses
and the need to mourn. As people Grow older, the perception
may be they “should expect” others their age to die. Adults
sometimes view children as “not understanding or
Comprehending” the loss and may assume wrongly that
their children’s grief Is minimal. Children may experience
the loss of a nurturing parental figure from death, divorce,
or family dysfunction such as alcoholism or abuse. These
losses are significant, yet they may not be recognized.

NURSES VULNERABILITY
Nurses are particularly vulnerable to experiencing
disenfranchised grief due to the nature of their work. They
often form close relationships with patients and their
families, yet their grief may go unrecognized or minimized
by others. For example, nurses who work in areas involving
organ donation or transplantation are involved intimately
with the death of clients who may donate organs to another
person. The daily intensity of relationships between nurses
and clients/families creates strong bonds among them. The
emotional effects of loss are significant for these nurses;
however, there is seldom a socially ordained place or time to
grieve. Additionally, nurses may witness traumatic events or
deaths that are not widely acknowledged or understood by
society, leading to feelings of isolation and alienation in
their grief.
Moreover, nurses may face challenges in seeking support for
their grief due to the hierarchical nature of the healthcare
system. They may feel pressure to maintain a professional
demeanor and prioritize the needs of their patients over
their own emotional well-being. As a result, nurses may
internalize their grief and struggle to find outlets for
expression and support.
B. Assess your anxiety levels during your clinical experience:

a. When facing a new experience; and when doing something with

which they are uncomfortable.

Experiencing anxiety during clinical experiences is not

uncommon, particularly when facing new situations or
undertaking tasks that provoke discomfort. The
apprehension often stems from uncertainty, fear of making
mistakes, or feeling ill-prepared. When encountering a new
experience, such as starting a new job or encountering
unfamiliar procedures, individuals may find themselves on
edge due to the unknown factors. The pressure to perform
well in a professional environment can exacerbate these
feelings, leading to heightened stress levels. Similarly, when
required to perform tasks with which they are
uncomfortable, such as administering a new treatment or
handling a challenging case, anxiety can intensify. In these
instances, seeking support from colleagues, asking questions
to clarify uncertainties, and gradually familiarizing oneself
with the new environment or task can be helpful. Moreover,
additional training, supervision, and feedback from mentors
can alleviate discomfort and build confidence.
Implementing coping strategies like deep breathing,
mindfulness, and positive self-talk can also mitigate anxiety
levels. Additionally, establishing a healthy work-life balance
and seeking support from mental health professionals when
needed are crucial components of managing anxiety in
clinical settings. Ultimately, recognizing and addressing
anxiety in clinical settings is essential for maintaining well-
being, preventing burnout, and providing quality care to
patients.
 B. Use the Hamilton Rating Scale for Anxiety

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. Using tools like the
Hamilton Rating Scale for Anxiety can help nurses
objectively assess their anxiety levels. This awareness
enables them to recognize escalating anxiety and
take proactive steps to manage it effectively.

C. Discuss your anxiety levels during these situations and

write about these experiences.

As someone who struggles with social anxiety, I often

find myself feeling afraid to speak to many people.
This fear manifests itself in various situations,
ranging from small social gatherings to large group
settings. The thought of having to engage in
conversations with numerous individuals at once can
be overwhelming and nerve-wracking for me. One of
the main factors that contributes to my anxiety
levels in these situations is the fear of judgement. I
worry about saying the wrong thing or appearing
awkward in front of others, which leads to self-
doubt and heightened anxiety. I constantly second-
guess my words and actions, fearing that I may
embarrass myself or be perceived negatively by those
around me.
Another aspect of my social anxiety is the fear of being
the center of attention. I dread the idea of all eyes
being on me, as it makes me feel extremely vulnerable
and exposed. The pressure to perform and entertain can
be suffocating, causing me to retreat into myself and
shy away from engaging in conversations with others.
Despite my fears and anxieties, I have had numerous
experiences where I have felt forced to push past my
comfort zone and speak to many people. Whether it be
at work meetings, social events, or family gatherings, I
have had to confront my fears head-on and force
myself to engage in conversations with multiple
individuals. These experiences have been challenging and
anxiety-inducing, but they have also been incredibly
rewarding. I have found that the more I push myself to
speak to many people, the more I am able to overcome
my fears and build my confidence. Each time I engage
in conversations with multiple individuals, I am able to
prove to myself that I am capable of overcoming my
social anxiety and connecting with others on a deeper
level.

While I may feel afraid to speak to many people due to

my social anxiety, I am working towards overcoming my
fears and building my confidence in these situations. It
is a constant battle, but one that I am determined to
conquer in order to grow and develop as a person.
Through pushing myself out of my comfort zone and
confronting my fears, I am gradually learning to
navigate social interactions with more ease and grace.
Group 1 BSN3B
Members:

Aala, Jenelyn O.

Abad, Alieson Mae D.

Acma, Jeeyah Grace T.

Ama, Angela P.

Amutan, Maria Ysabella R.

Ardales, Jasmine Mae

Atlas, Dennis M.

Bako, Jacquelyn Hasianda

Margareth M.

Baliña, Daisery Keith T.

Bersabe, Chrisziel Anwen S.

Casido, Angelica P.