GRIEF AND LOSS= normal and essential in human life lows a person to change, develop and human potential 9¢ planned, expected, or sudden. Can teficial or devastating and debilitating. g or bereavement - the process by which a person 8 griet Involves not only the v Anticipatory grieving when people facing an ae, loss fo grapple with the very real possibility of the loss or death in the near future. e~ amputation of a ir exchange, or | or liver functioning loss - loss of a safe environment i Loss of self-esteem — changes in how a person is valued at work or in relationships. Loss related to self-actualization - an external or internal crisis that blocks or inhibits strivings toward fulfillment and _may threaten personal goals and individual poteStages of grieving by Kubler-Ross: enial - shock and disbelief regar: the loss. - “No! Not me! I’m healthy.” inger ~ may be expressed towards God, relati friends, or healthcare providers. = “Why me? I’m a good person. What dis | do wrong?” —..argaining - occurs when the © person asks God or fate for more time + to delay the inevitable loss. “Yes me, but.” c epression — awareness of the loss | becomes acute. £ “Yes me! | want to be alone.” ‘€ceptance -the person shows 1. Experiencing numbness and denying the loss. 2. Emotionally. yearning for the lost loved one and protesting the permanence of the loss. 3, Experiencing cognitive disorganization and emotional _ despair with difficulty functioning in the everyday ‘world. 4. Reorganizing and reintegrating the sense of self to pull together.i Oars + Engel’s stages of 4. SHOCK AND DISBELIEF: The initial reaction to a less is a stunned, numbed feeling accompanied by refusal to acknowledge the reality of loss in an attempt to protect the elf against overwhelming stress. 2. DEVELOPING AWARENESS: As the individual "begins to acknowledge the loss, there may be érying. feelings of _ helplessness. 4 frustration, despair and anger that can be rected at self or others, including God of the deceased person. in the rituals such as. funeral, family gathering, or _ religious ceremonies that help the individual accept the reality of ‘the loss and begin, the. 4 recovery process. RESOLUTION OF THE LOSS: The individual is preoccupied with the loss, the lost person or object is idealized, and the mourner may even imitate the lost person. Eventually, the preoccupation decreases, usually in a year or perhaps more. 5, RECOVERY: The previous preoccupation ‘and obsession ends, and the individual is able to go on with life in a way that ‘encompasses the loss* Horowitz's Stages of Loss and Adaptation DENIAL AND. INTRUSION: People stage between denial and intrusion. ( Fluctuate between not 3. WORKING THROUGH: As time passes, the person spends less time bouncin trusion, and the emotions are not as intense and overwhelming. { begins to find new ways of managing _ life and loss) 4 COMPLETION: Life begins to feel normal again, although life is different after the loss. Memories are less painful ‘and don’t regularly interfere with day- to-day life.DIMENSIONS OF GRIEVING itive responses — questioning & © make sense of loss; attempting Jost one present; believing in an and as though the lost one is a _ with lost one, possible si « homicidal gestures 4 jess, anxiety, guilt, resentment, : 1g numb, loneliness, depre: ¥ Physiologic responses - headaches, impaired app wt loss, lack of energy ;Q_ Disenfranchised grief: a grief over a 1655 that is not or cannot be ‘acknowledged openly, mourned acy, loss or griever is not recognized) Complicated Grieving - when a person is void of emotion, grieves for prolonged periods or has expressions of grief that seem disproportionate to the event. Interventions for a client who is grieving: Y Explore pt perception and meaning of Joss. Y Allow adaptive denial, pt gradually adjusts fo the reality of loss and let pt let go of previous ways of thinkin: about himself, others, and the world. Encourage or assist pt to reach out for support, Encourage pt to examine patterns of ‘coping in the past. Offer foods without pressure to eat Use effective communication (offering self, broad openings, providing information, focusing) Establish rapport and maintain interpersonal skills such as attentive presence, respect or grieving process ‘and personal beliefs of pt, bein; = Hrustorthy. honest. dependable, consistent ENS: <beens iacnths since Day ly seems to have forgotten the bad _ addy’: 's funeral, She said that she ad that sense of is not be ly’s death, She acts like nothing perANGER, HOSTILITY AND AGGRESSION Oe ES ee2 v « fist, flus! ANGER - is a normal human emotion which is often perceived negatively. It is a strong, uncomfortable response to a real or perceived provocation. qctivates SNS response. anger expression can be under personal control and can be learned. Normal and healthy anger - when handled appropriately and assertively (directly, not violating the rights of self/others) —> positive creative force = problem solving and productive change. Angered expressed inappropriately > verbal / physical aggression > destructive and potentially life threatening. Symptoms of anger: Intense distress, frowning, gritting of teeth, eyebrow displacement, clenched Tad tee henge auereat “voice. AGGRESSION - means to go against, to assault, or to attack. It is a behavior intended to threaten or injure the victim’s security or self-esteem and to inflict pain or injury to others. Verbal aggression / hostility Physical aggression+ Five - Phase Aggression Cycle Triggering Phase - an event or circumstances ii * Nursing action: Provide and convey empathetic support, encourage deep breathing, use _ clear and calm statements, _ facilitate problem solving, 2. Escalation Phase ~ pt’s responses represent escalating behaviors that indicate movement towards loss of control. $ & Sx: flushed face, screaming; agitation, swearing, threatening gestures, loss of reasoning/problem solving ability. Nursing action: take charge and provide calm & firm directions, give pt “time out” ina q room, stand by staff at distance, prepare to show of force to ‘acquire control.a - period of emotional and physical er of control occurs. *S & $x: loss of physical and emotional control. fighting. hitting. »- kicking, rage, throwing things, ity to communicate clearly. ~ *Nursing:action: initiate involuntary seclusion, restraints or meds as ordered. is, loss . Recovery Phase - “cool down” riod, regains emotional and jical control. 'S & Sx: voice lowers, accusations, 1 body tension, more normal ‘responses, clearer-or more normal communication. Z ‘Nursing action: assess pt and sta' luries, process incident with staff other pts 5. Post - Crisis Phase - attempts to reconciliate and returns to level of functioning. "S & Sx: crying, apologies, reconciliatory efforts, remorse. *Nursing action: discuss alternatives to situations and feelings, gradually reduce the degree of restraint and seclusion, facilitate re-entry to the unit.+ Treatment of aggressive clients often focuses on the treatment _ of the underlying or comorbid Psychiatric diagnosis such as schizophrenia. effective in treating ‘aggressive clients with bipolar dio and mental retardation. Haloperidol (Haldol) and lorazepam (Ativan) are used to n/aggression in symptoms. Catharsis - safe yet aggressive activities that are used to express anger. ¥ Catharsis can increase angry feelings instead of alleviating it. ¥ Use non-aggressive activities instead like walking or talking to another person. Show of Force or Show of determination