MHN & BP FINAL.pptx
- 1. 1 Loss and Grief SHERAL SAMSON BScN
- 2. LOSS AND GRIEF 2 OBJECTIVES: By the end of the presentation, the learners will be able to: • Discuss loss and grief. • Identify a clinical scenario and can relate loss and grief theory to it. • Enlists the positive coping mechanisms applied to grief. • Review literature in support of loss and grief. • Develop a nursing care plan for a griever.
- 3. LOSS AND GRIEF 3 SCENARIO A 55-year-old female patient who is admitted to the general ward at the Karachi Psychiatric Hospital, presents with the chief complaint of intense grief, hallucinations, and aggression. Her life has been filled with stressful events that contributed to her schizoaffective disorder diagnosis, including her parents' divorce, her stepmother's violent behavior, and her father's death, her lack of an intimate relationship with her husband, his extramarital affairs, and domestic violence. However, the two tragedies that affected her the most were the murder of her son and the passing of her brother. She was so miserable that she made three suicide attempts. Her current complaints are that she is having hallucinations, is depressed, and is irritable. The treatment regimen includes only medications that are Anti- psychotics (Flucate), Glucophage and Atarax.
- 4. LOSS AND GRIEF 4 Predisposing factors: • Parent’s divorce • Father’s death • Violence by step mother Precipitating factors: • Psychological; Grief related to loss of son and brother • Husband’s extra marital affairs and violence stressor: Situational stressor Appraisal of stressor: • COGNITIVE: life is so miserable • AFFECTIVE: depressed • PHYSIOLOGICAL: drowsy, dizziness, fatigue • BEHAVIORAL: suicidal attempts Coping strategies: NEGATIVE COPING ; SOCIAL AVOIDANCE AND SUICIDAL ATTEMPTS
- 5. LOSS AND GRIEF 5 • This theory was introduced by Swiss-American psychiatrist Elisabeth Kübler-Ross in her 1969 book On Death and Dying. • It describes a series of emotions experienced by people who are grieving. • Kübler-Ross makes it clear that the stages are non-linear – people can experience these aspects of grief at different times and they do not happen in one particular order. KUBLER ROSS THEORY OF LOSS ANDGRIEF Grief is a natural emotional response to loss. “The more significant the loss, the more intense the grief is likely to be”. It might be the loss of a loved one, relationship, pregnancy, job or way of life. LOSS ANDGRIEF (Kristen Rogers, 2022)
- 6. LOSS AND GRIEF 6 The stages, popularly known by the acronym DABDA, include
- 7. LOSS AND GRIEF 7 DENIAL • Feeling numb is common in the early days after a bereavement. • Some people at first carry on as if nothing has happened. Even if we know with our heads that someone has died it can be hard to believe that someone important is not coming back. • “Don’t be ridiculous, it’s not true.” ANGER • Anger is a completely natural emotion, and very natural after someone dies. • Death can seem cruel and unfair, especially when you feel someone has died before their time or you had plans for the future together. • It’s also common to feel angry towards the person who has died, or angry at ourselves for things we did or didn’t do before their death. • “Why did it happen to me? God, isn’t it fair?” (Kristen Rogers, 2022)
- 8. LOSS AND GRIEF 8 BARGAINING • Bargaining is when we start to make deals with ourselves, or perhaps with God. • We want to believe that if we act in particular ways we will feel better • “I would do anything if he would just wake up.” DEPRESSION • In this stage, we begin to realize and feel the true extent of the death or loss. • Common signs of depression in this stage include trouble sleeping, poor appetite, fatigue, lack of energy, crying spells, feel lonely, isolated, empty, lost, and anxious • “He really left me, and I don’t want to live without him ……” (Kristen Rogers, 2022)
- 9. LOSS AND GRIEF 9 ACCEPTANCE • Gradually most people find that the pain eases, and it is possible to accept what has happened. • We may never ‘get over’ the death of someone precious, but we can learn to live again, while keeping the memories of those we have lost close to us. • “Now that it has happened this way, life must go on!” (Kristen Rogers, 2022)
- 10. LOSS AND GRIEF 10 POSITIVE COPINGSTRATEGIES IN LOSSANDGRIEF: • Positive reframing; “looking at bright side” (focus on good memories) • Setting goals; specific tasks (moving to a new place) • Meditation • Expressing feelings out loud or in a journal • Keep up a normal routine. • Getting plenty of rest • Starting psychotherapy • Reconnecting with family & friends. (Jacquelyn Johnson, 2021)
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- 12. LOSS AND GRIEF 12 • “Severe grief in response to the death of a close friend or family member is associated with a variety of physical and mental disorders as well as with persistent depressive symptoms.” (Cathaleene Macias, et al, 2010). • Factors expected to influence grief duration The four situational factors hypothesized to complicate grief: 1. Sharing a residence 2. The suddenness of death 3. The lack of social support 4. The co-occurrence of other stressors BEREAVEMENT IN THE CONTEXT OF SERIOUS MENTAL ILLNESS Cathaleene Macias, et al.(2010). “Bereavement in the Context of Serious Mental Illness”. Psychiatr Serv; 55(4): 421-425. DOI: 10.1176/appi.ps.55.4.421
- 13. LOSS AND GRIEF 13 Melinda Smith, M.A., Lawrence Robinson, and Jeanne Segal, Ph.D. (2022). “Coping with Grief and Loss”. HelpGuide. COPINGWITH GRIEF AND LOSS Myth: It’s important to “be strong” in the face of loss. Fact: Feeling sad, frightened, or lonely is a normal reaction to loss. Crying doesn’t mean you are weak. You don’t need to “protect” your family or friends by putting on a brave front. Showing your true feelings can help them and you. Myth: If you don’t cry, it means you aren’t sorry about the loss. Fact: Crying is a normal response to sadness, but it’s not the only one. Those who don’t cry may feel the pain just as deeply as others. They may simply have other ways of showing it. Myth: Grieving should last about a year. Fact: There is no specific time frame for grieving. How long it takes differs from person to person.
- 14. LOSS AND GRIEF 14 The psychology of grief – applying cognitive and behavior therapy principles. (2011). InPsych; Vol 33, Issue 6. COGNITIVE BEHAVIORAL THERAPY FOR GRIEVER: A CBT approach focuses on griever's thoughts and behavior, not only about the death itself, but also about building a new life without the deceased. The goal of CBT is to help the bereaved reconcile the death of their loved one. THE PSYCHOLOGY OF GRIEF-APPLYINGCOGNITIVE ANDBEHAVIORTHERAPY PRINICIPLES CBT STRATEGIES: • Provide information about grief and what to expect • Encourage identification of thoughts leading to feelings of guilt and anger • Prepare to face new or difficult situations • Promote self-care activities • Increase pleasant events
- 15. LOSS AND GRIEF 15 NURSING CARE PLAN
- 16. ASSESSMENT NURSING DIAGNOSIS PLANNING IMPLEMENTATION EVALUATION OBJECTIVE DATA: • Crying • Despair • Loneliness • Unable to perform ADLs. Loss and grief related to loss of love ones as evidenced by patient’s behavior and expression of emotions. SHORT TERM GOAL: the patient will be able to identify and express feelings in an appropriate manner within 5-7 days. LONG TERM GOAL: The patient will be able to identify and express feelings in an appropriate manner and continue ADLs as normal by the time of discharge.. • Encourage the expression of feelings to support client. • Provide continue support in the form of therapeutic communication. The patient is able to identify and express feelings in an appropriate manner. LOSS AND GRIEF 16
- 17. ASSESSMENT NURSING DIAGNOSIS PLANNING IMPLEMENTATION EVALUATION SUBJECTIVE DATA: “kisi se baat karne ko dil nahi chahta, bs chup rehna chahti” OBJECTIVE DATA: • Staying alone • Not interested in group talks • No friend Social isolation related to anhedonia as evidenced by staying alone in room. SHORT TERM GOAL: Client will involve in gatherings/group talks within 1 week. LONG TERM GOAL: Client will voluntarily spent time with other clients and staff within 2-3 weeks, and also with family by the time of discharge. • Show unconditioned positive regard. • Convey an accepting attitude by talking to client and listening to the client. Client involve in group talks within 3-4 days. LOSS AND GRIEF 17
- 18. LOSS AND GRIEF 18 REFERENCES • Cathaleene Macias, et al.(2010). “Bereavement in the Context of Serious Mental Illness”. Psychiatr Serv; 55(4): 421-425. DOI: 10.1176/appi.ps.55.4.421 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2759894/ • Melinda Smith, M.A., Lawrence Robinson, and Jeanne Segal, Ph.D. (2022). “Coping with Grief and Loss”. HelpGuide. https://www.helpguide.org/articles/grief/coping-with-grief-and-loss.htm • The psychology of grief – applying cognitive and behavior therapy principles. (2011). InPsych; Vol 33, Issue 6 https://psychology.org.au/for-members/publications/inpsych/2011/dec/the-psychology-of-grief-applying- cognitive-and- b#:~:text=Grief%20can%20be%20described%20as,be%20with%20that%20person%20again. • Kristen Rogers. (2022). “5 stages of grief, and how to get through them”. Mindfulness CNN. https://edition.cnn.com/2021/09/12/health/five-stages-of-grief-kubler-ross-meaning- wellness/index.html#:~:text=A%20Swiss%20American%20psychiatrist%20and,%2C%20bargaining%2C %20depression%20and%20acceptance. • Jacquelyn Johnson. (2021). “6 coping skills to work through grief”. PsychCentral. https://psychcentral.com/health/coping-skills-for-grief#coping-skills-vs-defense-mechanisms
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