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Chapter 8
Losses and Endings
20
Nursing
Undergraduate 3
11/23/2013

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Term
loss
Definition
generic term that signifies absence of an object, position, attribute, and ability.
Term
Loss frequency
Definition
Some losses are unfinished.

Others occur simultaneously or sequentially.
Term
Multiple losses
Definition
-over a short period intensify the experience.
-complicate the grieving process and usually take longer to resolve
Term
Death is associated with loss
Definition
signals the end of all that life hold: success, failures, relationships, careers, laughter,, and pain.
Term
Death
Definition
is feared, even in people that believes in afterlife

Fear of pain
Last phase of life unaccompanied
Term
Death support
Definition
help is always available from someone knowledgeable
Term
Fear of Death
Definition
rn are not immune form these fears.
often difficult for rns to balance between their own sensitivity to death and well-being.
Self-awareness about death and dying issues is so important in providing palliative care
Term
Stages of dying
Definition
Denial- "no not me"
Anger - "why me ?"-
unfairness of life,
anger with god
-- lashes out is
not personal attack
Bargaining - "yes but "
- time extension
- consideration
Depression- "yes me but "
mood swings, depression
acceptance- Final thought
-though not everybody reaches this stage
- detach from world
- sense of peace
Term
Palliative Care
Definition
clinical approach designed to improve the quality of life for clients and family coping with a life threatening illness.
- an emerging practice discipline.
Term
Palliative Care requirement
Definition
- life limiting disease with care needs that will go beyond traditional modes of medical intervention,
- may be still receiving active treatment for their disease process to contorl symptoms and improve quality of life.
Term
Palliative Care Strategies
Definition
designed to help client and families understand the dying process as a part of life and to assist terminally ill clients to achieve the best quality of life in the time left to them

- to follow what clients actually want for themselves

- supporting family as resources and as units of care themselves,
-after death, offers grief support for family members.
Term
Palliative care vs. hospice
Definition
palliative care can admit and serve patients still receving curative treament with no time restrictions regarding prognosis.

- Hospice pt must have prognosis of 6 months or less, and cannot be recieving active medical treatment.
Term
lindermann
Definition
- grief can immediate or delayed
-3 components of support
a. open, empathetic communication
b. honesty,
c. tolerance of emotional expression
When grief is absent or exeraggerated. --> pathologic or complicate grief.
Term
Engel's Contributions to grief
Definition
builts on lindemanns' work
3 sequential phases of grief:
a. shock and disbelief
may feel alienated/detached
from normal
b. developing awareness
void created by loss fills
consciousness
loss of energy to accomplish things without having either the
organization capacity or energy to
follow through with related tasks.
c. restitution
adapatation to new life without
the deceased
resurgence of hope
renewed energy to fashion a new
life
Term
Florczak's model of grieving
Definition
individual maintain connections with the absent and the meaning of the experience continually changes
- past is not forgotten
- continuous spiritual connection wiht the deceased
- past experience with the loved one are removen into the fabrice of a person's life in a new form
Term
Acute grief
Definition
Somatic distress- tightness in throat, SOB, empty feeling in abdomen, a sense of heaviness and lack of muscular power, and intense mental pain

- death is untimely,
out of normal sequence,
complicated by stigma,
challenge for the family is greater.


Suicide survivors are at a disadvantage.
overestimate their ability to influence the suicidal behavior or outcome.
-shame or preceived stigma
Term
Anticipatory Grief
Definition
response before the actual death around a family member with degenerative or terminal disorder.
also experienced by a person anticipating his or her death.
Term
Chronic Sorrow
Definition
ill-defined form of grief, occuring while a person is still alive, in relation to a limiting disease, or as an ongoing loss of potential in a loved one.
- intermittent grier process
of neutrality and positive emotions
- inability to achieve closure & discontinuous nature.
-may not be aware that they are griefing
Term
complicated grieving
Definition
a form of grief = distinguished by being unusually intense, significantly longer in duration, or incapacitating,

-a history of complications predispose a person to complicated grief

-symptoms can be absent
death and important losses are not mourned
feelings dont just disappear- reappear in unexpected ways sometimes years later,
Term
grief
Definition
personal emotions and adaptive process a person goes through in recovering from loss
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