Greif and Loss
- The nurses role is to simply support them while in the loss process
Disenfranchised Greif
- Grief that cannot be spoken of because something happened
- If they feel like they cannot talk about it (abortion or death row)
Complicated Grief
- Any response that is outside the normal grieving process
- Previously having a psychiatric disorder
- Most pts do not like change, so change is hard for some pts
o Low self-esteem
o Unhealthy attachment to deathbed person
- Sudden unexpected death (suicide or homicide)
- Can use immune system problems
- Avoid all reminders of them OR they over surround themselves with TONS of stuff to remind them of deathbed person
Assessment
Human response observation
1. Cognitive
2. Emotional
3. Spiritual
o Values and beliefs
4. Behavioral
o Are they just going through the motion?
5. Physiological
o Are they having SLEEP ISSUES? Weight loss or decreased appetite? All physical stuff
o Pg. 164 and 165 charts on psych book
Three critical components
1. Perception
o Money perception and how they support their family
2. Support
o Ask about friends and family situation OR if they’ve delt with previous losses
3. Coping
o What will help them cope? Have they coped before?
Care for the grieving patient
Anticipated vs. actual loss
Help develop plan for coping with loss
Encourage professional help as needed
Self-awareness inventory
Ongoing self-evaluation
Mood Disorders (affective disorder)
- Interferes with everything these people try and do.
- Bipolar disorder
o Bipolar 1:
o Bipolar 2:
- Rapid cycling is manic episodes with depression every day
Related disorders
- Persistent depressive disorder
o Not as intense
- Disruptive mood dysregulation disorder
- Cyclothymic disorder
- Substance-induced depressive or bipolar disorder
o From people who get drunk
- Seasonal affective disorder
o Seasonal depression
o Weight gain and weight loss
o Fall and spring
- Postpartum blues/depression/psychosis
o Baby blues, moms get sad/ medicated/ thinking about harming self or baby
- Premenstrual dysphoric disorder
o Severe form of PMS
, - Self-injury
o Self-harm or self-mutilation. Cut or burn themselves. Can be from a ton of different things
Etiology
Biologic theories
- Genetics- you have twice the risk from immediate family
o Bipolar has 10 times the risk if mother or father has it
- Neurochemical theories
o Neurotransmitters that help are serotonin and norepinephrine
- Neuroendocrine influences
o Treat endocrine first then take care of behavior issues
Psychodynamic theories
- Self deprecation
- Ego victimized by the superego
- Mania as defense against underlying depression
- Depression as reaction to life experience
- Rejecting or unloving parents
- Cognitive distortions
Cultural Considerations
Hamilton Rating Scale for Depression (standards tool and rating scale for depression)
- Found reliable for symptoms r/t general depression:
o Depressed mood
o Guilt
o Loss of interests
o Retardation (slowing down)
Longer to answer questions or answering in short
o Suicide
o Psychological anxiety
- Somatic complaints
Major depressive disorder
- Sad mood or lack of interest in life
- Weight loss or weight gain
- Sleep insomnia (or sleep disorders)
- Lasts 2 weeks or more
- More common in women (twice as much)
o Goes down in women and up in men as age on
- Incidence changes with age
- Recurrent and chronic episodes
Psychopharmacology
Antidepressants (Chapter 18 in ati)
- SSRI- most common
- Tricyclic
o Panic, eating, and OCD disorders.
o Used in older people and not as common.
- Atypical
o If SSRIS are too side effecty or don’t help enough
o Can be pills or a type of nasal spray
o To doctors office to use
- MAOI
o Not seen a whole lot of anymore
o Fetal side effects
o Last resort because they have so many side effects and things you CANT eat/do
Other Medical Treatments
Electroconvulsive therapy (ECT)
- Makes the brain recorrect itself by shocking (Seizure like)
- 6 treatments before seeing results
- Not any better results after 15
- Safe during pregnancy
Psychotherapy (combined with medications)
- The nurses role is to simply support them while in the loss process
Disenfranchised Greif
- Grief that cannot be spoken of because something happened
- If they feel like they cannot talk about it (abortion or death row)
Complicated Grief
- Any response that is outside the normal grieving process
- Previously having a psychiatric disorder
- Most pts do not like change, so change is hard for some pts
o Low self-esteem
o Unhealthy attachment to deathbed person
- Sudden unexpected death (suicide or homicide)
- Can use immune system problems
- Avoid all reminders of them OR they over surround themselves with TONS of stuff to remind them of deathbed person
Assessment
Human response observation
1. Cognitive
2. Emotional
3. Spiritual
o Values and beliefs
4. Behavioral
o Are they just going through the motion?
5. Physiological
o Are they having SLEEP ISSUES? Weight loss or decreased appetite? All physical stuff
o Pg. 164 and 165 charts on psych book
Three critical components
1. Perception
o Money perception and how they support their family
2. Support
o Ask about friends and family situation OR if they’ve delt with previous losses
3. Coping
o What will help them cope? Have they coped before?
Care for the grieving patient
Anticipated vs. actual loss
Help develop plan for coping with loss
Encourage professional help as needed
Self-awareness inventory
Ongoing self-evaluation
Mood Disorders (affective disorder)
- Interferes with everything these people try and do.
- Bipolar disorder
o Bipolar 1:
o Bipolar 2:
- Rapid cycling is manic episodes with depression every day
Related disorders
- Persistent depressive disorder
o Not as intense
- Disruptive mood dysregulation disorder
- Cyclothymic disorder
- Substance-induced depressive or bipolar disorder
o From people who get drunk
- Seasonal affective disorder
o Seasonal depression
o Weight gain and weight loss
o Fall and spring
- Postpartum blues/depression/psychosis
o Baby blues, moms get sad/ medicated/ thinking about harming self or baby
- Premenstrual dysphoric disorder
o Severe form of PMS
, - Self-injury
o Self-harm or self-mutilation. Cut or burn themselves. Can be from a ton of different things
Etiology
Biologic theories
- Genetics- you have twice the risk from immediate family
o Bipolar has 10 times the risk if mother or father has it
- Neurochemical theories
o Neurotransmitters that help are serotonin and norepinephrine
- Neuroendocrine influences
o Treat endocrine first then take care of behavior issues
Psychodynamic theories
- Self deprecation
- Ego victimized by the superego
- Mania as defense against underlying depression
- Depression as reaction to life experience
- Rejecting or unloving parents
- Cognitive distortions
Cultural Considerations
Hamilton Rating Scale for Depression (standards tool and rating scale for depression)
- Found reliable for symptoms r/t general depression:
o Depressed mood
o Guilt
o Loss of interests
o Retardation (slowing down)
Longer to answer questions or answering in short
o Suicide
o Psychological anxiety
- Somatic complaints
Major depressive disorder
- Sad mood or lack of interest in life
- Weight loss or weight gain
- Sleep insomnia (or sleep disorders)
- Lasts 2 weeks or more
- More common in women (twice as much)
o Goes down in women and up in men as age on
- Incidence changes with age
- Recurrent and chronic episodes
Psychopharmacology
Antidepressants (Chapter 18 in ati)
- SSRI- most common
- Tricyclic
o Panic, eating, and OCD disorders.
o Used in older people and not as common.
- Atypical
o If SSRIS are too side effecty or don’t help enough
o Can be pills or a type of nasal spray
o To doctors office to use
- MAOI
o Not seen a whole lot of anymore
o Fetal side effects
o Last resort because they have so many side effects and things you CANT eat/do
Other Medical Treatments
Electroconvulsive therapy (ECT)
- Makes the brain recorrect itself by shocking (Seizure like)
- 6 treatments before seeing results
- Not any better results after 15
- Safe during pregnancy
Psychotherapy (combined with medications)
