Milestone Exam 2 Blueprint NSG221

NSG221.04.02.04 Grief therapeutic response - Therapeutic relationship and therapeutic communication skills (active listening) - Attentive presence, open body language (eye contact, facing client), assure confidentiality, refrain from judging or giving specific advice, allow client to share thoughts and feelings freely Dimensions (Responses) and Symptoms of the Grieving Client Cognitive responses Disruption of assumptions and beliefs Questioning and trying to make sense of the loss Attempting to keep the lost one present Believing in an afterlife and as though the lost one is a guide Emotional responses Anger, sadness, anxiety Resentment Guilt Feeling numb Vacillating emotions Profound sorrow, loneliness Intense desire to restore bond with lost one or object Depression, apathy, despair during phase of disorganization Sense of independence and confidence as phase of reorganization evolves Spiritual responses Disillusioned and angry with God Anguish of abandonment or perceived abandonment Hopelessness, meaninglessness Behavioral responses Functioning “automatically” Tearful sobbing, uncontrollable crying Great restlessness, searching behaviors Irritability and hostility Seeking and avoiding places and activities shared with lost one Keeping valuables of lost one while wanting to discard them Possibly abusing drugs or alcohol Possible suicidal or homicidal gestures or attempts Seeking activity and personal reflection during phase of reorganization Physiologic responses Headaches, insomnia Impaired appetite, weight loss Lack of energy Palpitations, indigestion Changes in immune and endocrine systems - It is essential to remember that the grieving response is individual. There is no one right way to grieve. It is a dynamic process, not an orderly progression through easily identifiable stages. - Exploring the client’s perception and meaning of the loss is a first step that can help alleviate the pain of what some would call the initial emotional overload in grieving. It is particularly important that the nurse listens to whatever emotions the person expresses, even if the nurse doesn’t “agree” with the feelings. The nurse needs to encourage the person to express any and all feelings without trying to calm or placate them. - When loss occurs, especially if it is sudden and without warning, the cognitive defense mechanism of denial acts as a cushion to soften the effects. - Intervention involves giving the client the opportunity to compare and contrast ways in which he or she has coped with significant loss in the past and helping him or her review strengths and renew a sense of personal power. - Encouraging the client to care for him or herself is another intervention that helps the client cope. Being careful to eat, sleep well, exercise, and take time for comforting activities are ways that the client can nourish him or herself. Going back to a routine of work or focusing on other members of the family may provide that respite. - The client trusts that the nurse will have what it takes to assist him or her in grieving. In addition to previously mentioned skills, these tools include: o Using simple nonjudgmental statements to acknowledge loss: “I want you to know I’m thinking of you.” o Referring to a loved one or object of loss by name (if acceptable in the client’s culture). o Remembering words are not always necessary; a light touch on the elbow, shoulder, or hand or just being there indicates caring. o Respecting the client’s unique process of grieving. o Respecting the client’s personal beliefs. o Being honest, dependable, consistent, and worthy of the client’s trust. Nursing Interventions •Explore client’s perception and meaning of his or her loss. •Allow adaptive denial. •Encourage or assist the client in reaching out for and accepting support. •Encourage client to examine patterns of coping in past and present situation of loss. •Encourage client to review personal strengths and personal power. •Encourage client to care for him or herself. •Offer client food without pressure to eat. •Use effective communication: •Offer presence and give broad openings. •Use open-ended questions. •Encourage description. •Share observations. •Use reflection. •Seek validation of perceptions. •Provide information. •Voice doubt. •Use focusing. •Attempt to translate into feelings or verbalize the implied. •Establish rapport and maintain interpersonal skills such as •Attentive presence. •Respect for client’s unique grieving process. •Respect for client’s personal beliefs. •Being trustworthy: honest, dependable, consistent. •Periodic self-inventory of attitudes and issues related to loss.