N109: Foundations in Nursing Practice

N109: Foundations in Nursing Practice Study Guide concentrating. Signs and symptoms of dysfunctional grief, on the other hand, include an extended time of denial, severe physiological symptoms, depression, and suicidal thoughts. Grief responses can be categorized by type: • Normal grief: Normal grief is found in the majority of survivors and is described as grief that is eventually lessened as a person readjusts to his loss. This is done with support as one moves through the phases of the grief process. • Abbreviated grief: Abbreviated grief is genuine, but brief. • Anticipatory grief: Anticipatory grief occurs prior to the actual loss as an individual prepares for and grieves the loss to come. • Delayed grief: Delayed grief may represent the intentional postponement of grief. This delay may be related to other life events or losses that drain an individual’s ability to work through the grief process. • Disenfranchised grief: Disenfranchised grief often occurs when a grieving individual cannot openly acknowledge his grief, or is one that society does not accept as real. For example, disenfranchised grief might be losses related to AIDS, miscarriage, or loss of a homosexual partner. • Exaggerated grief: Exaggerated grief is an intense reaction to the loss that may include nightmares, delinquent behaviors, phobias (abnormal fears), and thoughts of suicide. • Unresolved grief: In unresolved grief, the grieving person has trouble finding closure and returning to normal activities over an extended amount of time. • Inhibited grief: Inhibited grief is an unhealthy reaction that occurs when an individual denies or does not acknowledge a loss and suppresses many of the normal symptoms. 4.3 Theories of Loss and Grieving Several major theorists have studied and identified stages of grieving after loss. It is helpful for the nurse to understand these various theories in order to intervene if necessary. Physical reactions to grief may include shortness of breath, heart palpitations, sweating, dizziness, loss of energy, sleeplessness or increase in sleep, changes in appetite, or stomach aches. Emotional reactions are as individual as physical reactions. A preoccupation with the image of the deceased, feelings of fear, hostility, apathy, emptiness, fear of one’s own death, depression, diminished sex drive, sadness, and anger at the deceased may occur. Bereavement may cause short or long-term changes in the family unit. Elisabeth Kubler-Ross Dr. Elisabeth Kubler-Ross identified five stages of grief people go through following a serious loss. Movement through these stages may not be sequential and some individuals fail to make it to the acceptance stage. The role of the nurse is to help the individual understand the stage and deal with the emotions. • Denial: During this stage, the individual may deny the loss has taken place and may withdraw from usual social contacts. This stage may last a few moments or longer.

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