N109: Foundations in Nursing Practice

N109: Foundations in Nursing Practice Study Guide • Anger: During this stage, the grieving person may become angry at the person who inflicted the hurt or at the world or God for letting it happen. He may be angry with himself for letting the event take place, even if nothing could have stopped it. • Bargaining: In the bargaining stage, the grieving person may make bargains with God, asking, “If I do this, will you take away the loss?” • Depression: During this stage, the person feels numb, although anger and sadness may remain. An individual may be in this stage for a long period of time. • Acceptance: When an individual reaches the acceptance stage, anger and sadness have diminished and the person simply accepts the reality of the loss. George Engel Father of the biopsychosocial model of healthcare, George Engel described five stages of grieving: • Shock and disbelief: A stunned and numb feeling is the initial reaction to a loss. This feeling is often accompanied by a refusal to acknowledge the loss. • Developing awareness: In this stage, the individual begins to acknowledge the loss and may feel helpless and angry at the loss. • Restitution: During the restitution stage, the individual may participate in the rituals associated with death, including rituals associated with his religion. These rituals may help the individual begin to accept the reality of the loss. • Resolution: During this stage, the individual may be preoccupied with the loss and will often idealize the person, object, or skill that has been lost. • Recovery: In the recovery stage, the preoccupation ends and the individual goes on with life while accepting the loss. Therese Rando Researcher and psychologist Therese Rando also has contributed a stage model of the grief process that she observed people to experience while adjusting to significant loss. She called her model the “Six R’s”: • Recognize the loss: First, the individual must experience the loss and understand that it has happened. • React: In this stage, the individual reacts emotionally to his loss. • Recollect and re-experience: The individual may review memories of the lost relationship or skill. • Relinquish: In this stage, the individual begins to put the loss behind him, realizing and accepting that the world has truly changed and that there is no turning back. • Readjust: The grieving person begins the process of returning to daily life and the loss starts to feel less acute and sharp. • Reinvest: Ultimately, the individual re-enters the world, forming new relationships and commitments. He accepts the changes that have occurred and moves past them.

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