N109: Foundations in Nursing Practice

N109: Foundations in Nursing Practice Study Guide

Catherine Sanders Catherine Sanders’ integrative theory of bereavement emphasizes the idea that the individual has choices during the grieving process. The five stages of this theory include: • Shock: The individual may experience initial confusion, disbelief, restlessness, and a state of high alert. • Awareness of loss: In the second stage, the individual will experience stress, feelings of conflict, and separation anxiety. • Conservation-withdrawal: In this stage, despair, withdrawal, and helplessness will be the primary emotions. • Healing: The fourth stage brings a sense of a turning point, rebuilding identity, and relinquishing roles. • Renewal: In the final stage, the individual experiences a new sense of freedom, awareness, and learning to live without the person or skill. Martocchio Martocchio described five stages of grief that very closely resemble the stages described by Kubler- Ross. In Martocchio’s model, the grieving process is very individualized and an individual may progress and regress through the stages depending on external forces. The five stages identified by Martocchio are: • Shock and disbelief • Yearning and protest • Anguish, disorganization, and despair • Identification • Reorganization and restitution 4.4 Factors Influencing End of Life Care and the Grief Response Age/Developmental Level Children go from no intellectual understanding of death as infants and toddlers to realizing it is inevitable as older, school-age children. Adolescents feel invincible, while young adults perceive death as a future event. Middle-age adults accept their mortality but often find the thought of death frightening. Older adults will most likely have some experience in dealing with death and dying. Death of a loved one is typically better understood by an older individual. Significance of the Loss When a young person dies, the intensity of the grief response will likely be more intense, particularly if the death is unexpected and sudden. The grief response is also dependent on the relationship of the individual with the dying person. If the dying individual is a major source of support for the person, it can be expected that the grief response will be more intense for that individual as well. The significance of the loss of a person or object, and the level of change required by the individual, will make a difference as well.

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