After studying Module 7: Lecture Materials & Resources, discuss the following: Grief: define and describe the physical symptoms, psychological and social responses and

29 Nov After studying Module 7: Lecture Materials & Resources, discuss the following: Grief: define and describe the physical symptoms, psychological and social responses and

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After studying Module 7: Lecture Materials & Resources, discuss the following:

Grief: define and describe the physical symptoms, psychological and social responses and its spiritual aspects.
Summarize the types of grief.
Although death is a universal human experience, please specify culture-specific considerations that exist regarding attitudes toward the loss of a loved one, including age (child or older adult) and cause of death.

Submission Instructions:

Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.

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Meiner, S. E., & Yeager, J. J. (2019).
- Chapter 26
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- Chapter 27
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- Chapter 28
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- Chapter 29
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Chapter 27

Chronic Illness and Rehabilitation

Chronic disease affects physical, psychologic, and social aspects of lives of individuals and families.

Many with chronic illness become homebound; decreased outside contact leads to social isolation.

Chronic disease is the leading cause of death and disability in the United States.

Chronic Disease

Disease refers to a condition viewed from a pathophysiologic model, such as an alteration in structure and function; it is a physical dysfunction of the body.

Illness is what the individual (and family) are experiencing, how the disease is perceived, lived with, and responded to by individuals and families.

Disease vs. Illness

Noncommunicable illnesses that are prolonged in duration, do not resolve spontaneously, and are rarely cured completely (Bernall & Howard, 2016)

Nurses need to consider the illness related issues that the patient and family experiences.

Understanding the perception of and response to the disease will allow for a more individualized plan of care.

Chronic Disease Defined

Increase in chronic conditions is caused by: Lifesaving and life-extending technologies not previously available, increase in population of older adults, and increasing life expectancy

The health care system applies the “acute care model” to those individuals with chronic conditions, and as a result, the needs of older adults and what the system can provide do not match.

This results in fragmented care, inadequate or inappropriate care from the system, and dissatisfaction on the part of the patient.

Chronic Conditions

The State of Aging and Health in America (CDC, 2013) reports two out of three older Americans have multiple chronic diseases and account for 66% of the health care budget.

Nursing care needs to focus on increasing functional ability, preventing complications, promoting the highest quality of life, and, when the end stage of life occurs, providing comfort and dignity in dying.

Prevalence of Chronic Illness

Include hypertension, hyperlipidemia, heart disease, arthritis, diabetes, chronic kidney disease, ischemic heart disease, dementia, depression, and chronic obstructive pulmonary disease.

Repeated hospitalizations are common to treat exacerbations of heart disease, cancer, pneumonia, and stroke.

Women are hospitalized for injuries like hip fractures.

Most Frequently Occurring Chronic Diseases

Course of a chronic illness varies from one individual to another.

Variables that impact the disease include: socioeconomic factors, psychosocial factors, culture, and other contributing comorbid disease or illness

Older adults often view themselves as “well”; their disease is only one component of their life and not their identity.

Chronic Illness Experience

Concepts of health and illness are deeply rooted in culture, race, and ethnicity and influence an individual’s (and family’s) illness perceptions and health and illness behavior.

30% of the population is racially and ethnically diverse.

Nursing frameworks assist health care providers in providing culturally competent care.

Cultural Competency

Multiple definitions for quality of life exist most include physical, psychological, and social components; disease and treatment-related symptoms; and spirituality.

QOL is determined by the individual, not the health care provider.

Health-related quality of life (HRQOL) is a multi-dimensional concept used along with well-being to measure the impact of chronic illness, the treatments, and the corresponding related disabilities.

Quality of Life

Adherence is how well the patient manages the treatment plan.

Use of the five A’s to assist patients with the self-management aspects of their chronic disease: assess, advise, agree, assist, and arrange.

Also important to (1) advise the patient of the importance of the treatment plan, (2) establish agreement with the treatment plan, and (3) arrange adequate follow-up

Adherence in Chronic Illness

Understanding the relationship between the older adult’s social, psychologic, and physiologic needs is important for health care providers.

Adaptation to chronic illness: three frameworks for practice demonstrate the importance of controlling symptoms, managing the trajectory of the disease process, and engaging the patient in self-care

Discussed on next slides

Psychosocial Needs of Older Adults With Chronic Illness

Issues and concerns framework—examines the psychosocial needs of patients VS their physical needs

Trajectory framework—the illness trajectory is set in motion by the pathology of the patient, but the actions taken by the health care providers, patient, and family may modify the course.

Chronic Care Model—assists with the management of multiple chronic diseases and improve outcomes by providing a method of care coordination to improve patient self-care

Chronic Illness and Quality of Life

Powerlessness

Stigma

Social isolation

Chronic Illness Experience

Is educating and providing a treatment plan that allows the patient to be in charge of the management of the chronic illness and have open communication with health care providers

Nurse should guide, educate, and support older adults and their families in developing positive coping strategies.

The nurse serves as a resource for older adults and their families in solving care management problems.

The Chronic Care Model

Pain is a major issue.

Fatigue may be difficult to manage.

Immobility and activity intolerance predictor of ability to maintain or recover wellness

Sexual activity can be affected by many aspects of chronic illness.

Physiologic Needs of the Chronically Ill

Situational factors related to caring for adults with chronic illnesses contribute to caregiver stress.

Role strain—balancing the role as primary caregiver with other roles within the family network

Female caregivers experience a greater sense of burden and stress than male caregivers.

Caregivers’ Stress

Providing care not only to the patient but also to the caregiver

Get to know the caregiver

Provide information about the illness

Reassure the caregiver that feelings of frustration or helplessness are not unusual reactions

Referral to social worker

Respite services

Nursing Implications of Caregiver Stress

Rehabilitation: services and programs designed to assist individuals who have experienced trauma or illness that results in impairment that creates a loss of function, which can be physical, psychologic, social, or vocational

Gerontologic rehabilitation nursing is a specialty practice that focuses on restoring and maintaining optimal function while considering holistically the unique effects of aging on the person.

Rehabilitation

You are a nurse caring for a patient with several chronic illnesses and who lives with a daughter. Discuss some of the ways the nurse can assist the patient and daughter to adapt the their illness and improve their health outcomes.

Quick Quiz!

Answers will vary

Answer to Quick Quiz

Goal: maintain or improve function

Activities older adults enjoy can be incorporated into exercise and endurance training.

Helps with chronic illness and disease prevention

Endurance training, strength training, balance exercises, and flexibility exercises are important exercises for older adults.

Enhancement of Fitness and Function

Function is a useful measure in the diagnosis of illness and self-care deficits.

Functional independence measure (FIM) measures abilities in six areas: self-care, sphincter control, transfers, locomotion, communication, and social cognition.

Establishing a patient’s baseline level of functioning helps identify the patient’s strengths and rehabilitation potential.

Functional Assessment

First check mental status

Conduct specific assessments based on the degree of potential or actual disability

Ask what they can do VS cannot do

Safety screening for self-care limitations

Consider values and beliefs about quality of life

Completing a Functional Assessment

Within rehabilitation allows older adults to achieve a maximum level of functioning and increase longevity

In chronic illness involves behavioral change for positive lifestyle activities, accepting one’s condition and making the necessary adjustments, decreasing the risk of secondary disabilities, and preventing further disease, all while striving for optimal health

Health Promotion

A person with a chronic illness or disability finds taking health or ability for granted is no longer possible.

Older adults must reorganize their lives to enhance functional ability and rehabilitation.

The nurse may assist older adults with organization and maximize financial resources.

Life Issues

Nurses assist patients in setting and achieving goals that facilitate reintegration to former environments.

Improving range of motion

Improving endurance and tolerance for activity

Restoring functional ability to an acceptable level

Improving ambulation (if appropriate)

Maintaining safety

Goals must be the patient’s goals, not the health care provider’s goals of care.

Nursing Strategies

Chapter 29

Loss and End-of-Life Issues

Employment to retirement

Lifelong home to a smaller home or senior apartment

Very active to being less so

Health to chronic illness

Marriage to widowhood

Extensive social networks to smaller circles of family and friends

Losses Associated With Aging

Successful aging requires learning to deal with losses and adapting to changes over time

Loss: broad term that connotes losing or being deprived of something such as one’s health, home, or a relationship

Bereavement: the state or situation of having experienced a death-related loss

Grief: one’s psychologic, physical, behavioral, social, and spiritual reactions to loss

Mourning: used to refer to ritualistic behaviors in which people engage during bereavement

Definitions

Life transitions such as retirement, ill health, and death of loved ones evoke varying responses of grief.

Many older adults experience multiple losses with little time for grieving between losses.

Individual coping styles, support systems, ability to maintain a sense of control, griever’s health status, and spiritual beliefs all influence responses to multiple losses.

Response to Multiple Losses

Bereavement includes grief and mourning.

Death of a spouse is most significant loss.

Surviving spouses must take on new responsibilities while coping with the loss.

Perceived social support after death of a spouse has been shown to be a factor affecting adjustment of many surviving spouses.

Other factors: ambivalent or dependent relationships, mental illness, low self-esteem, and multiple prior bereavements

Bereavement

Bereavement adjustments are multidimensional.

It is a highly stressful process.

The overall effect on the physical and mental health is not as devastating as expected.

Older bereaved spouses commonly experience both positive and negative feelings simultaneously.

Loneliness and problems with the tasks of daily living are two of the most common and difficult adjustments.

The process is most difficult in the first several months.

Much diversity in how older adults adjust to the death of a spouse

Bereavement Experiences of Older Persons

Early phase: shock, disbelief, and denial

Middle phase: intense emotional pain and separation often accompanied by physical symptoms and labile emotions

Last phase: reintegration and relief occur as the pain gradually subsides and a degree of physical and mental balance returns

Phases of Normal Grief Reactions

Tearfulness, crying, loss of appetite

Feelings of hollowness in the stomach, decreased energy, fatigue, lethargy, and sleep difficulties

Tension, weight loss or gain, sighing, feeling something stuck in one’s throat, tightness in one’s chest or throat

Heart palpitations, restlessness, shortness of breath, dry mouth

Physical Symptoms of Grief

Feelings of sadness, guilt, anxiety, anger, depression, apathy, helplessness, and loneliness

Diminished self-concern, a preoccupation with the deceased, and a yearning for their presence

Some become confused and unable to concentrate

Grief spasms, periods of acute grief, may come when least expected.

Psychological Responses of Grief

Depends on the type of relationship and the definition of social roles within the relationship

Bereaved person must often learn new skills and roles to manage tasks of daily living.

Socialization and interaction patterns also change.

LGBT partners grieve differently because of previous experiences with discrimination.

Social Responses of Grief

Examination of meaning of life

Religion and spirituality can provide a stabilizing influence during grief.

Anger at God, sometimes followed by a crisis of faith and meaning, may accompany bereavement.

Gender, social class, ethnicity, and culture may influence one’s spiritual response to grief.

Spiritual Aspects of Grief

Anticipatory grief: grieving that occurs before actual loss

Disenfranchised grief: grief that is not validated or recognized by others

Complicated grief: four types

Chronic grief reactions

Delayed or postponed grief reactions

Exaggerated grief reactions

Masked grief reactions

Types of Grief

Ritualistic activities such as wearing dark clothes during bereavement or lighting candles for the dead

Processes related to learning how to live with one’s loss and grief

Mourning

Accept the reality of the loss—realize the person is dead

Experience or work through the pain of grief—prevents physical manifestations of pain

Adjust to an environment in which the deceased is missing—assuming roles that the deceased was responsible for

Emotionally relocate the deceased and move on with life—removing the emotional attachment

Four Tasks of Mourning

The meaning of a loss to a bereaved person has a significant effect on his or her responses to that loss.

Caregivers should explore the perceptions of the bereaved to understand and assist them as they mourn their loss.

The bereaved are encouraged to find or create new meaning in their lives and in the deaths of the deceased.

Meaning Making

Assist and support bereaved persons through the grieving process

Recognize that pain is a normal and healthy response to loss

Allow bereaved persons to accomplish the tasks of mourning in their own ways

Nursing Care

Simple tool to assess progress in bereavement is the 10-Mile Mourning Bridge (Worden,1991)

On the bridge, the 0 represents the time before grief; 10 reflects Worden’s last stage, where patients recover the emotional energy consumed by grieving and reinvest it in their own lives.

Nursing Assessment

Help the survivor actualize the loss, identify, and express his or her feelings.

Assist the survivor in living without the deceased

Facilitate the survivor’s emotional withdrawal from the deceased.

Provide the survivor with time to grieve.

Interpret “normal” behavior for the survivor.

Allow for individual survivor differences.

Provide continuing support for the survivor.

Examine the survivor’s defenses and coping styles.

Identify pathologic conditions and make appropriate referrals.

Principles of Grief Counseling

Used to facilitate successful progression through the grief process

Grief counseling is used to facilitate successful progression through the grief process—nurses may provide

Grief therapy is intended for those who are experiencing complicated mourning—skilled therapist necessary

Grief

Help the survivor actualize the loss.

Help the survivor identify and express feelings.

Assist the survivor in living without the deceased.

Facilitate the survivor’s emotional withdrawal from the deceased.

Give the survivor time to grieve.

Interpret “normal” behavior for the survivor.

Allow for individual survivor differences.

Worden’s Grief Counseling Principles (1 of 2)

Provide continuing support for the survivor.

Examine the survivor’s defenses and coping styles.

Identify pathologic conditions, make appropriate referrals.

Worden’s Grief Counseling Principles (2 of 2)

An older adult has moved through all the phases of grief when which of the following has occurred?

The patient cries every day for the deceased spouse.

The patient talks about the spouse as if the deceased is still in the hospital.

The patient takes on the daily chores of cooking and cleaning the house.

The patient talks about the spouse in the past tense.

Quick Quiz!

ANS: D

Answer to Quick Quiz

Major concerns are fears of a long debilitating illness, fears of being a burden, pain and suffering, quality of life, and fear of dying suddenly and not being found.

A person who has had positive experiences of coping and is relatively well adjusted usually approaches the stress of being close to death with adaptation and acceptance

Life review: process where one tries to make sense of life as a whole

Approaching Death: Psychologic Aspects

Religious beliefs and spiritual experiences play an important part when older persons make sense of their lives.

Dying or a threat of loss can trigger a crisis of faith, in which people question their previous beliefs in an effort to make sense of the present experience.

Assessing patients’ desires for religious and spiritual assistance is particularly important when they are dying.

Approaching Death: Spiritual Aspects

Adoption of the sick role may be accompanied by an acceptance of one’s fate.

Dying individuals may adopt a fighting stance, determined to do all they can to forestall death

The stance people take toward dying is affected by sociocultural, psychologic, and life history factors.

Death and dying have been regarded as taboo topics in American society.<

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29 Nov After studying Module 7: Lecture Materials & Resources, discuss the following: Grief: define and describe the physical symptoms, psychological and social responses and

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