grief & loss and trauma & stressor-related disorders

types of grief

Anticipatory: feeling of sadness prior to the death of a loved one or someone’s own death 

Complicated: lasts for a longer period of time, continues to be severe 

• 6-12 mos 

• Come with symptoms of depression, trauma 

• Factors that make it harder 

Delayed 

• Days, months, hours to take effect 

• Same intensity as other grief 

• No grief in the initial period 

Disenfranchised 

• Stigma around it 

• Substance use, abortion 

• Make the person not want to grief openly 

Prolonged 

• Longer than 6-12 mos 

Unresolved 

• Ongoing or suppressed grief 

types of loss

Tangible 

• Separation from loved one 

• Death of a loved one 

• Loss of body part or function 

• Loss of property 

• Loss of employment 

Intangible 

• Loss of self-worth 

• Loss of memory 

• Loss of role 

• Loss of income 

• Loss of dignity 

• Loss of privacy 

• Loss of freedom 

nursing interventions following loss

• Individual 

• Family: providing comfort measures for the family, making a calm environment (ie turning off alarms) 

• For younger kids, describing that death is permanent 

• Help them find some sort of daily routine 

• No comparisons or how they “should act” 

trauma exposure

ACE’s

trauma exposure

• Sleep disturbance 

• Nightmares 

• Mood changes 

• Substance use 

• Somatic symptoms 

• Poor concentration 

• Aggression 

• Homicidal ideation 

• Suicidal ideation 

• Self-harm 

• Social isolation 

• Anhedonia 

Characteristics of various trauma and stressor-related disorders 

Acute stress disorder: 9+ PTSD symptoms, symptoms present from 3 days to 1 mo after event 

Post-traumatic stress disorder: symptoms last over a month; exposure to actual or threatened death, serious injury, or serious violence 

• Symptom clusters: 

• Intrusive (1+) 

• Avoidant (1+) 

• Cognitive & mood (2+) 

• Hyperarousal (2+) 

Adjustment disorder: emotional or behavioral symptoms happening within 3 mos of an identifiable stressor; common in acute settings; symptoms last less than 6mos after stressor 

• Specifiers: 

• Depressed mood 

• Anxiety 

• Mixed anxiety and depressed mood 

• Disturbance of conduct 

• Mixed disturbance of emotions and conduct 

• unspecified 

Prolonged grief disorder 

• Timeline, duration, trauma 

• Same treatment 

nursing interventions

• Therapeutic communication 

• Adjust environmental stimuli 

• Teach and practice healthy coping skills 

• Encourage problem-solving 

• Avoid punishing maladaptive coping skills 

• Model appropriate social interactions 

• Model appropriate emotional expression 

psychotherapy

Individual 

• TF-CBT 

• Prolonged exposure 

• EMDR (eye movement desensitization and reprocessing) 

• Art, music, drama therapy 

• Mindfulness 

Family 

• Group (support group)