Grief, Loss, and Trauma Notes

Grief, Loss, & Trauma - M. Shackelford

Death & Death Anxiety (Page 1)

• Death: The state of permanent and irreversible cessation of all biological functions that sustain an organism's life. It is the end of life and often brings significant emotional reactions in those who are affected by the loss.

• Death Anxiety: This is an emotional response that encompasses feelings of insecurity and anxiety when considering death or dying. It functions as a reminder of one's own mortality, often manifesting in fears regarding the process of dying or the potential of an afterlife.

Grief (Page 1)

• Grief: A complex emotional reaction that follows significant loss, particularly the death of a loved one. Grief can involve a range of emotions, such as sorrow, anger, guilt, and confusion, and can affect one's mental and physical health.

• Types of Grief:

  • Normal/Uncomplicated Grief: The expected and typical emotional response to loss that usually resolves over time.

  • Anticipatory Grief: The grief experienced before the actual loss occurs, often enabling individuals to start the process of letting go.

  • Complicated Grief: An intense and prolonged form of grief that interferes with normal functioning.

  • Delayed/Inhibited Grief: Grief that is suppressed or postponed, leading to delayed emotional responses at later times.

  • Distorted/Exaggerated Grief: A form of grief where the reaction is excessively intense, often overwhelming the individual.

  • Chronic/Prolonged Grief: Extended grief that does not seem to diminish over time and continues to impact daily life.

    • 12 months or longer adult. 6 months for a child

  • Disenfranchised Grief: Grief that is not openly acknowledged or socially supported, often based on societal norms or the context of the relationship.

Uncomplicated Grief (Page 2)

• Response: This refers to a normal, appropriate reaction to loss that fosters adaptation to life after the loss.

• Symptoms:

  • Physical: Manifestations may include headaches, chest pain, palpitations, changes in appetite, and difficulties with sleep.

  • Emotional: Feelings may include persistent sadness, fear, anxiety, and moments of depression.

  • Cognitive: Problems may arise in concentration, leading to confusion, increased irritability, and forgetfulness.

• Timeline: There is a general expectation that some level of acceptance can be reached within six months following a significant loss.

Anticipatory Grief (Page 2)

• Definition: The process of letting go of a loved one or significant object before the actual loss occurs, often involving feelings of mourning in advance.

• Characteristics: This type of grief can happen before a death or loss occurs. It is not exclusively linked to death and may be prolonged if the expected loss is drawn out over time.

Complicated Grief (Page 3)

• Types: Complicated grief can manifest as chronic/prolonged, distorted, or delayed grief reactions.

• Characteristics: This type of grief often occurs unexpectedly or later than would typically be anticipated, sometimes appearing unrelated to the initial loss, marked by an absence of traditional grief symptoms.

• Risk Factors:

  • Overdependence on the deceased individual.

  • Experience of an unexpected or violent death.

  • Inadequate coping mechanisms following loss.

  • Existing mental health conditions that complicate the grieving process.

Prolonged Grief Disorder (Page 3)

• Definition: A mental health condition characterized by persistent distress regarding the deceased, significantly disrupting daily life and exceeding social or cultural norms of mourning.

  • 12 months for adult, 6 months for children

Traumatic Grief and Loss (Page 4)

• Definition: A severe and intense form of separation distress that arises from a sudden, unexpected death of a loved one, often leading to severe emotional turmoil.

• Types of Traumatic Loss:

  • Deaths occurring during military duty.

  • Homicides or suicides.

  • Fatal accidents, disasters, or violent incidents.

• Response: In this situation, individuals may experience heightened emotional responses characterized by feelings of shock, numbness, overwhelming pain, and self-blame.

Coping Strategies (Page 4)

• Types:

  • Problem-focused coping: Strategies aimed at addressing the problem causing distress directly.

  • Active/Emotional coping: Involves engaging with the emotions felt about the loss.

  • Avoidant/Emotional coping: Methods that attempt to deny or avoid consciousness of the emotional impacts of grief.

Interventions (Page 5)

• Grief-Informed Approach: A therapeutic stance that recognizes and validates the client's loss, understanding its impact on their emotional state and life.

• Cognitive Behavioral Therapy (CBT): A form of psychotherapy that emphasizes client-centered care with a focus on encouraging self-reflection and addressing cognitive distortions related to grief.

Assessment (Page 5)

• Components:

  • Comprehensive medical and mental health history evaluation.

  • Physical examination to rule out other potential health concerns.

  • Detailed psychosocial history and cultural considerations.

  • Mental status examination (MSE) to gauge emotional and cognitive functioning.

Analysis of Grief Response (Page 6)

• Important considerations include the elapsed time since the loss, observable distress signals, ability to participate in normal daily activities, and any avoidance behaviors regarding discussions about the loss.

• Prioritize the safety of the client in assessments.

Planning and Support (Page 6)

• Ongoing bereavement support; foster safe, confidential environments for clients to express their feelings.

• Encourage discourse around the client’s relationship with the deceased and the circumstances of the loss.

Implementation of Care (Page 7)

• Develop therapeutic relationships that are personalized to address each client's unique needs effectively.

• Ensure that interventions respect the cultural and spiritual contexts relevant to the client's experience of grief.

Evaluation of Care (Page 7)

• Continuously track the effectiveness of the provided support, the presence of grief symptoms, their impact on daily functioning, and the overall success of coping strategies employed.

Occupational Stress Related to Grief (Page 8)

• Risk Factors: Constant exposure to death and grief with a lack of support can increase occupational stress.

• Effects: May lead to professional burnout, secondary trauma impacts, and compassion fatigue in caregivers.

Burnout (Page 8)

• Definition: A state of physical, emotional, or mental exhaustion that diminishes motivation and performance.

• Impacts on Nursing: Can result in poor client outcomes, higher turnover rates among staff, and various health-related issues.

Secondary Trauma (Page 9)

• A condition similar to PTSD that develops from witnessing the suffering and trauma experienced by clients.

Compassion Fatigue (Page 9)

• A phenomenon resulting from repetitively experiencing trauma through caring for victims, leading to a significant depletion of empathy and an inability to provide compassionate care.

Trauma Definition (Page 10)

• Trauma: Experiences that are profoundly disturbing, leading to significant fear, confusion, and dissociation, especially harmful in childhood.

Types of Trauma (Page 10)

• Acute Trauma: Involves a single overwhelming traumatic event, such as an accident.

• Chronic Trauma: Consists of multiple persistent traumatic events, like ongoing abuse.

• Complex Trauma: Refers to trauma that distorts a person’s self-identity, often due to social inequities.

• System- induced Trauma- Trauma that is experienced during movement through organizational (such as foster care or juvenile detention)

• Vicarious Trauma: Occurs as a result of secondary exposure to trauma through engagement with victims.

• Historical Trauma: Represents cumulative adversity experienced across generations within specific groups.

Effects of Trauma (Page 11)

• Trauma can lead to impaired functioning in mental, social, and spiritual spheres.

• Symptoms: Individuals may experience intense fear, confusion, dissociation, and disruptive emotional responses.

• Risk Factors: Prior family history of trauma, pre-existing mental health issues, and negative life events can increase vulnerability to trauma-related symptoms.

Toxic Stress (Page 12)

• Refers to biological and physiological changes resulting from prolonged exposure to adversity, impacting recovery and overall well-being.

Manifestations of Toxic Stress (Page 12)

• Children/Adolescents: May face developmental delays, issues with thriving, and learning difficulties, as well as behavioral problems that raise health risks.

• Adults: Can lead to chronic diseases, mental health challenges, diminished quality of life, and escalated risks to health.

Adverse Childhood Experiences (ACES) (Page 13)

• Refers to negative childhood experiences that can have lasting effects on health and behavior throughout one's life.

Trauma-Related Disorders in Children (Page 13)

• Lack of protective factors in a child’s environment can result in developmental challenges and difficulties functioning.

Violence (Page 14)

• A social act representing the misuse of power, often perpetuating cyclical patterns of abuse and trauma.

Crisis Situations (Page 14)

• Refers to acute emotional reactions that are overwhelming and require comprehensive interventions.

Crisis Intervention Goals (Page 15)

• Focus on restoring individuals to pre-crisis functioning by addressing the present challenges effectively.

Nursing Care in Crisis Situations (Page 15)

• Three Levels of Care:

  • Primary Care: Measures taken to prevent crises (pre-emptive).

  • Secondary Care: Interventions introduced during a crisis.

  • Tertiary Care: Ongoing support for recovery after a crisis.

Anger, Aggression, & Violence (Page 16)

• Anger: A natural emotion that can vary in intensity and may manifest in various forms.

• Violence: Involves intentional acts meant to cause harm, not always originating from anger but often complex in nature.

Cycle of Violence (Page 16)

• Involves phases that typically include tension-building, the act of serious battering, and a honeymoon phase where apologies are made, creating a cycle of repeated abusive behavior.

• Phase 1 Build up (tension-building phase)

  •Can last days, weeks or years

  •Breakdown in communication occurs

  •Perpetrator initiates more arguments

  •Environment becomes more tense

  •Abusive incidents begin

  Phase 2 Acute (Serious battering phase)

  •Normally limited to a few hours up to 24 hr.

  •Abusive acts are filled with rage and intensity

  •Law enforcement may become involved

  Phase 3 Honeymoon

  •Perpetrator becomes very affectionate and apologetic toward survivor

  •Regretful of actions and promises to change

  •Will frequently continue to maintain control over survivor through economic and emotional abuse

  

Different Forms of Abuse (Page 17)

• Categories of Abuse: Include physical, neglect, emotional, economic, and sexual abuse, each having distinct characteristics and consequences.

Self-Injury as Coping Mechanism (Page 17)

• Refers to the intentional act of self-harm, often initiated during adolescence, as a way to cope with emotional pain or distress.

Risk Factors and Warning Signs of Self-Injury (Page 18)

• Associated with various mental health conditions, self-injury can lead to severe consequences, including potential suicide risk.

Intervention Strategies for Self-Injury (Page 18)

• Recommended strategies include immediate outreach for help, creative expression to articulate emotions, formulating action plans for coping, and establishing strong support systems to ensure safety and recovery.