NSG 152: Grief, Loss, Spirituality TEST 5 UPDATED ACTUAL
Questions and CORRECT Answers
Kubler-Ross 5 Stages of Grief 1. Denial & Isolation- Refusing to accept the reality of the loss, often as a
defense mechanism to cope with overwhelming emotions.
2. Anger- Frustration and resentment, which may be directed at oneself, others,
or the situation.
3. Bargaining- Attempting to negotiate or make deals to reverse or lessen the
impact of the loss.
4. Depression- Deep sadness and despair as the reality of the loss sinks in.
5. Acceptance- Coming to terms with the loss and finding a way to move
forward.
Engel's 6 Stages of Grief 1. Shock & Disbelief- Refusal to accept loss, followed by stunned response.
2. Developing Awareness- Emotional Response such as anger, emptiness, and
crying as the result of the loss sets in.
3. Restitution- Rituals surrounding loss.
4. Resolving the loss- Dealing with the void left by the loss and attempting to
move forward.
5. Idealization- Exaggeration of good/ positive qualities of the lost person or
object, followed by acceptance and reduced focus on loss.
6. Outcome- Dealing with loss as common life occurrence.
Advanced Directives Example: A living will, & durable power of attorney for healthcare.
-The person I want to make care decisions for me when I can’t
-The kind of medical treatment I want or don’t want
-How comfortable I want to be
-How I want people to treat me
-What I want my loved ones to know
POLST form A Physician Order for Life-Sustaining Treatment form
A medical order indicating a patient’s wishes regarding treatments commonly
used in a medical crisis.
POLST forms are not available in every state. In some states, such as Maryland,
they are called Medical Orders for Life-Sustaining Treatment forms, or MOLST
forms.
,Palliative Care/Cedation The lowering of patient consciousness using medication for the express
purpose of limiting patient awareness of suffering that is intractable and
intolerable.
- Taking care of the whole person—body, mind, and spirit, heart and soul. The
goal of palliative care is to give patients with terminal illness the best quality of
life they can have by the aggressive management of symptoms.
Physiologic Needs Physical needs, such as hygiene, pain control, and nutritional needs.
Psychological Needs Patient needs control over the fear of the unknown, pain, separation, leaving
loved ones, loss of dignity, loss of control, unfinished business, isolation.
Needs for Intimacy Patient needs ways to be physically intimate that meets needs of both partners.
Spiritual Needs Patient needs meaning of purpose, love and relatedness, and forgiveness and
hope.
Name the 3 Spiritual Needs 1. Need for meaning & purpose
2. Need for love & belonging
3. Need for forgiveness
O'Brien's Spiritual Assessment Guide - Spiritual Pain
- Spiritual Alienation
- Spiritual Anxiety
- Spiritual Guilt
- Spiritual Anger
- Spiritual Loss
- Spiritual Despair
Actual Loss Recognized by others and by person experiencing loss (ex: loss of limb, child,
money, job, etc.)
Perceived Loss Loss of youth & financial independence (Valued by person that is intangible to
others)
Maturational Loss Experienced as a result of developmental processes. Examples include: A first
child may experience a loss of status when a sibling is born. Or when a parent
of a single child may experience a sense of loss when the child begins school.
Situational Loss Result of unpredictable event (traumatic injury, disease, death, or national
disaster)
Anticipatory Loss When a person displays loss and grief behaviors for a loss that has not yet
taken place. Often seen in families of patients with serious and life-threatening
illnesses and may lessen the effect of the actual loss of the family member.
Complicated Loss A response outside the norm and occurring when a person is void of emotion,
grieves for prolonged periods, or has expressions of grief that seem
disproportionate to the event.
Disenfranchised Loss Grief over loss that is not or cannot be acknowledged openly, mourned
publicly, or supported socially.
, Grief Internal emotional reaction.
Mourning Actions & expressions of grief.
Bereavement State of grieving due to loss of loved one.
Implementing Spiritual Care - Offering supportive presence
- Facilitating patient's practice
- Nurturing spirituality
- Praying with patient
- Praying for the patient
- Counseling the patient spiritually
- Contacting a spiritual counselor
- Resolving conflicts between treatment & spirituality
Dimensions of Grieving - Cognitive Response (Questioning and Trying to Make Sense of the Loss):
“Why did this have to happen? He took such good care of himself!”
“Why did such a young person have to die?”
“She was such a good person! Why did this happen to her?”
- Emotional Response (Anger, sadness, and anxiety):
“He should have stopped smoking years ago.”
“If I had taken her to the doctor earlier, this might not have happened.”
“It took the doctor too long to diagnose his illness.”
- Spiritual Response (Closely associated with the cognitive and emotional
dimensions of grief are the deeply embedded personal values that give
meaning and purpose to life.)
- Phy siological Response (Physiological symptoms and problems associated
with grief responses are often a source of anxiety and concern for the grieving
person as well as for friends or caregivers. Those grieving may complain of
insomnia, headaches, impaired appetite, weight loss, lack of energy,
palpitations, indigestion, and changes in the immune and endocrine systems.
Sleep disturbances are among the most frequent and persistent bereavement-
associated symptoms.)
Acculturation Cultural rituals with roots in major religions.
Cultural Considerations for Deceased viewed in church before burial in cemetery; public prayers, black
African Americans clothing, decreased social activities
Cultural Considerations for Five steps of burial procedure, including washing, dressing, and positioning of
Muslim Americans the body
-First step involves traditional washing of the body by a Muslim of the same
gender.
Cultural Considerations for novena (9-day devotion) and rosary; wear black or black and white; behave in
Hispanic Americans subdued manner
Cultural Considerations for Tribal medicine man or priestly healer; baptism ceremonies; end of mourning
Native Americans noted with ceremony at burial ground with grave covered with blanket or cloth
later given to tribe member
Questions and CORRECT Answers
Kubler-Ross 5 Stages of Grief 1. Denial & Isolation- Refusing to accept the reality of the loss, often as a
defense mechanism to cope with overwhelming emotions.
2. Anger- Frustration and resentment, which may be directed at oneself, others,
or the situation.
3. Bargaining- Attempting to negotiate or make deals to reverse or lessen the
impact of the loss.
4. Depression- Deep sadness and despair as the reality of the loss sinks in.
5. Acceptance- Coming to terms with the loss and finding a way to move
forward.
Engel's 6 Stages of Grief 1. Shock & Disbelief- Refusal to accept loss, followed by stunned response.
2. Developing Awareness- Emotional Response such as anger, emptiness, and
crying as the result of the loss sets in.
3. Restitution- Rituals surrounding loss.
4. Resolving the loss- Dealing with the void left by the loss and attempting to
move forward.
5. Idealization- Exaggeration of good/ positive qualities of the lost person or
object, followed by acceptance and reduced focus on loss.
6. Outcome- Dealing with loss as common life occurrence.
Advanced Directives Example: A living will, & durable power of attorney for healthcare.
-The person I want to make care decisions for me when I can’t
-The kind of medical treatment I want or don’t want
-How comfortable I want to be
-How I want people to treat me
-What I want my loved ones to know
POLST form A Physician Order for Life-Sustaining Treatment form
A medical order indicating a patient’s wishes regarding treatments commonly
used in a medical crisis.
POLST forms are not available in every state. In some states, such as Maryland,
they are called Medical Orders for Life-Sustaining Treatment forms, or MOLST
forms.
,Palliative Care/Cedation The lowering of patient consciousness using medication for the express
purpose of limiting patient awareness of suffering that is intractable and
intolerable.
- Taking care of the whole person—body, mind, and spirit, heart and soul. The
goal of palliative care is to give patients with terminal illness the best quality of
life they can have by the aggressive management of symptoms.
Physiologic Needs Physical needs, such as hygiene, pain control, and nutritional needs.
Psychological Needs Patient needs control over the fear of the unknown, pain, separation, leaving
loved ones, loss of dignity, loss of control, unfinished business, isolation.
Needs for Intimacy Patient needs ways to be physically intimate that meets needs of both partners.
Spiritual Needs Patient needs meaning of purpose, love and relatedness, and forgiveness and
hope.
Name the 3 Spiritual Needs 1. Need for meaning & purpose
2. Need for love & belonging
3. Need for forgiveness
O'Brien's Spiritual Assessment Guide - Spiritual Pain
- Spiritual Alienation
- Spiritual Anxiety
- Spiritual Guilt
- Spiritual Anger
- Spiritual Loss
- Spiritual Despair
Actual Loss Recognized by others and by person experiencing loss (ex: loss of limb, child,
money, job, etc.)
Perceived Loss Loss of youth & financial independence (Valued by person that is intangible to
others)
Maturational Loss Experienced as a result of developmental processes. Examples include: A first
child may experience a loss of status when a sibling is born. Or when a parent
of a single child may experience a sense of loss when the child begins school.
Situational Loss Result of unpredictable event (traumatic injury, disease, death, or national
disaster)
Anticipatory Loss When a person displays loss and grief behaviors for a loss that has not yet
taken place. Often seen in families of patients with serious and life-threatening
illnesses and may lessen the effect of the actual loss of the family member.
Complicated Loss A response outside the norm and occurring when a person is void of emotion,
grieves for prolonged periods, or has expressions of grief that seem
disproportionate to the event.
Disenfranchised Loss Grief over loss that is not or cannot be acknowledged openly, mourned
publicly, or supported socially.
, Grief Internal emotional reaction.
Mourning Actions & expressions of grief.
Bereavement State of grieving due to loss of loved one.
Implementing Spiritual Care - Offering supportive presence
- Facilitating patient's practice
- Nurturing spirituality
- Praying with patient
- Praying for the patient
- Counseling the patient spiritually
- Contacting a spiritual counselor
- Resolving conflicts between treatment & spirituality
Dimensions of Grieving - Cognitive Response (Questioning and Trying to Make Sense of the Loss):
“Why did this have to happen? He took such good care of himself!”
“Why did such a young person have to die?”
“She was such a good person! Why did this happen to her?”
- Emotional Response (Anger, sadness, and anxiety):
“He should have stopped smoking years ago.”
“If I had taken her to the doctor earlier, this might not have happened.”
“It took the doctor too long to diagnose his illness.”
- Spiritual Response (Closely associated with the cognitive and emotional
dimensions of grief are the deeply embedded personal values that give
meaning and purpose to life.)
- Phy siological Response (Physiological symptoms and problems associated
with grief responses are often a source of anxiety and concern for the grieving
person as well as for friends or caregivers. Those grieving may complain of
insomnia, headaches, impaired appetite, weight loss, lack of energy,
palpitations, indigestion, and changes in the immune and endocrine systems.
Sleep disturbances are among the most frequent and persistent bereavement-
associated symptoms.)
Acculturation Cultural rituals with roots in major religions.
Cultural Considerations for Deceased viewed in church before burial in cemetery; public prayers, black
African Americans clothing, decreased social activities
Cultural Considerations for Five steps of burial procedure, including washing, dressing, and positioning of
Muslim Americans the body
-First step involves traditional washing of the body by a Muslim of the same
gender.
Cultural Considerations for novena (9-day devotion) and rosary; wear black or black and white; behave in
Hispanic Americans subdued manner
Cultural Considerations for Tribal medicine man or priestly healer; baptism ceremonies; end of mourning
Native Americans noted with ceremony at burial ground with grave covered with blanket or cloth
later given to tribe member
