Wednesday, December 19, 2018
'Grief and Loss in Adolescence: Principles, Responses and Challenges\r'
' tribulation and expiry atomic issuance 18 inherent aspects of bearing sentence; they ar inevitabilities that stem from our mortality rate and our natural propensity to form deep stirred up bonds with those closest to usÃ¢â¬our family, booster amplifiers and colleagues.Perhaps C. S. Lewis captured the sensation of distress outstrip when he said: Ã¢â¬Å"No one forever told me that sorrowfulness felt so man days fear.ÃÂ I am non afraid, yet the sensation is like world afraid. The self-importancesame(prenominal) fluttering in the stomach, the same restlessness, the yawning. I keep on swallowing. Ã¢â¬ C. S. Lewis, A Grief Observed How one physically manifests ruefulness whitethorn vary between age classs and cultures but it is a universal occurrence in humans who argon of normal cognitive growment.In this paper, trouble and expiration depart be reviewed in the context of WordenÃ¢â¬â¢s principles and theories; specifically, what these principles presuppos e about grief and prejudice, how they might apply to the adolescence demographic, what challenges the wellness cautiousness contributer might expect to copse when organiseing with a suffer adolescent, and how a health apportion provider fag best do to a grieving teenageageragedager. A series of suppositious acute simple machinee settings will be presented to ornament how a think of might best depart in responding to a grieving adolescent.Death during AdolescenceAdolescence is a transitionary coiffure of life that poses unique challenges for the various(prenominal). Change is the hallmark of this civilizemental period as teenagers struggle with hormonal changes, newfound go fors for independence, confidence issues, and concerns about body image. Grief and loss during this confront of life, whether it be the loss of a parent, relative, or close ace, often immensely exacerbates the emotional realm of a teen who is already experiencing the stresses associa ted with the transition from chela to adult.According to Metzgar, typical grief rejoinders of teenagers embroil anger, depression, withdrawal, frustration, confusion, forming out, and disobedience (Metzgar, 2002). Unlike young children, who often do non fully contemplate the finality of remnant, adolescents are unremarkably aware that wipeout is final (Freeman, 2005). According to Freeman, adolescents permit the mature intellectual discipline necessary to substantiate the core concepts of remnantÃ¢â¬universality, non-functionality, irreversibility, and causalityÃ¢â¬and atomic number 50 crystallize fully the details (Freeman, 2005).This greater understanding of cobblers last blanks adolescents closer to adults on the level of death awareness; however, teens whitethorn wonder if a dead someone will return; this thinking may allow in supernatural elements as teens often associate an unthought-of death or serious illness with a supernatural event or cause (Brewst er, 1982). An adolescentsÃ¢â¬â¢ grief pick up is highly individualised in nature, and contradictory adults, teens tend to grieve more intensely.Often their grief response is not stub outed smoothly or unendingly but takes the form of a series of punctuated outbursts; in some eludings an adolescent may ramp up a concerted effort to control his or her emotions (Worden, 1996). In attempting to control their emotions, a teen may draw inwardly by immersing themselves in highly personal activities such(prenominal) as reading, writing, listening to music, or example; in other cases, a teen may involve to release the anger and sadness associated with their grief; in this case, he or she may act out angry or antisocial appearance (Worden, 1996).Of special(a) importance from a health simple machinee perspective is the recognition that teens often perceive death as something that happens to others even though they recognize that death is a phenomenon that can and will happen to everyone. When a teen is confronted with the death of a close friend or relative, their perception of death as cosmos a phenomenon that is distant from them, is abruptly challenged. In the case of the death of a peer, death is often choppyÃ¢â¬in an American study, the three leading causes of death in the 15 to 24 year-old age group are accidents, homicide, and suicide (Minino and Smith, 2001).In such cases, a teenÃ¢â¬â¢s sense of pseudo-immortality is often shattered (Freeman, 2005). The trauma associated with this may cause a teen to endure an overwhelming sense of wait onlessness or impotence (Aronson, 2005). In the case of the loss of one or twain parents, a teen may experience a grief reaction that is unique for their age demographicÃ¢â¬an irrational guilt associated with the normal desire to detach from their parents (Freeman, 2005). For the health care worker, it is crucial that this particular grief reaction is considered when helping a teen deal with the loss of o ne or ii parents.Theoretical Principles: Grief and Loss according to Worden.In Grief commission and Grief Therapy, Worden conceptualizes the process of grief into a modeling of four pro permitariats that he suggests urgency to be intercommunicate and completed before the process of mourning can be concluded (Worden, 1991). WordenÃ¢â¬â¢s four task paradigm consists of:Task 1. To acquit the reality of the lossTask 2. To work done the pain of griefTask 3. To adjust to an environment in which the departed is missingTask 4. To emotionally relocate the deceased and trip on with lifeAccording to Worden, children and teens, like adults, must acknowledge and accept the reality and finality of death before they can begin to deal with the emotional impact of this loss (Worden, 1991). Generally this is easier for teens than children because their concept of death is more create and in tune with that of an adultÃ¢â¬â¢s. In value to help facilitate acknowledgement of loss, a hea lth care worker needs to develop the serving of the loss in a language that is both accurate and age appropriate.Since adulthood levels vary inside the teen demographic, one must not dupe a given maturity level base on age; in this case the carer should make a concerted effort to determine the maturity level of a teen with chat and observation (Smead, 1994). In task two, Worden suggests that the painful emotions associated with grief need to be worked through. By working through, Worden suggests that emotions need to be released in a healthy modal value such that a teen is adequate to roll in the hay with the nature of their loss.In this case, the carer needs to assist the teen with enterprise upÃ¢â¬helping the teen discuss their fears and anxieties in a non-judgmental way. Encouraging teens to express their grief through creative arts and by engaging in rituals can be therapeutic in this regard. (Silverman and Nickman, 1999) In WordenÃ¢â¬â¢s third task, adjusting to th e loss of a deceased peer, sibling or parent requires that the adolescent develop an adaptation to this loss.Adaptation will be heavily influenced by what role the deceased played in the teenÃ¢â¬â¢s life; often this adaptation requires an panoptic period of adjustment (Worden, 1991). In this case, the health care workerÃ¢â¬â¢s role is to help the teen adapt to the loss of old roles (roles associated with the deceased) and adjust to the process of new roles (roles previously associated with the deceased now interpreted up by other individuals). In WordenÃ¢â¬â¢s final task, the deceased are relocatedÃ¢â¬they are placed in an appropriate emotional place such that the bereaved can move on with their lives.For many bereaved individuals, relocation may lease the pondering of existential questions: Where did the deceased go? why did they die? Is at that place a Heaven? Children and teens are often more open to supernatural explanations, and in this case, belief in an subsequent lylife can be therapeutic as it helps the individual maintain a healthy and tangible link to the deceasedÃ¢â¬it may give the bereaved a sense that the deceased is watching over me from Heaven (Silverman, Nickman and Worden, 1992).Grief and Loss in the Acute Care Setting: A applyÃ¢â¬â¢s RoleWhen a nurse is expected to provide emotional care to a bereaved teen, he orÃÂ she must consider a number of factors that may influence the grieving process. These may include: age, level of maturity, psychological state, physical state, and circumstances of the loss. In the following hypothetical case studies, a nurse will offer emotional support tell specifically at teens whom are experiencing different stages of grief as outlined by Worden. The question to be answered in from each one case is this: What would be the nigh appropriate nursing response? In each case, as the at care nurse, you will note the individualÃ¢â¬â¢s age, statements, stress level, and physical demeanor.Case Study i Ã¢â¬ The immediate loss of a best friendTom is an 18 year old who has been admitted to a hospital parking brake room after a traumatic car accident. His best friend Bret was a passenger and has been killed in the accident. Tom has minor physical injuries that you are tending to. He has just been informed that his best friend died at the scene. Emotional and in disbelief, he yells: Ã¢â¬Å"YouÃ¢â¬â¢re all lying! Bret is not dead! He canÃ¢â¬â¢t be dead! He canÃ¢â¬â¢t be! ItÃ¢â¬â¢s my rift!Ã¢â¬Â Bret is shaking. result:Using compassionate but clear and civilize language you reaffirm that Bret has died. You show empathy to Tom but avoid making value judgments for him that offer explanations for the death or attribute blame. When interfacing with TomÃ¢â¬â¢s parents you explain to them the stage of grief their son is going through and how best to assist him through it.Case Study twain Ã¢â¬ Working through the loss of a parentSarah is a somewhat rebellious 17 year-old w ith a substantive sense of independence. She doesnÃ¢â¬â¢t always see affectionateness to eye with her mother, Jenifer. Six months previous, Jenifer died utterly in car accident. Since the accident, Sarah has suffered major anxiety attacks and has been plagued by guilt. At indoctrinate she has been come to in arguments and fights with other girls; on this condition she is in the school infirmary after armed combat with another girl. After initially appearing angry, Sarah breaks shine in tearsÃÂ and says: Ã¢â¬Å"Why did my Mom endure to die! I didnÃ¢â¬â¢t really want her out of my life!Ã¢â¬ÂResponse:You consol Sarah, and listen to herÃ¢â¬you let her release her emotions without restraining or judging her. You reassure Sarah that it is ok and normal to feel fear, guilt and doubt, and that is ok to express her feelings. You tell Sarah that she can come and share her feelings with you whe neer she feels the need. If interfacing with SarahÃ¢â¬â¢s father, explain to him what Sarah is experiencing, and offer helpful suggestions that are in line with WordenÃ¢â¬â¢s model for task two grief.Case Study Three Ã¢â¬ Adapting to the loss of a siblingJanet and Karen are infants close in age, 15 and 17 respectively. They were inhering and enjoyed doing things together such as sports, shopping and public lecture about boys. Janet looked up to Karen who she thought of as being her pillar of strength and confidant. Last year Karen died suddenly from a rare form of meningitis. Janet has accepted the loss but has had a hard time readjusting to life without her sister. She is in the hospital being attended to for self inflicted cuts on her arms. Janet states that life is unexciting now because her sister is gone.Response:With empathy you help Janet recognize and reassign the emotional roles fill by her sister. You may suggest ways to help Janet remember Karen in a desensationalized way such that the memory of Karen is retained and respected but that recognize s that life must go on. The suggestion of doing activities (previously done with Karen) with friends or classmates might be helpful. This information should be relayed to JanetÃ¢â¬â¢s parents to help them understand how they might be able to assist Janet adjust to life without Karen.Case Study quadruple Ã¢â¬ Relocating a deceased grandparentFourteen year old Ben love fishing with his grandfather. Granddad was BenÃ¢â¬â¢s best friend. sooner this year BenÃ¢â¬â¢s granddad died suddenly from a heart attack. Ben accepted that granddad was gone, and he knew that there would be no more fishing. Ben was admitted to the hospital to happen stitches for a fall; Ben asks you: Ã¢â¬Å"Miss, where do dead pack go? My Granddad died this year you know.Ã¢â¬Â In a melancholy tone he continues, Ã¢â¬Å"IÃ¢â¬â¢ll never gestate a friend like him again.Ã¢â¬ÂResponse:In a compassionate tone reply that you are not sure where people go when they die and that it is one of lifeÃ¢â¬â¢s great mysteries. You may suggest that many people have different ideas as to where people go after death. Suggest to Ben that life is about continuing to develop special moments with people we associate with in life. take for in mind that grief resolution involves reflecting on the meaning of a deceased personÃ¢â¬â¢s life, and keeping this as a pleasant memory. It is not meant to focus on the death itself.ConclusionsGrief is a fundamental aspect of life. Adolescence, being a major transitional stage in human growth and development brings with it unique emotional challenges. These challenges need to be address by the health care worker if he or she is to effectively assist a teen who is grieving for a deceased peer, sibling or parent. Worden suggests a four step paradigm for the grieving process that can serve as a guide for elucidating the stage of grief an individual may be experiencing.Knowledge of this model can assist the health care worker in grief stage recognition, and in makin g informed decisions that will finally help a teen deal with challenges involved in the of grieving process. With the support and encouragement of health care workers, peers, and relatives, adolescents can learn to successfully write out grief and loss, and move forward with their lives.\r\n'