Stages of Grieving – Based on Elizabeth Kubler-Ross Idea

Hey everyone! I am so sorry that i haven’t posted anything recently. You know how life gets in the way right? And I have finals this week and next so I have been crunching with all my studying.

So anyways for today I thought I would touch on the grieving process. This is based on Elizabeth Kubler-Ross’ theory, To me, it seems to make a lot of sense, I can see though how some of the stages could be switched around. I have included an example following both stage based on the patient being diagnosed with terminal cancer.

1) Denial – this is very commonly seen.  Where the patient doesn’t want to accept what they are being told.

2) Anger – very quickly follows the denial.  This is a good reason why there is a witness in the room, this is one of the reasons. When some individuals get angry enough violence can break out.  As a professional nurse, or doctor you need to allow all of this feeling come out, while it is still safe for them to do so.  This will aid in the entire process of grieving.

3) Bargaining – this is when the patient starts asking the doctor or nurse what other options there are.  Whether there are alternative medicines, new drugs, and methods of medicine that can be used to continue there life.

4) Depression – obviously this will be when the person may become tearful, maybe spilling feelings of sadness and parts of life they fell they haven’t finished.

5) Acceptance – when the person understands and come to terms with what they have heard, and they understand what has happened to them, and are willing and ready to either continue living as they are or are willing to take treatment.

And those are the steps to grieving. Sometimes you will find in yourself or see in others that some steps are switched especially steps four and five, but the person will still successfully be able to grieve.

 

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I am so sorry i haven’t posted anything lately!! I have been so swamped with homework, the last thing i could think of was posting another blog.

I promise though that I will have one up by next wednesday.

 

Developmental Disabilities and Mental Illness

In this weeks communication class I learned the difference between developmental disabilities and mental illness. I knew that sometimes there are things that can go wrong when a baby is in utero and that can cause various issues to the baby – what I thought is mental illness.  But as I found out was it is actually a developmental disability, because of various reasons such as something that happened while the baby was in its developmental stages, or some trauma was caused to mom and baby, genetic disorder, or trauma occurred at time of birth.  Mental illness, however, is different because it is something that has developed more likely because of physiological situations or inheritance, and a mental illness can be treated, or can be attempted to treat with medications/supplements.

A learning disability can be recognized by significant differences between expected and actual performance by an person.  As well as difficulty with reading, writing, spelling and math, poor auditory and/or visual memory, and good abilities when it comes to talking but poor abilities expressing them in the written language.  Also consider on whether the individual can directly follow directions, if they get distracted easily, quite impulsive, they have difficulties organizing and keeping track of time, activities and responsibilities.

There are eight pointers I thought could be really helpful to anyone when it comes to being in the presence of an individual who has a mental illness or a developmental disorder.  One, speak directly to the person. Two, offer to shake the person’s hand, these usually are able to have use, even if limited, and are able to try to shake your hand back. Three, when meeting a person who is affected, be sure to identify yourself, especially to one who may have a visual impairment or blindness. Four, treat any adults as adults, NEVER patronize or use childish language. Five, respect this person’s personal space, never invade the personal bubble.  Six, when they have something to say, listen mind-fully, don’t interrupt or supply words, be patient and let them finish, if you need any clarification, explain what you didn’t understand, and then wait for their response. Seven, keep up direct eye contact, this means if the person that you talking to is in a bed or in a wheelchair, kneel or sit down to their level.  Eight, when you express yourself make sure that you are directly facing the person, and when you speak you speak clearly, slowly, and expressively, make sure that you do not have any gum, candy, or cigarettes in your mouth.  This is especially important when the person has their hard of hearing or are deaf but can lip read.

The last main point of the class was the then pointers for a better communication partner:

1)      Get on the same level – sit, bend, squat so that you can be at eye level

2)      Establish Attention – be more interesting than the environment, get it in the line of vision, get close, and be animated

3)      Prepare the Individual for what you are going to communicate – use verbal signs such as “watch, look, listen, ready”, pair a verbal sign with a gesture when you are unsure if you still have the attention of the person, and use visual props

4)      Use gestures and body language meaningfully – exaggerate movements, use gestures in a slow pronounced way REMEMBER THAT YOUR HANDS, FACE, AND BODY ARE CRITICALLY IMPORTANT COMMUNITCATION TOOLS

5)      Support your communication visually – pictures, gestures, your body

6)      Speak slowly and clearly

7)      Limit verbalization – sometimes talking isn’t the best in the situation

8)      Include a “wait time” in your interactions – always pause, wait your responses when you ask questions, look at the individual as you  wait your response

9)      Guide or prompt the person to respond if needed – guides or prompts can be simple and subtle

10)  Stay in the interaction until you reach a desired response

 

Reflection:

Sometimes people think that someone with a developmental disability or mental illness is not capable of carrying on a conversation or feeling emotions. It is sometimes the case that these people are not able to carry on a conversation but they may be able to understand conversation, or specific words, or hand signs or gestures.  These people, although maybe a one way conversation in a sense, can still be communicated with and they can feel a part of society as well.  Some people also have the same stigma with those who have learning disabilities. I know from personal experiences that this not the case.  Some of my friends have learning disabilities, this doesn’t meant that they are shut off from the world, or that they need to be separated from ‘normal’ society.  They are fully functionally, stable jobs, have their own vehicles, furthering their education, and they are the most fun to hang out with

 

Self-Concepts

Hello World!  Todays class was really good! Our instructor did a fantastic job of discussing the topic of self concepts.  I felt so bad during the first hour and half though, I didn’t have that great of a sleep last night and I was sitting there listening to her and my eyes were fluttering up and down because I was trying to keep them open.  Thankfully!! Break time I was able to run to McD’s for a coffee, and I got paid to do so because some of my fellow students were also in desperate need of caffeine.  There was a Bon Jovi concert this weekend … need I say more? So they all gave me the money and I got to keep the change…THANK YOU FOR TOMORROWS COFFEE! I will definitely need it.

So on to today’s topic… Self-concepts are the individuals evaluations of himself or herself, a person’s self-appraisal, how well you know your self.

There are four ways of how ‘self’ develops. a) appraisals made by significant others about the self.  This is when someone would for instance tell you that you are a thoughtful person.  It is when someone states something about your personality whether good or bad. b) appraisals that are repeated, become a pattern and become incorporated into self.  Like the first appraisal this would be when there are more than one comments of others stating that you are a thoughtful person. c) Behavior emerges to match the appraisals.  This would be when you notice yourself being thoughtful toward others.  Noticing that the comments that others have mad are true about you. d) With each new era of development , the self it open for reappraisal.  This meaning that with new situations, you are ready to hear constructive criticism.

The functions of self-concepts are: a) helping explaining behavior, b) providing a conceptual frame-work for decision-making, c) shaping expectations for the future, (making goals that you are able to meet), and d) provides bridges for meaning (knowing the reasons for why something happened).

Components of Self-Concepts are our body image, how we view ourselves.  Our self-awareness, all of our psychological beliefs and attitudes.  Our personal self-esteem, whether we see the value and significance of ourself or not.  And our role performance, the roles that we play in teams, in your family, and how we function with expected behavior.

Aspects that can make it hard for us to improve our self-concepts, essentially the barriers, are:

1. To be perfect – trying to perform at unrealistically high levels at work, school, and home; thinking that anything short of perfection is unacceptable.
2. Being Strong – weakness and any of the more vulnerable emotions like sadness, compassion, or loneliness are wrong.
3. Pleasing Others – seeking approval from others; assuming that if you gain the approval of others, then you are worthy and deserving person, but if others disapprove of you then you are worthless and undeserving.
4. Hurrying Up – doing thing quickly, doing more than should be reasonably expected in any given amount of time.
5. Trying to Hard – taking on more responsibilities than any person should be expected to handle.  Trying to more than is what expected in your scope of practice.

One section I really like about today’s class is ways to improve our self-esteem and that of our patients.  I am sure that all of us have one thing in our lives that make us feel insecure, maybe we don’t like the way we get all flustered when talking in front on an audience, or we feel we aren’t qualified for certain responsibilities.  These strategies could definitely be helpful for ourselves, and with others around us:

• make and define clear and realistic goals
• make your self think clearly, or your patient
• give positive feedback, give yourself a pat on the back, or indulge yourself in treat because you know you did well
• encourage positive self-affirmations
• stop negative thinking, not negative put downs when performing a task
• visualization exercises, showing how wonderful a place is, or bringing to mind the wonderful benefits for after the fact

In summary, we defined what self-concepts are, and the four steps to how one develops.  The various components of self-concepts and the aspects that make it hard on our selves to improve.  Lastly, I shared some strategies on how we can build up our self-esteem, or that of others, in my case it will be building up the patients self-esteem.

And that was today’s Communication Class!! It flew by, thanks to a great teacher!!

 

Perception in Communication

Yesterday’s class was able to help me think a little more on my communication techniques. Communication is very important between nurse and patient/client, and perceptions have a lot to do with communication. Perception is a personal identity constructed by which a person transforms external sensory data into personalized images of reality. Perceptions are ‘functions of the mind and not sense.’

Sensory stimuli are firstly ‘sorted’, then they are ‘organized’ by the CNS, then all the stimuli are ‘interpreted’. In nursing, a nurse wants to get as close to all the facts as possible, so a nurse wants to make sure that all that is perceived is organized into subjective (non-factual) and objective data (factual).

In our perception there are three different phases.

1. Selection – the process of neglecting some stimuli in the environment to focus on other stimuli
· Selective exposure – is the tendency to expose ourselves to information
· Selective attention – is the tendency to focus on certain cues and ignore others
· Selective perception – is the tendency to see, hear, and believe what we want
· Selective retention – is the tendency to remember better the thing that reinforce our views and beliefs
2. Organization: grouping of stimuli into meaningful units
· Figure – focal point of a person’s attention
· Background – the environment, circumstances
· Closure – the process of getting as much information as possible
· Proximity – being as close to patient so as to get as much factual information as possible
· Similarity – noticing similarities in patient cases with either conditions, treatments and/or recommendations
3. Interpretation: process of assigning meaning to get the perfect evaluation

Through all this, you want to take time after taking in information; we want to avoid making judgements on patients, as this could distort our care depending on personal ethics, values and beliefs. What was suggested regarding this was the 4T’s: think (initial thoughts and evaluation), time (do not come to conclusion after conversation, take time to think over conversation), trust (major requirement for a good nurse-patient rapport), and touch (this only comes after strong trust has been developed). The 4T’s will aid a nurse in their way of gaining true facts about their patient.

Then there are four factors that affect our perceptions so that our view is different to that of another person. These factors are really good to keep in mind when communicating with anyone! They can really help you try and understand a person.

1. Physiological Factors – such as gender, look, size, and needs
2. Past Experiences – life experiences, pearls of wisdom
3. Culture – knowing people and how they see, what they see, what they taste, feel, and like
4. Present Feelings and Circumstances – daily, monthly, and yearly cycles of thinking can affect how you perceive stimuli (e.g. good and wonderful attitude one day, depressed or cranky following day)

Lastly, guidelines that can improve our perception and communication, which I am going to start using these daily. I think that everyone can improve their communication using this. Think of how much better some of us would get along if we all practiced this! We would all get along, or at least respect each other a lot more. Well that’s what I would hope would happenJ.

1. Remember that all perceptions are subjective (in nursing our perceptions need to be sorted into subjective and objective)
2. Avoid mind reading
3. Check perceptions with others (don’t use this as an excuse to gossip about others, this is simply asking another co-worker, or family member or friend if your perception is correct so that you don’t make a false judgement on someone)
4. Be able to distinguish between the facts and the inferences
5. Monitor the self-serving bias
6. Monitor labels (no matter who you are, where you are from, your station in life, never ever label a person based on the color of their skin, accent, religion; and when and if there is a label make sure you do a back ground check to see whether it is a label you want to use for someone)

And that is that. I missed class today cause I wasn’t feeling good, I won’t give the details :p so I even have more homework for the following few days! Hopefully I will be able to complete all of it by Saturday night because I want to go out on Sunday and have some fun with friends!! Which I think I deserve after three weeks and six turned down invites. Lights out, g’night