Psychology

• There are three types of neurons: sensory (afferent), motor (efferent), and interneuron.
• Stress is a non specific response of the body to any demand
• The autonomic nervous system has two branches, sympathetic and parasympathetic
• Parasympathetic branch restores homeostasis when stressor removed
• Sympathetic branch prepares us for action by increasing heart rate, blood pressure, respiration, etc.
• Hypothalamus controls pituitary gland which releases hormones that control other endocrine glands
• Sympathetic branch prepares us for fight or flight
• Freeze Response - decreases movement, heart rate, breathing, and digestion
• Fight or Flight Response - increases heart rate, blood pressure, respiration, sweating, pupil dilation, muscle tension, and glucose levels
• Endocrine system uses hormones to regulate bodily functions
• Adrenal medulla produces adrenalin
• Adrenal cortex produces steroid hormones such as aldosterone and cortisol
• Adrenal medulla secretes adrenalin into bloodstream
• Cortisol increases glucose levels in blood stream
• Adrenal cortex produces steroid hormones such as cortisol
• Fight response - increases muscle strength, heart rate, and adrenalin
• Diathesis model
• Loss


  Perceived deprivation of either a physical or psychological possession or status
• Bereavement is considered to be grief due to the death of a person
• Mourning


  Outward expression of grief e.g. crying, looking sad, rolling on the ground, etc.
• Doctors and nurses work with many people who experience different types of loss. Coping mechanisms determine the person’s ability to face and accept loss
• Grief is a natural response to loss. It is intense sadness that results from the loss of a possession or status. Clinicians and nurses assist patients/clients in understanding and accepting loss so that life can continue
• Normal grief symptoms


  • Disbelief, shock, numbness, feelings of unreality, anger, feelings of guilt, sadness and tearfulness, preoccupation with the deceased, disturbed sleep and appetite, occasionally weight loss, seeing or hearing the voice of the deceased
• Typical grief reaction lasts up to 12 months (mean 6 months) but cultural differences exist
• Models that describe dying and bereavement demonstrate that these processes usually involve a series of stages and that individuals take varying lengths of time in each stage and may move from one to the other and back again. Each individual’s reaction to loss is unique and there is no right or wrong way to grieve
• Death can be defined as the permanent end of the life of a person. A dying person is one who is very ill and is likely to die soon
• Signs of impending death

  Loss of muscle tone, changes in vital signs, slowing of circulation, sensory impairment
• Grieving process


  Denial, Anger, Bargaining, Depression, Acceptance
• Maladaptive response to loss can include symptoms outside the normal range e.g. preoccupation with feelings of worthlessness, excessive guilt, marked slowing of thoughts and movements, a prolonged period of not being able to function normally, hallucinations
• Mal adoptive response to loss

  • Preoccupation with feelings of worthlessness (or thoughts of death), excessive guilt, marked slowing of thoughts and movements, prolonged period of not being able to function normally, hallucinatory experiences, reliance on mal adoptive coping strategies such as alcohol or drug misuse
• Mal adoptive response symptoms

  • Hostility against specific people
  • Alteration in relationships with friends and family
  • Agitation
  • Insomnia
  • Feelings of worthlessness
  • Extreme guilt
  • Suicidal tendencies
  • Inability to discuss the loss without crying
  • False euphoria
• Individuals with prolonged grief may require long-term support, referral to psychiatric help, or counseling
• Management of a person dealing with loss

  Goals: resolve grief, accept the reality of the loss, regain self-esteem, renew normal activities and relationships, meet physiological needs
• Normal grief does not require specific treatment. Abnormal grief or clinical symptoms of depression/anxiety may require treatment with antidepressants and supportive counseling
• Management of a person with chronic illness

  Promoting comfort, maintaining independence, preventing loneliness and isolation, promoting spiritual comfort, supporting the grieving family
• Provide adequate pain relief

  eg. Aspirin or paracetamol. If pain persists, consider morphine or pethidine. Maintain comfort and dignity, massage and deep breathing exercises may help relaxation. Keep the patient nourished and hydrated
• Grieving is an individual process and resolution of loss does not follow a set schedule. Bereavement support should be available before and after the person dies
• People's responses to loss may be affected by circumstances of the death. Bereavement counseling should provide an opportunity to talk about events leading up to the death, the death itself, and observances and rituals after the death
• Reassure people that feelings of disbelief, denial, sadness, pain, and anger are normal. Allow expression of feelings and concerns to facilitate acceptance of loss and looking towards the future
• Provide psychological care


  Clients and families may experience anxiety, depression, altered body image, denial, powerlessness, uncertainty, and isolation towards the end of life. Support in managing symptoms, creating a support system, feeling safe, and finding meaning in circumstances