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  2. Introduction • Coping refers to a person’s efforts through action and thought to deal with demands perceived as taxing or overwhelming. • It refers to the cognitive and behaviour efforts used to manage stressful encounters.
  3. COPING LOSS Exceeding the resources of the person Situation in which valued object is changed
  4. Coping strategies fall into two categories –
  5. Coping strategies fall into two categories – Problem focused • Problem focused coping is direct; it consists of reducing or eliminating the source of stress itself. Emotion focused • involves trying to reduce the negative emotional responses associated with stress such as embarrassment, fear, anxiety, depression, excitement and frustration.
  6. Problem focused coping It consists of – • Reducing • Eliminating the source of stress itself.
  7. For example (?) • If you are getting poor in history and appraise this as a threat, what you will do in that kind of situation?
  8. Problem focused coping contd… 1. You may study harder 2. Talk over your problem with your professor
  9. Problem focused coping contd… 3. Form a study group 4. Get a tutor
  10. But what can people do when they face stress (loss) that they cannot fight, escape from, avoid or modify in any way?
  11. For example (?) • If you lose your job, what you will do ???
  12. Emotion focused coping contd… • To cope emotionally, people may use anything from  religious faith wishful thinking humour or denial to alcohol, drugs etc.
  13. Emotion focused strategies include: • Keeping yourself busy to take your mind off the issue • Letting off steam to other people • Praying for guidance and strength • Ignoring the problem in the hope that it will go away • Distracting yourself (e.g. TV, eating) • Building yourself up to expect the worse
  14. PROACTIVE COPING • Dealing with stress in advance • It is all about ‘taking aim, getting ready, then firing’. • Mentally it is about thinking differently about the stressful situation. • It means efforts or actions taken in advance of a potentially stressful situation to prevent its occurrence or to minimize its consequences. • Its important feature is action itself. • Self-talk is a popular approach used by athletes to refocus themselves. In the case of cricket, this can be “keep the bat straight” or “keep my eye on the ball”.
  15. Loss • Throughout our lives, from birth to death, we form attachments and suffer losses. We develop independence from our parents, start and leave school, change friends, begin careers, and form relationships. • The more significant the loss, the more intense the grief. Grief is a natural response to loss.
  16. Loss Contd.. • It is the emotional suffering you feel when something or someone you love is taken away. However, even subtle losses can lead to grief. For example, you might experience grief after moving away from home, graduating from college, changing jobs, selling your family home, or retiring from a career you loved.
  17. LOSS • Loss can be tangible or intangible. Loss is any situation in which a valued object is changed or is no longer accessible to the individual.
  18. Loss of external object • It is a type of perceived loss which occurs when a sense of loss is felt by an individual but is not tangible to others. When an object that a person highly values is damaged, changed, or disappears, loss occurs. The valued object may be a person, pet, prized possession, or one’s home.
  19. Loss of familiar environment • The loss of familiar environment occurs when a person moves to another home or a different community, changes schools, or starts a new job.
  20. Loss of aspect of self Psychological Aspect It may be loss of- • Ambition • A sense of humour • Entertainment of life Physiological Aspect • Loss of physical function as a result of injury or illness Psychological loss is such as a woman feeling inadequate after menopause and resultant infertility. For example loss of an extremity in an accident, scarring from burns permanent injury.
  21. Loss of significant others • It is a type of actual loss • Such a loss can be the result of  separation  divorce  running away  moving to different area  theft of one’s property  death.
  22. EXERCISE – (?) TYPE OF LOSS 1. Change of school loss of familiar environment 2. Divorce loss of significant others 3. Scaring from burns loss of physiological aspect of self 4. Infertility loss of psychological aspect of self 5. New job loss of familiar environment
  23. TERMINOLOGY • GRIEF- Grief is a normal process of reacting to the loss. Grief reactions may be felt in response to physical losses (for example, a death) or in response to symbolic or social losses (for example, divorce or loss of a job).
  24. TERMINOLOGY CONTD…. • BEREAVEMENT- It is the period after a loss during which grief is experienced and mourning occurs. The time spent in a period of bereavement depends on how attached the person was to the person who died, and how much time was spent anticipating the loss.
  25. TERMINOLOGY CONTD…. • MOURNING- It is the process by which people adapt to a loss. Mourning is also influenced by cultural customs, rituals, and society’s rules for coping with loss.
  26. THEORIES OF GRIEVING PROCESS • There are four theories who are well known in the field of loss. Erich Lindemann George L Engle John Bowlby J. William Worden
  27. Erich Lindemann • Lindemann coined the phrase “grief work” Grief work includes the processes that a mourner needs to complete before resuming daily life. These processes include separating from the person who died, readjusting to a world without him or her, and forming new relationship (Lindemann, 1944)
  28. George L Engle • Engle gave the theory of mourning. According to him a mourner goes through three stages: Shock and disbelief Developing awareness Restitution and resolution
  29. J. William Worden • Worden (1982) had identified four tasks that an individual must perform in order to successfully deal with a loss: Accept the fact that the loss is real. Experience the emotional pain of grief. Adjust to an environment without the deceased.
  30. How does coping works on all domains of life? Domains Adaptations Biological domain Psychological domain Social domain
  31. Adaptation • Conceptualised as a person’s capacity to survive & flourish. Adaptations or lack of its effects on three important areas:  health  psychological wellbeing and  social functioning • If a person’s copes successfully with stress he or she returns to a previous level of adaptation. Successful coping results in an improvement in health, wellbeing, & social functioning
  32. Biological domain • Biologic Assessment:- The nurse should include a careful health history, focusing on past and present illness & traumas. • Gender Difference: Males are more likely to respond to stressor with a fight or flight response, whereas females has less aggressive responses; they tend and be friend.
  33. Review of system: can also provide important data on the effect of chronic illnesses. These data are useful for understanding the person environment situation and the persons stress reaction, coping response and adaptation. Physical functioning:- Physical functioning usually changes during stress response. Typically, sleep is disturbed, appetite either increases or decreases, body languages expresses muscle tension ,which convey a state of anxiety not usually present.
  34. Pharmacological assessment:- In assessing a person’s coping strategies, nurse needs to ask about the use of alcohol, tobacco, marijuana & other addictive substances. Knowing the details about the person’s use of these substances (number of times a day or week, amount, characteristics’, circumstances, side effects ) helps in determining the role of substances play in overall stress reduction or management .
  35. Psychological domain Psychological Assessment: Psychological assessment focuses on the -person’s emotions & their severity as well as his or her coping strategies by using therapeutic communication technique.
  36. Social domain Social Assessment • Assessment include Recent Life Changes Questionnaire to determine the number & importance of life changes that patient has experienced within the past year. • Size & extent of the network, both relatives & nonrelatives, professional & nonprofessional & how long known. • Functions that the network serves (guidance & advice, access to new contacts)
  37. COPING EFFECTIVELY • The most effective approach is to deal directly with the problem, taking some direct action to change or eliminate it. In fact direct action is the only method of really solving the problem. • If the problem is insoluble, then indirect methods must be used and there are several indirect, positive methods of coping.
  38. COPING EFFECTIVELY contd… • One such method is to think about the problem differently. • In refraining the problem, also called cognitive restructuring, the individual looks at the problem from a new perspective. • It is defined as more tolerable, less disruptive or simply unimportant.
  39. In addition, the individual can attempt to relive stress reaction. These techniques include two rather opposite approaches. 1. Complete relaxation • Muscle relaxation • Breathing control • Visualization technique in which one imagines relaxation scenes
  40. Contd… 2. Vigorous exercises • Weight training • Aerobics • Athletic competition
  41. Suggestions to help you cope with stress • Exercise- Physical exercise (sports, yoga, dancing and walking)
  42. Suggestions to help you cope with stress contd…. • Meditate- To quiet the body and promote relaxation
  43. Suggestions to help you cope with stress contd…. • Relax- Relax your body regularly through a systematic method of tension and relaxing all of our muscles. • Slow down your pace of life- Move more slowly and deliberately.
  44. Suggestions to help you cope with stress contd… • Organize your life activities with priority- so that you always accomplish what must be done at the right time. • Balance- Balance your life activities with work and play, family and fiends & time for yourself.
  45. Suggestions to help you cope with stress contd… • Make your goals realistic- Understand and accept what you can and cannot do or be. • Develop healthy social relationship- People will support and help you in stressful situation.
  46. Suggestions to help you cope with stress contd… • Practice coping statements- These are things you say to yourself when in a stressful situation. When you are ready to take an examination, for example, “you may be thinking, I am scared”, “I won’t remember the right things”, or “I’m not smart enough to pass”. You would use your coping statements to replace your negative thoughts. Then you would think, I ‘m keyed up & ready to go, “if I forgot something I will just wait for a moment or I will do my very best”. These mental statements are very helpful but must be practiced to be of value.
  47. INEFFICIENT COPING- • Though we respond to everyday problems of adjustment in diverse way but some problems may be inefficient. They may drain our energy, cause needless expenditure of time, prevent us from finding better solutions, and even make us more troubled.
  48. Defence mechanisms • Acting out • Altruism • Anticipation • Denial • Displacement • Dissociation • Distortion • Fantasy • Humour • Hypochondriasis • Idealism • Identification • Intellectualization • Introjections • Isolation • Passive aggression • Projection • Rationalization • Reaction formation • Regression • Repression • Sublimation
  49. REMEMBER THE BASIC WHEN COPING WITH LOSS Healthy strategies when facing a life challenge. Many healthy ways to manage and cope with loss, but they all require change. Change the situation or change your reaction. Unique response to stress, there is no “one size fits all” solution to managing it. Different techniques and strategies for different individuals.
  50. When deciding which option to choose, it’s helpful to think of the four As: avoid, alter, adapt, or accept. Management strategy #1: Avoid unnecessary stress Learn how to say “no Avoid people who stress you out Take control of your environment Avoid hot-button topics Pare down your to-do list
  51. b) Management strategy #2: Alter the situation Express your feelings instead of bottling them up Be willing to compromise Be more assertive Manage your time better. c) Management strategy #3: Adapt to the stressor Reframe problems. Look at the big picture. Adjust your standards. Focus on the positive. Adjusting Your Attitude.
  52. d) Management strategy #4: Accept the things you can’t change Don’t try to control the uncontrollable Look for the upside Share your feelings Learn to forgive e) Management strategy #5: Make time for fun and relaxation Healthy ways to relax and recharge Go for a walk.
  53. Spend time in nature. Call a good friend. Sweat out tension with a good workout. Write in your journal. Take a long bath. Light scented candles Savour a warm cup of coffee or tea. Play with a pet. Work in your garden. Management strategy #5: Make time for fun and relaxation contd…
  54. Management strategy #5: Make time for fun and relaxation contd…  Curl up with a good book  Get a massage.  Listen to music.  Watch a comedy  Set aside relaxation time  Connect with others  Do something you enjoy every day  Keep your sense of humour
  55. Management strategy #6: Adopt a healthy lifestyle  Exercise regularly  Eat a healthy diet  Reduce caffeine and sugar  Avoid alcohol, cigarettes, and drugs  Get enough sleep
  56. OTHER MOST IMPORTANT THINGS TO REMEMBER ABOUT COPING WITH LOSS • Be patient with yourself. • Find healthy ways to let your feeling out. • Let people who are close to you offer their support. • See a counsellor if you feel like you could use help getting through your loss. Written by CYWH Staff at children’s hospital Boston.
  57. NURSING IMPLICATIONS FOR COPING WITH LOSS Loss is a part of life, it may varies from one person to another or even same,  Coping pattern are some coping strategies will be effective for one. Others will be appropriate for different person.  A nurse who is sensitive can choose methods of interventions that will be more effective for each individual.
  58. Assessment Nursing assessment of a client’s stress & coping patterns. – Nursing history – Physical examination of client for indicator of loss. • When obtaining the nursing history, the nurse poses questions related to clients other perception to loss & past & present coping strategies.
  59. • During physical examination, the nurse observes for verbal, motor, cognitive or other physical manifestation of loss. • Remember , however that clinical signs & symptom may not occur when cognitive coping is effective.
  60. NANDA diagnosis related to adaptation & coping Compromised Family Coping: - Usually Supportive primary person provides insufficient, ineffective or compromised support, comfort, assistance or encourage that may be needed by client to manage or master adaptive tasks related to his or her health challenge.
  61. Decisional conflict:- Uncertainly about course of action taken when choice among competing action involves risks, loss or challenge to personal life values. Impaired adjustment:- Inability to modify lifestyles in a manner consistent with the change in health status.
  62. Disabled family coping:- Behaviour of significant persons (family or other primary person) that disables his/her capacities & the client’s capacities to effectively address tasks essential to either person’s adaption to health challenge. Fear:- Response to perceived threat i.e. Consciously recognised as danger.
  63. Ineffective coping:- inability to a valid appraisal of stressors, inadequate choices of practice response or inability to use responses. Post trauma syndrome:- sustained maladaptive response to a traumatic, overwhelming event.
  64. Planning According to the client’s • state of health ,level of anxiety, support, resources, coping mechanism & sociocultural & religious affiliation . The overall goal for experiencing loss related response. • Decrease or resolve anxiety. • Increase ability to manage or cope with loss. • Improve role performance.
  65. Implementation Encouraging health promotion strategies • Exercise:- promote both physical and emotional health. • Nutrition:- optimal nutrition is essential for health and increasing resistance of the body to stress(loss).
  66. Implementation contd… • Rest and Sleep:- It helps to restore the body’s energy levels. • Using Relaxation Techniques:- • To quiet the mind, • Release tension. • Counteract the flight & fight response .
  67. Implementation contd… There are various relaxation techniques • Breathing exercise • Massage • Progressive relaxation • Imagery guidance • Yoga • Meditation
  68. Implementation contd… • Therapeutic touch • Music therapy • Humour & laughter therapy • Biofeedback
  69. Conclusion • Coping helps us to realize the importance of intimacy, job role or death or any type of loss. • Life and its daily activities never stops. Coping with loss provides opportunity to deal with life in difficult situation. • Foundation of stress management.
  70. • Managing stress is all about  taking charge of your thoughts,  Emotions & schedule,  Our environment, and the way you deal with problems. • The ultimate goal is a balanced life,  with time for work,  relationships, relaxation, and fun –  plus the resilience to hold up under pressure and meet challenges head on.
  71. Bibliography • Boyd Ann Mary, Psychiatric Nursing,4th edition, published by Lippincott Williams & Wilkins, Pp 229-234 • Neeb Kathy, Fundamentals Of Mental Health Nursing, Second Edition, Published by F.A Davis Company, Philadelphia. Pp 89-90 • Kozier Barbara, ERB Glenora, Berman Audrey, Fundamental of Nursing, Seventh Edition, Published by pearson education, Pp 1058-1066
  72. Bibliography contd… • mechanisms/ retrieved on 19-2-2012 • good-grief-coping-after-loss retrieved on 19-2-2012 • retrieved on 20-2-2012 • focused-coping.html retrieved on 20-2-2012
  73. Bibliography contd… • blog/archives/367 retrieved on 20-2-2012 • retrieved on 25-2-2012
  74. THANK YOU!