Grief and Loss in Adolescence: Principles, Responses and Challenges

Grief and privation atomic number 18 positive looking ats of flavor they are inevitabilities that stem from our mortality and our natural propensity to take deep worked up bonds with those closest to usour family, jocks and colleagues.Perhaps C. S. Lewis captured the supporter of distress go around when he said No one ever told me that sadness mat up so like fear.I am non afraid, but the sensation is like be afraid. The same fluttering in the stomach, the same restlessness, the yawning. I keep on swallowing. C. S. Lewis, A Grief Observed How one physically manifests grief whitethorn vary between age groups and cultures but it is a universal occurrence in homos who are of normal cognitive development.In this paper, grief and loss will be reviewed in the context of Wordens principles and theories specifically, what these principles say astir(predicate) grief and loss, how they might apply to the adolescence demographic, what challenges the wellness take succeedr mi ght expect to encounter when snuff iting with a suffer adolescent, and how a health shell out provider can best suffice to a grieving juvenileager. A series of hypothetical acute address settings will be presented to illustrate how a nurse might best proceed in responding to a grieving adolescent.Death during AdolescenceAdolescence is a transitionary stage of life that poses unique challenges for the individual. Change is the hallmark of this developmental period as puerileagers oppose with hormonal changes, newfound desires for independence, confidence issues, and concerns about body image. Grief and loss during this stage of life, whether it be the loss of a call down, relative, or close friend, frequently greatly exacerbates the emotional state of a immature who is already experiencing the stresses associated with the transition from child to adult.According to Metzgar, typical grief responses of teenagers include resentment, depression, withdrawal, frustration, co nfusion, snatching out, and noncompliance (Metzgar, 2002). impertinent young children, who a good wish do not fully contemplate the decisiveness of termination, adolescents are usually aware that closing is final (Freeman, 2005). According to Freeman, adolescents withdraw the mature intellectual development necessary to understand the core concepts of deathuniversality, non-functionality, irreversibility, and causalityand can elucidate fully the details (Freeman, 2005).This greater accord of death places adolescents closer to adults on the level of death awareness however, teens whitethorn wonder if a dead per parole will return this thinking whitethorn include supernatural elements as teens often associate an unannounced death or serious illness with a supernatural core or cause (Brewster, 1982). An adolescents grief cover to it is extremely personal in nature, and unlike adults, teens tend to grieve more intensely.Often their grief response is not expressed smoothly or continuously but takes the form of a series of punctuated outbursts in some looks an adolescent may shoot a concerted effort to control his or her emotions (Worden, 1996). In attempting to control their emotions, a teen may retreat inwardly by immersing themselves in highly personal activities much(prenominal) as reading, writing, listening to music, or exercising in another(prenominal) cases, a teen may want to acquittance the anger and sadness associated with their grief in this case, he or she may act out angry or antisocial behavior (Worden, 1996).Of particular enormousness from a health fretfulness 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 being a phenomenon that is distant from them, is abruptly challenged. In the case of the death of a peer, death is often suddenin an American study, the three in the lead causes of death in the 15 to 24 course of instruction-old age group are accidents, homicide, and suicide (Minino and Smith, 2001).In such cases, a teens sense of pseudo-immortality is often shattered (Freeman, 2005). The trauma associated with this may cause a teen to experience an overwhelming sense of military servicelessness or powerlessness (Aronson, 2005). In the case of the loss of one or both parents, a teen may experience a grief reaction that is unique for their age demographican irrational wrong-doing associated with the normal desire to detach from their parents (Freeman, 2005). For the health care doer, it is crucial that this particular grief reaction is considered when helping a teen deal with the loss of one or both parents.Theoretical Principles Grief and redness according to Worden.In Grief Counseling and Grief Therapy, Worden conceptualizes the dish out of grief into a f ramework of four tasks that he proposes need to be address and absolute before the process of mourning can be concluded (Worden, 1991). Wordens four task paradigm consists ofTask 1. To accept the reality of the lossTask 2. To work through the pain of griefTask 3. To adjust to an environment in which the dead person person is missingTask 4. To emotionally relocate the deceased and drop dead on with lifeAccording to Worden, children and teens, like adults, moldiness notice and accept the reality and finality of death before they can start out 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 developed and in tune with that of an adults. In bless to help facilitate acknowledgement of loss, a health care worker needs to explain the circumstances of the loss in a dustup that is both accurate and age appropriate.Since due date levels vary within the teen demographic, one must not assume a given maturity level based on age in this case the carer should make a concerted effort to determine the maturity level of a teen through dialogue and observation (Smead, 1994). In task two, Worden suggests that the agonised emotions associated with grief need to be worked through. By working through, Worden suggests that emotions need to be released in a healthy manner such that a teen is able to cope with the nature of their loss.In this case, the carer needs to advert the teen with beginning uphelping the teen discuss their fears and anxieties in a non-judgmental way. supporting(a) teens to express their grief through creative arts and by engage in rituals can be therapeutic in this regard. (Silverman and Nickman, 1999) In Wordens third task, adjusting to the loss of a deceased peer, sib or parent requires that the adolescent develop an reconcileation to this loss.Adaptation will be heavily influenced by what role the deceased played in the teens life often this a daptation requires an extended period of adjustment (Worden, 1991). In this case, the health care workers role is to help the teen adapt to the loss of old roles (roles associated with the deceased) and adjust to the emergence of new roles (roles previously associated with the deceased now taken up by other individuals). In Wordens final task, the deceased are relocatedthey are placed in an appropriate emotional place such that the bereaved can move on with their lives.For many bereaved individuals, relocation may involve the excogitate of existential questions Where did the deceased go? Why did they die? Is there a Heaven? Children and teens are often more open to supernatural explanations, and in this case, belief in an afterlife can be therapeutic as it helps the individual maintain a healthy and tangible link to the deceasedit may give the bereaved a sense that the deceased is observation over me from Heaven (Silverman, Nickman and Worden, 1992).Grief and Loss in the Acute Care put A Nurses RoleWhen a nurse is expected to provide emotional care to a bereaved teen, he orshe 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 next hypothetical case studies, a nurse will offer emotional support directed specifically at teens whom are experiencing several(predicate) stages of grief as outlined by Worden. The question to be answered in separately case is this What would be the most appropriate nursing response? In each case, as the attending nurse, you will note the individuals age, statements, stress level, and physical demeanor.Case Study One The immediate loss of a best friend tomcat is an 18 year old who has been admitted to a infirmary sine qua non 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 Youre all lying Bret is not dead He cant be dead He cant be Its my fault Bret is shaking. responseUsing pity but clear and direct language you reaffirm that Bret has died. You show empathy to Tom but avoid reservation value judgments for him that offer explanations for the death or attribute blame. When interfacing with Toms parents you explain to them the stage of grief their son is going through and how best to assist him through it.Case Study two Working through the loss of a parentSarah is a somewhat uncontrollable 17 year-old with a strong sense of independence. She doesnt always see eye to eye with her mother, Jenifer. Six months previous, Jenifer died abruptly in car accident. Since the accident, Sarah has suffered study anxiety attacks and has been plagued by guilt. At school she has been involved in arguments and fights with other girls on this occasion she is in the school infirmary after conflict with another girl. After initially appearing angry, Sarah breaks down in bustand says Why did my Mom have to die I didnt in truth want her out of my lifeResponseYou consol Sarah, and listen to heryou 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 whenever she feels the need. If interfacing with Sarahs father, explain to him what Sarah is experiencing, and offer helpful suggestions that are in line with Wordens model for task two grief.Case Study Three Adapting to the loss of a siblingJanet and Karen are sisters close in age, 15 and 17 respectively. They were inseparable and enjoyed doing things in concert such as sports, shopping and talking about boys. Janet looked up to Karen who she estimate of as being her pillar of strength and confidant. Last year Karen died suddenly from a rare form of meningitis. Janet has evaluate the loss but has had a hard time readjusting to life without her sister. She is in the hospital being go to to for self inflicted cuts on her arms. Janet states that life is unexciting now because her sister is gone.ResponseWith empathy you help Janet recognize and reassign the emotional roles filled 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 recognizes 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 Janets parents to help them understand how they might be able to assist Janet adjust to life without Karen.Case Study Four Relocating a deceased grandparentFourteen year old Ben loved fishing with his grandfather. Granddad was Bens best friend. originally this year Bens grandd ad 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 receive stitches for a fall Ben asks you Miss, where do dead people go? My Granddad died this year you know. In a melancholy tone he continues, Ill never have a friend like him again.ResponseIn a compassionate tone reply that you are not sure where people go when they die and that it is one of lifes 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. hang on in mind that grief resolution involves reflecting on the meaning of a deceased persons life, and keeping this as a pleasurable 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 b rings with it unique emotional challenges. These challenges need to be addressed by the health care worker if he or she is to in effect 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 making informed decisions that will ultimately 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 manage grief and loss, and move prior with their lives.