Nursing Diagnoses in Psychiatric Nursing Care Plans and Psychotropic Medications

(^392) Stage V: Acceptance.Stage IV: Depression.^ ment. If this is an impending death of self, the individual is The person acknowledges the loss, or impending loss, but holds out hope for additional alternatives, as evidenced by such statements as, “If only I could...” or “If only I had... .”drawn, seemingly devoid of feelings. These behaviors are increasingly interested in other aspects of the environ-has been or will be lost. This is a very painful stage, dur-ing which the individual must confront feelings associated with having lost someone or something of value (called reactiveThe client is less preoccupied with what has been lost and who is mourning a change in body image. Feelings associ-ated with an impending loss (called methods for coping with the loss have been established. ●are also confronted. Examples include permanent life-style changes related to the altered body image or even an impending loss of life itself. Regression, withdrawal, and social isolation may be observed behaviors with this stage. Therapeutic intervention should be available, but not imposed, and with guidelines for implementation based on client readiness.ready to die. The person may become very quiet and with-accepts or is resigned to the loss. Anxiety decreases, and the behaviors associated with the other stages and either^ SPECIAL TOPICS IN PSYCHIATRIC depression). An example might be the individual The individual has worked through The individual mourns for that which preparatory depression)

2 2506_Ch24_390-405.indd 0392 506 Ch 24 390 - 405 .indJOHNvalue, even in infants as young as 6 months.implied that these behaviors can be observed in all individu-als who have experienced the loss of something or someone of John Bowlby hypothesized four stages in the grief process. He d 0 Stage III: Disorganization and Despair.Stage I: Numbness or Protest.Stage II: Disequilibrium. 39 2 has a profound urge to recover what has been lost. Behaviors associated with this stage include a preoccupation with the ated with the loss.Reality of the loss is not acknowledged.an attempt to facilitate the passage by slowly disengaging despair occur in response to the realization that the loss has occurred. Activities of daily living become increasingly disorganized, and behavior is characterized by restlessness by a feeling of shock and disbelief that the loss has occurred. self and others, and feelings of ambivalence and guilt associ-from the environment.loss, intense weeping and expressions of anger toward the BOWLBY During this stage, the individual This stage is characterized Feelings of 1 10/1/10 9:38:45 AM 0 / 1 / 10 9 : 38 : 45 AM