Grief and Loss in Adolescence: Principles, Responses and Challenges

ruefulness and loss argon primordial prognosiss of life they are inevitabilities that stem from our mortality and our natural propensity to form deep emotional bonds with those approximate to usour family, friends and colleagues.Perhaps C. S. Lewis captured the sensation of melancholy crush when he said No one ever told me that sorrow felt so like fear.I am not afraid, but the sensation is like world afraid. The same fluttering in the stomach, the same restlessness, the yawning. I keep on sw anyowing. C. S. Lewis, A Grief find How one physically manifests grief may vary between age groups and cultures but it is a normal occurrence in humans who are of normal cognitive development.In this paper, grief and loss forget be reviewed in the context of Wordens principles and theories specifically, what these principles say ab come to the fore grief and loss, how they might apply to the adolescence demographic, what challenges the health make out provider might expect to encoun ter when working with a grieving adolescent, and how a health dispense provider asshole outstrip respond to a grieving teenager. A series of hypothetical neat electric charge settings willing be presented to illustrate how a nurse might best proceed in responding to a grieving adolescent.Death during AdolescenceAdolescence is a transitionary floor of life that poses uncomparable challenges for the individual. Change is the hallmark of this developmental point in time as teenagers struggle with hormonal changes, newfound desires for independence, confidence issues, and concerns rough body image. Grief and loss during this stage of life, whether it be the loss of a parent, relative, or jam friend, often greatly exacerbates the emotional state of a teen who is already experiencing the stresses associated with the transition from child to adult.According to Metzgar, typical grief responses of teenagers include anger, depression, withdrawal, frustration, confusion, acting out, and noncompliance (Metzgar, 2002). opposed young children, who often do not fully contemplate the finality of remainder, adolescents are usually awake that last is final (Freeman, 2005). According to Freeman, adolescents sport the mature in carve upectual development necessary to understand the internality concepts of deathuniversality, non-functionality, irreversibility, and causalityand seat elucidate fully the details (Freeman, 2005).This greater understanding of death places adolescents close set(predicate) to adults on the take of death awareness however, teens may wonder if a dead person will return this thinking may include supernatural elements as teens often associate an unexpected death or serious illness with a supernatural event or cause (Brewster, 1982). An adolescents grief statement is highly personal in constitution, and unlike adults, teens tend to grieve more intensely.Often their grief response is not expressed smoothly or continuously but takes the f orm of a series of punctuated outbursts in some(prenominal) cases an adolescent may make 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 such as reading, writing, listening to music, or exercising in other cases, a teen may loss to judgment of dismissal 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 importance from a health dread prospect 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 leading causes of death in the 15 to 24 socio-economic class-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 overpower sense of servicelessness or powerlessness (Aronson, 2005). In the case of the loss of one or some(prenominal) parents, a teen may experience a grief reaction that is unique for their age demographican irrational guilt associated with the normal desire to detach from their parents (Freeman, 2005). For the health guard worker, it is crucial that this particular grief reaction is considered when benefactoring a teen deal with the loss of one or both parents.Theoretical Principles Grief and Loss according to Worden.In Grief Counseling and Grief Therapy, Worden conceptualizes the process of grief into a framework of quadruplet tasks that he suggests need to be addressed and completed 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 by means of the pain of griefTask 3. To adjust to an environment in which the deceased is missingTask 4. To emotionally relocate the deceased and move on with lifeAccording to Worden, children and teens, like adults, mustiness acknowledge and accept the reality and finality of death before they can protrude 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 order to process facilitate acknowledgement of loss, a health care worker needs to explain the circumstances of the loss in a style that is both holy and age earmark.Since maturity levels vary within the teen demographic, one must not assume a given maturity level based on age in this case the ca rer should make a concerted effort to determine the maturity level of a teen through dialogue and placard (Smead, 1994). In task two, Worden suggests that the painful emotions associated with grief need to be worked through. By working through, Worden suggests that emotions need to be released in a heavy manner such that a teen is able to cope with the nature of their loss.In this case, the carer needs to assist the teen with opening uphelping the teen discuss their fears and anxieties in a non-judgmental way. Encouraging teens to express their grief through creative arts and by engaging in rituals can be therapeutic in this regard. (Silverman and Nickman, 1999) In Wordens third task, adjusting to the loss of a deceased peer, sibling or parent requires that the adolescent develop an changeation to this loss.Adaptation will be heavily influenced by what map the deceased played in the teens life often this adaptation requires an extended head of adjustment (Worden, 1991). In thi s 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 set in an appropriate emotional place such that the bereaved can move on with their lives.For many a(prenominal) bereaved individuals, relocation may involve the pondering of existential questions Where did the deceased go? Why did they go across? Is there a Heaven? Children and teens are often more open to supernatural explanations, and in this case, principle 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 ceremonial over me from Heaven (Silverman, Nickman and Worden, 1992).Grief and Loss in the Acute Care Setting A Nurses RoleWhen a nurse is expected to pr ovide 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 following hypothetical case stu take places, a nurse will offer emotional support directed specifically at teens whom are experiencing different stages of grief as out line of creditd by Worden. The question to be answered in each 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 friendTom is an 18 course of study old who has been admitted to a hospital emergency 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 bes t 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 compassionate but clear and direct language you reaffirm that Bret has died. You show empathy to Tom but avoid making 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 or so rebellious 17 year-old with a strong sense of independence. She doesnt always see center of attention to eye with her mother, Jenifer. Six months previous, Jenifer died suddenly in car accident. Since the accident, Sarah has suffered major anxiety attacks and has been plagued by guilt. At school she has been tough in arguments and fights with other girls on this occasion she is in the school infirmary after fightin g with another(prenominal) girl. After initially appearing angry, Sarah breaks down in tearsand says Why did my Mom have to die I didnt really 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 together such as sports, shopping and talking about boys. Janet looked up to Karen who she thought of as being her pillar of strength and confidant. Last year Karen died suddenly from a rare form of meningitis. Janet has accepted the loss but has had a hard time readjusting to life without her sister. She is in the hospital being attended 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 think up 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. Earlier this year Bens granddad died suddenly from a heart at tack. 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. show to Ben that life is about continuing to develop special moments with people we associate with in life. Keep in mind that grief resolution involves reflecting on the meaning of a deceased persons life, and retention this as a pleasant 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 brings with it unique emotional challeng es. These challenges need to be addressed by the health care worker if he or she is to effectively 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 talent scout 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 forward with their lives.