Question

Case study to discuss

Eleanor has always loved working with patients at a large cancer center in her city. Recently, however, you have noticed that the loss of one particular patient, Maria, has really been quite a blow for Eleanor. This is not the usual response Eleanor has to a patient’s death, and having worked at the center for 8 years, she has experienced her share of patient deaths.

After Maria’s death, Eleanor wrote a brief post on her Facebook page saying, “Lost a very special person today,” and posting a funny little traditional Irish poem Maria liked to recite. She has also, by invitation, joined a special page Maria’s family has set up to celebrate Maria’s life and share memories.

One day, a few of Eleanor’s colleague’s criticize her for this while you are having lunch with Eleanor in the center’s cafeteria.

“Sharing anything about a former patient is inappropriate,” one nurse tells her.

The other nurse nods. “Even participating or joining the page at all is inappropriate.”

After they leave, Eleanor looks at you, and then buries her face in her hands. “Do you think I was wrong?” she says. “Maria was my patient, I know, but we grew so close over the last months. She and her sisters and I became actual friends. I just thought my happy memories of some of Maria’s good moments might help other people celebrate her life too. In fact, I got very positive feedback from Maria’s family, and even friends of hers that I didn’t know, on the anecdote I shared.”

She lowers her hands and looks at you. “I don’t know. I know, I know, she was a patient, yes, and I was the nurse. But I loved her anyway. Am I unprofessional for grieving like this? Do you think maybe I’m depressed or having some kind of breakdown? What should I do?”

Given the criticism Eleanor has received, what specific type of grief is she most likely experiencing? How might it be contributing to Eleanor’s prolonged pain, and what can you do to help her?

What other types of grief do you know?

Eleanor feels guilty for grieving like this for a patient and worries that she is experiencing depression. Based on what you know, how would you answer? What is the difference between normal grief and major depressive disorder?

This story mentions Eleanor’s participation in celebrating Maria’s life on Facebook. What is your impression of this as a positive or negative contribution—given what you’ve learned from the text?

Answer 1

1) This type of grief is called disenfranchised grief.

Disenfranchised grief is a term describing grief that is not acknowledged by society. Examples of events leading to disenfranchised grief are the death of a friend, the loss of a pet, a trauma in the family a generation prior,^[1] the loss of a home or place of residence particularly in the case of children, who generally have little or no control in such situations, and whose grief may not be noticed or understood by caregivers.

Chronic stress also is common during acute grief and can lead to a variety of physical and emotional issues, such as depression, trouble sleeping, feelings of anger and bitterness, anxiety, loss of appetite, and general aches and pains.

Tips to control the disenfranchised grief:

1. normalize your feelings.
2. help you realize it's OK to mourn.
3. offer a safe, judgment-free space to express grief.
4. provide resources on peer support or self-help groups.

2) Other types of grief are:

a.anticipatory grief

b.normal grief

c.delayed grief

d.complicated grief(traumatic or prolonged)

e.dis enfranchised grief(ambiguous)

f.chronic grief

g.cumulative grief

h.masked grief

i.distorted grief

j .exaggerated grief

k.inhibited grief

l.secondary losses in grief

m.collective grief

n.abbreviated grief

o .absent grief

3) This is not a depression, it was just a grief which can be cured within certain period of time. As she is connected with others,periodically experiencing pleasure and continues functioning.

Differences:

Grief and major depression share several common characteristics. Both may include intense sadness, fatigue, sleep and appetite disturbances, low energy, loss of pleasure, and difficulty concentrating. The key difference is that a grieving person usually stays connected to others, periodically experiences pleasure, and continues functioning as he rebuilds his life. With depression, a connection with others and the ability to experience even brief periods of pleasure are generally missing. Sometimes people describe feeling as if they have fallen into a black hole and fear they may never climb out. Overwhelming emotions interfere with the ability to cope with everyday stressors.

4) Nurses don't realize that what they're posting is a HIPAA violation. Online comments and images violate patient privacy even if they don't mention the patient's name. Talking about PHI is always off-limits, and posting it online is as bad, if not worse.

Nurses cannot post patient identifiable information. Many health organizations also discourage nurses from connecting with or “friending” patients on social media. If the patients and nurses become close online there's a chance they can share personal information.