Role-Relationship Pattern



Role-Relationship Pattern






Anticipatory Grieving* (1980, 1996)



DEFINITION

Expectation of disruption in or loss of a familiar pattern or significant relationship(s) (includes people, possessions, job, status, home, ideals, body part, or body process)


DEFINING CHARACTERISTICS


Diagnostic Cues



  • Potential for loss of significant people, possessions, job, status, home, ideals, and parts and processes of the body


  • Verbal expression of distress at potential (anticipated) loss

and one or more of the following:



  • Anger


  • Sadness, sorrow, crying


  • Crying at frequent intervals, choked feeling


  • Change in eating habits


  • Alteration in sleep or dream patterns


  • Alteration in activity level


  • Altered libido


  • Idealization of anticipated loss


  • Developmental regression


  • Alteration in concentration or pursuit of tasks



OUTCOME


Grief Resolution



  • Adjusts to impending loss



Grieving (2006)



DEFINITION

A normal complex process (emotional, physical, spiritual, social, and intellectual responses/behaviors) by which individuals, families, and communities incorporate an actual, anticipated, or perceived loss into their daily lives


DEFINING CHARACTERISTICS


Diagnostic Cues



  • Experience of loss

and one or more of the following:



  • Alteration in activity level


  • Alterations in immune function


  • Alterations in neuroendocrine function


  • Alterations in sleep patterns


  • Alterations in dream patterns


  • Anger


  • Blame


  • Detachment


  • Despair


  • Disorganization


Supporting Cues



  • Maintaining the connection to the deceased


  • Making meaning of the loss


  • Experiencing relief


  • Pain


  • Panic behavior


  • Personal growth


  • Psychological distress


  • Suffering




OUTCOME


Grief Resolution



  • Adjusts to loss


ETIOLOGICAL OR RELATED FACTORS



  • Anticipatory loss of significant object (e.g., possession, job, status, home, parts and processes of body)


  • Anticipatory loss of a significant other


  • Death of a significant other


  • Loss of significant object (e.g., possession, job, status, home, parts and processes of body)



Complicated Grieving (2006)



DEFINITION

A disorder that occurs after the death of a significant other, in which the experience of distress accompanying bereavement fails to follow normative expectations and manifests in functional impairment


DEFINING CHARACTERISTICS


Diagnostic Cues



  • Prolonged decrease in functioning (life roles)


  • Decreased sense of well-being


  • Lack of acceptance of the loss (e.g., death)

and one or more of the following:



  • Depression


  • Experiencing somatic symptoms of the deceased


  • Fatigue


  • Grief avoidance


  • Low levels of intimacy


  • Persistent emotional distress


  • Persistent painful memories


  • Preoccupation with thoughts of the deceased


  • Rumination, longing, and searching for the deceased


  • Separation distress


  • Verbalizes anxiety, distress


  • Verbalizes feeling dazed and empty


  • Verbalizes feeling in shock or stunned


  • Verbalizes feelings of anger and self-blame


  • Verbalizes feelings of detachment from others


  • Verbalizes feelings of disbelief


  • Verbalizes feelings of mistrust


  • Yearning



RELATED FACTORS



  • Emotional instability


  • Lack of social support



OUTCOME


Grief Resolution



  • Adjusts to loss



Risk for Complicated Grieving (2006)



DEFINITION

Presence of risk factors for a disorder that occurs after the death of a significant other, in which the experience of distress accompanying bereavement fails to follow normative expectations and manifests in functional impairment


RISK FACTORS



  • Death of a significant other


  • Emotional instability


  • Lack of social support



OUTCOME


Grief Resolution



  • Adjusts to loss



Dysfunctional Grieving* (1980, 1986, 2004)



DEFINITION

Extended length or severity of grieving process (unresolved grieving) following an actual or perceived loss or change in pattern of relationships (includes people, possessions, job, status, home, ideals, and parts and processes of the body)


DEFINING CHARACTERISTICS


Diagnostic Cues



  • Verbal expression of distress/despair at a loss or denial of loss

and one of the following:



  • Arrested grieving process before resolution


  • Prolonged grieving beyond expected time for cultural group


  • Emotional response more exaggerated than expected for cultural group (severity of reaction)


Supporting Cues



  • Alterations in concentration and/or pursuits of tasks


  • Expression of guilt, self-criticism


  • Expression of unresolved issues


  • Sadness, anger, crying, labile affect


  • Difficulty in expressing meaning of loss


  • Alterations in activities of daily living: work, socialization, altered libido, change in eating habits, change in sleep-dream pattern


  • Idealization of lost object


  • Reliving past experiences, developmental regression


  • Death anxiety




OUTCOME


Grief Resolution



  • Adjusts to actual loss


ETIOLOGICAL OR RELATED FACTORS



  • Loss or perceived loss or change (specify)


  • Unavailable support systems


HIGH-RISK POPULATIONS



  • Preloss neuroticism


  • Frequent major life events, changes


  • History of psychiatric or mental health disorder


  • Congenital anomaly


  • Perinatal loss (later gestational age, length of life of infant, marital adjustment problems, past perinatal losses, absence of other living children)



Chronic Sorrow (1998)



DEFINITION

Cyclical, recurring, and potentially progressive pattern of pervasive sadness, experienced in response to continual loss, throughout the trajectory of a chronic illness or disability


DEFINING CHARACTERISTICS



  • Describes differences or gap between current and former or desired situation


  • Expresses one or more of the following feelings that vary in intensity, are periodic, may progress and intensify over time, and may interfere with the client’s ability to reach the highest level of personal and social well-being:



    • Periodic, recurrent feelings of sadness


    • Anger


    • Being misunderstood


    • Confusion


    • Depression; loneliness; emptiness


    • Disappointment; frustration


    • Fear


    • Guilt or self-blame


    • Helplessness; hopelessness; overwhelmed


    • Low self-esteem


    • Loss (recurring)



OUTCOME


Psychosocial Adjustment: Life Change



  • Adaptation to significant life change


ETIOLOGICAL OR RELATED FACTORS



  • Chronic or life-threatening illness or disability (specify mental retardation, multiple sclerosis, infertility, cancer, Parkinson’s disease, prematurity, spina bifida or other birth
    defects, chronic mental illness [e.g., schizophrenia, bipolar disorder, autism, dementia])


  • Death of a loved one


  • One or more trigger events (those circumstances, situations, and conditions that bring the disparity resulting from the loss experience clearly into focus or that exacerbate the experience of disparity):



    • Crises in management of the illness


    • Crises related to developmental stages and missed opportunities or milestones (that bring comparisons with developmental, social, or personal norms)


    • Unending caregiving or other role changes that serve as a constant reminder of disparity between self and others


HIGH-RISK POPULATIONS



  • Individual or family caregiver experiencing continual loss throughout the trajectory of a chronic or life-threatening illness


  • Bereaved individual in response to loss of a loved one


  • Anatomical defect (e.g., cleft palate; altered neuromuscular visual system, auditory system, or phonatory apparatus)



Ineffective Role Performance (Specify) (1978, 1996, 1998)



DEFINITION

Change, conflict, denial of role responsibilities or inability to perform role responsibilities (specify type; this is a broad taxonomic category)


DEFINING CHARACTERISTICS



  • Denial of role


  • Conflict in roles


  • Change in self-perception of role


  • Change in others’ perception of role


  • Change in physical capacity to resume role


  • Lack of knowledge of role


  • Change in usual patterns of responsibilities:



    • Role overload


    • Role dissatisfaction


    • Role confusion


    • Role strain


    • Role ambivalence



OUTCOME


Role Performance



  • Role behavior consistent with role expectation



Unresolved Independence-Dependence Conflict



DEFINITION

Need and desire to be dependent, with a therapeutic, maturational, or social expectation to be independent; or need and desire to be independent, with a therapeutic, maturational, or social expectation to be dependent


DEFINING CHARACTERISTICS


Diagnostic Cues



  • Repeated verbal expressions of desire for independence (in situations that require some dependence: therapeutic, maturational, social)

or



  • Repeated verbal expressions of desire for dependence (in situations that require independence; therapeutic, maturational, social)

and one or more of the following:



  • Expression of anger


  • Anxiety



OUTCOME


Conflict Resolution



  • Acceptance of need for both independence and dependence


HIGH-RISK POPULATIONS



  • Spinal cord injury


  • Adolescents


  • Bed rest confinement


  • Degenerative chronic disease


  • Physical activity restrictions



Social Isolation or Social Rejection* (1982)



DEFINITION

Condition of aloneness experienced by the individual and perceived as imposed by others and as a negative or threatening state


DEFINING CHARACTERISTICS


Diagnostic Cues

One or more of the following:



  • Expresses feelings of aloneness imposed by others, feelings of rejection, feelings of difference from others


  • Shows behavior unaccepted by dominant cultural group


  • Expresses values acceptable to subculture but unacceptable to dominant cultural group


  • Observed or expressed interests or activities inappropriate or not acceptable for the developmental age or stage


Supporting Cues



  • Preoccupation with own thoughts, repetitive meaningless actions


  • Perceived inability to meet expectations of others or insecurity in public


  • Seeks to be alone or to exist in a subculture


  • Perceived inadequacy of significant purpose in life or absence of purpose in life


  • Sad, dull affect


  • Uncommunicative, withdrawn, no eye contact


  • Projects hostility in voice, behavior



OUTCOME


Social Involvement



  • Interacts with others and participates in activities



ETIOLOGICAL OR RELATED FACTORS



  • Alteration in physical appearance or mental status


  • Developmental delay (social skills)


  • Immature interests


  • Unacceptable social behavior or values


  • Altered state of wellness


  • Inability to engage in satisfying personal relationships


HIGH-RISK POPULATIONS



  • Mental disorders


  • Observable disabilities, stigmata


  • Retardation



Social Isolation



DEFINITION

Feelings of aloneness attributed to interpersonal interaction below level desired or required for personal integrity


DEFINING CHARACTERISTICS


Diagnostic Cues



  • Verbalization of isolation from others

and one or more of the following:



  • Lack of contact with, or absence of, significant others


  • Absent or limited contact with community


  • Low contact with peers


Supporting Cues



  • Apathy


  • Seclusion



OUTCOME


Social Involvement



  • Interacts and participates in activities with others


ETIOLOGICAL OR RELATED FACTORS



  • Impaired mobility


  • Therapeutic isolation


  • Sociocultural dissonance


  • Insufficient community resources


  • Body image disturbance


  • Fear (environmental hazards, violence)


HIGH-RISK POPULATIONS



  • Frail elderly


  • Therapeutic isolation


  • Disfigurement



Impaired Social Interaction (1986)



DEFINITION

Insufficient or excessive quantity or ineffective quality of social exchange


DEFINING CHARACTERISTICS


Diagnostic Cues



  • Verbalized or observed discomfort in social situations (e.g., inability to receive or communicate a satisfying sense of belonging, caring, interest, or shared history)


  • Observed use of unsuccessful social interaction behaviors


Supporting Cues



  • Dysfunctional interaction with peers, family, others


  • Family report of change of style or patterns of interaction



OUTCOME


Social Involvement



  • Productive social interactions with persons, groups, or organization


ETIOLOGICAL OR RELATED FACTORS



  • Knowledge or skill deficit (ways to enhance mutuality)


  • Communication barriers


  • Self-concept disturbance


  • Absence of available significant others or peers (support system deficit)


  • Limited physical mobility


  • Therapeutic isolation


  • Sociocultural dissonance


  • Environmental barriers


  • Altered thought processes


  • Sensory deficit (vision, hearing)



Developmental Delay: Social Skills (Specify)



DEFINITION

Demonstrates deviations from age-group norms in acquisition of social skills


DEFINING CHARACTERISTICS


Diagnostic Cues



  • Delay or difficulty in acquisition of social interaction skills typical of age-group or developmental level


  • Dysfunctional interactions



OUTCOME


Social Development



  • Acquisition of social skills is within age-group norm


ETIOLOGICAL OR RELATED FACTORS



  • Environmental, stimulation, modeling deficiencies


  • Inconsistent responsiveness


  • Multiple caretakers, inadequate caretaking


  • Separation (from significant others)


  • Physical disability effects


  • Indifference


  • Self-esteem disturbance


  • Social isolation



Relocation Stress Syndrome* (1992, 2000)



DEFINITION

Physiological and psychosocial disturbances resulting from transfer from one environment to another


DEFINING CHARACTERISTICS


Diagnostic Cues



  • Change in environment or location


  • Anxiety, apprehension, verbalization of being concerned or upset about transfer


  • Reactive depression, sad affect, and/or increased confusion (elderly population)


  • Expressions of loneliness


  • Feeling of powerlessness or anger regarding move


  • Sleep pattern disturbance and/or change in eating habits, gastrointestinal disturbances


Supporting Cues



  • Moderate to high degree of environment change


  • Unfavorable comparison of posttransfer with pretransfer staff


  • Little or no preparation for impending move


  • History of previous transfers (same or different type)


  • Losses involved with decision to move


  • Concurrent, recent, past losses


  • Dependency


  • Insecurity, lack of trust


  • Support system deficit


  • Restlessness, vigilance, or withdrawal


  • Weight change


  • Impaired or decreased health status (psychosocial/physical)




OUTCOME


Stress Level



  • Low physical or mental tension resulting from factors that alter existing equilibrium


HIGH-RISK POPULATIONS



  • Lack of predeparture counseling/support


  • Language barrier


  • Isolation from family/friends


  • Unstable health status



Risk for Relocation Stress Syndrome (2000)



DEFINITION

Risk for physiological and psychosocial disturbances resulting from transfer from one environment to another


RISK FACTORS

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Jun 12, 2016 | Posted by in NURSING | Comments Off on Role-Relationship Pattern

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