Wednesday, November 13, 2013

The Importance of Social Support and Spirituality in Overcoming Grief

The following article was written by a student of mine, Andrea Nealon, who is a junior in the first semester of the BSN program at UW-Madison School of Nursing. I was impressed by the empathy she demonstrated here, as well as her discussion of evidence-based interventions to help this patient, and I feel it has some important messages for all of us. She's given me permission to share it with you. 

Evidence-based Interventions for Anxiety and Grief 
by Andrea Nealon

This week during clinical at the assisted living community, I met with a lovely woman named E. At the age of 85, she is still in exceptionally good health and enjoys staying active. In the hour that I spent with E, I felt I was able to gain a good sense of her health patterns, and what life experiences have helped shaped her into who she is today. In talking with her, I came to realize how much the death of her husband had on her quality of life, mental health and behavior. Her daughter-in-law, who was present for the entire time, explained to me that E moved to assisted living community in order to ease the debilitating worries that she developed after her husband passed in their home. While both claim that moving to the assisted living center has helped somewhat, my nursing diagnosis for her would be anxiety and grieving related to the loss of her husband. In addition to the daughter-in-law’s description of her debilitating anxieties, this nursing diagnosis is evidenced by her shortness of breath, worried facial expressions and confusion when talking about the situation, and history of having trouble sleeping. With this in mind I began researching ways that nurses can help patients suffering from anxiety, especially elderly widows, ease their worries and regain a sense of peace and comfort.

According to Haugen and Galura (2011), expressing feelings of anxiety and fear are encouraged in helping patients overcome grief. However, E tended to avoid talking about the death of her husband and any of her anxieties with me, and when her daughter brought them up, she became physically tense, anxious, and had trouble communicating. With this in mind, as a nurse, I would encourage E to open up by first establishing a calm environment and trusting relationship between the two of us. This will help them feel secure and more likely to share her emotions with me (Haugen & Galura, 2011). Then, I would encourage E to express her feelings of sadness, anxiety and grief in whatever ways are comfortable to her in order to help decrease her negative feelings associated with the incident. This includes but is not limited to engaging in conversation with myself or family and friends, writing or drawing. This will ultimately help them in the grieving process and allow me to better understand them so that I can provide the best suggestions and give them the best nursing care possible (Haugen & Galura, 2011).

In addition to expressing emotions, research by Stewart, Craig, MacPherson, and Alexander (2001) supports the claim that elderly, bereaved widows have an incredible need for social support. In a study, four face-to-face support groups for widowed seniors were conducted weekly for a maximum of 20 weeks. The results showed a strong correlation between support groups and improved mental health in elderly widows. Specifically, during post intervention interviews, widows reported that the support groups decreased their feelings of loneliness and isolation, enhanced their confidence and hope, gave them a greater sense of competence and self-esteem, helped them gain a fresh perspective and more positive outlook on life, and enabled them to clarify and confirm their new identity and role following the death of their spouse (Stewart et al., 2001). Forming friendships with other widows and sharing coping mechanisms with each other likely contributed to these findings (Stewart et al., 2001). With this in mind, I would suggest that E considers joining a similar support group to help her cope and decrease her anxiety. I would provide her with resources in assisted living community and in the larger community, and also educate her on how these groups can help her. 

Finally, encouraging E to become more involved with her Lutheran religion could help her decrease anxious feelings and improve her quality of life because, according to Huang, Hsu, and Chen (2011), religious involvement is associated with lower levels of anxiety and depression, and is positively related to the psychological well being of older adults (p. 615). In the interview, E explained that her religion was important to her when she was younger, as her and her family would attend church services and pray before mealtimes together. While she explained that she still holds the same beliefs as before, she rarely attends services and does not pray anymore because she no longer lives with her family. Thus, I think re-kindling her spirituality could help E in many ways. First, it would give her a sense of community and more opportunities for social interaction and friendships. Furthermore, according to Huang et al. (2011), “Religion may give the person a clear framework within which to explain and cope with life and hardship, which may mean less worry and stress” (p. 616). Also, “Religious involvement acts as a coping resource to cope and adapt with stressful situations” (Huang et al., 2011, p. 615). Thus, explaining these findings with E and offering resources on local church services could make it easier for her to increase involvement and ultimately reduce feelings of anxiety.

While I cannot begin to understand what E is going through after experiencing the loss of her loved one, I can be sympathetic and provide E and patients like her with suggestions and resources to help. In addition to caring for one’s health concerns, looking at the patient as a whole person is key in being a great nurse. For E, encouraging her to express her feelings, participate in a social support group, and return to her religious involvement are just three realistic ways for her to decrease her anxiety related to the traumatic death of her husband and work towards acceptance and peace.

Haugen, N. & Galura, S.  (2011). Ulrich & Canale's nursing care planning guides, 7th ed. 

Huang, C. Y., Hsu, M. C., & Chen, T. J. (2011). An exploratory study of religious involvement as a moderator between anxiety, depressive symptoms and quality of life outcomes of older adults. Journal of Clinical Nursing, 21, 609-619. doi: 10.1111/j.1365-2702.2010.03412.x

Stewart, M., Craig, D., MacPherson, K., & Alexander, S. (2001) Promoting positive affect and diminishing loneliness of widowed seniors through a support intervention. Public Health Nursing, 18, 1, 54-63.