Question

Reflect: The Concept of Grief and Loss Josie Duncan is a 32-year-old African American woman whose 7-year-old daughter, Tasha, died 3 months ago after fighting leukemia. Mrs. Duncan took a week off from work after her daughter died and then returned to her job. She visits her primary care physician's office complaining of difficulty falling asleep over the past 2 weeks. After checking her vital signs, weight, and temperature, you notice that Mrs. Duncan has lost 15 pounds since her last visit 6 months ago. Her blood pressure and temperature are both normal. You observe that she looks exhausted and has deep circles under her eyes; the clothes she is wearing are at least a size too large. She also seems to be very distracted. Question 1 Why might Mrs. Duncan be having trouble sleeping? Question 2 What are some factors that influence an individual's grief response? Question 3 What additional questions would you want to ask Mrs. Duncan? Why?

Answer 1

1. Mrs. Duncan might be having trouble sleeping due to insomnia caused due to the grief reaction from the loss of her child. Often complex somatic and psychological issues may arise from a grief reaction. The person who experiences a loss may feel shocked with numbness, denial, anger, sadness, guilt, depression, helplessness, and yearning.

2. Some factors influencing an individual's grief response are:

• Age
• Significance of loss
• Cause of loss
• Spiritual beliefs
• Culture
• Support system
• Socioeconomic status

3. Additional questions to Mrs. Duncan and reasons to ask them:

• Could you please explain your sleep pattern before the loss of your child? Do you have any previous incidents of insomnia? The answer to these questions will shed some light on the sleeping pattern of Mrs. Duncan in general and any previous incidents of insomnia.
• How was your grief response with the loss of any other close relative or friend? This answer would lead me to calculate the average time the patient will take to overcome this grief reaction.
• Do you like to be part of any grief reaction support system for some more time? A grief reaction support system provides the necessary support to the grieving person and would help her overcome insomnia and psychological condition, which might be causing weight loss.