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Factors affecting sleep

Sleep quality- subjective characteristics determined by whether a person wakes

up feeling energetic or not
Quantity of sleep- total time the individual sleeps
1. Illness

illness that causes pain and or physical distress (ex. Arthritis, back pain) resulting
a sleeping problems

they require more sleep than normal, and the normal of sleep and wakefulness is
often disturbed

-Respiratory conditions- shortness of breath, nasal congestion, or sinus drainage
-the need to urinate during night

2. Environment

promotes or hinder sleep

noise, discomfort from environmental temperature, lack of ventilation, light levels,

comfort and size of bed, person around the client who snores, diff sleeping
habits, and other sleeping difficulties

3. Emotional Stress

stress is considered to be number 1 cause of short term sleeping difficulties

person preoccupied with personal problems may be unable to relax sufficiently to

get sleep.

anxiety increases noripinephrine blood levels through stimulation of SNS

it change results in deep sleep and REM sleep and more stage changes and

4. Lifestyle


Following an irregular morning and night time schedule can affect sleep.

The persons ability to relax before retiring is an important factor affecting the
ability to fall asleep.

Stimulants and Alcohol

caffeine-containing beverages stimulates the CNS

drinking it in afternoon or evening may interfere with sleep

alcohol disrupts REM sleep

alcohol-tolerant person may be unable to sleep well and become irritable as a


weight gain is associated with reduced total sleep time, broken sleep and earlier

weight loss, associated with an increase in total sleep time and less broke sleep

6. Diet

7. Smoking

nicotine has a stimulating effect resulting of more difficulty falling asleep than
non smokers do.

they often describe themselves light sleepers

8. Motivation

it increases alertness in some situations

boredom is not sufficient to cause sleepiness but when insufficient sleep

combines with boredom, sleep is likely to occur



some medications affect the quality of sleep

Drugs that disrupt REM sleep, delay onset of sleep, decrease sleep time:
Alcohol, amphetamines, antidepressants, beta blockers, bronchodilators,
caffeine, decongestants, narcotics, steroid

Grief, Bereavement, and Mourning

Grief (kalungkutan)

is total response to the emotional experiences related to loss. Manifested in thoughts,

feelings and behaviours associated with overwhelming distress or sorrow.

grieving is essential for good mental and physical health

permits individual to cope with the loss gradually and to accept it as part of reality

social process

best shared and carried out with the assistance of others

accompanied by anxiety, depression, weight loss, difficulties in swallowing, vomiting,

fatigue, headaches, dizziness, fainting, blurred vision, skin rashes, excessive sweating,
menstrual disturbances, palpitations, chest pain, dyspnea

Bereavement (pangungulila)

the subjective response experienced by the surviving loved ones after the death of a
person with whom they have shared a significant relationship

accompanied by alterations in libido, concentration, patterns of eating, sleeping, activity

and communication

Mourning (pagluluksa)

behavioral process through which grief is eventually resolved or altered; often influenced
by culture, spiritual beliefs, and custom.

Types of Grief responses

normal grief reaction may be abbreviated or anticipatory

1. Abbreviated grief- brief but genuinely felt; occurs when the lost object is not
significantly important to the grieving person or may have been replaced immediately by
another, equally esteemed object.
2. Anticipatory grief- experienced in advance of the event
-grief is expressed in anticipation
3. Disenfranchised grief-occurs when a person is unable to acknowledge the loss to
other persons.
-situations that relate to a socially unacceptable loss that cannot be spoken about
-examples: abortion, suicide, giving child for adoption, loses of relationship that are
socially unsanctioned
4. Complicated grief
-pathologic, unhealthy grief
-exists within the strategies to cope with the loss are maladaptive
-factors like traumatic loss, family or cultural barriers, emotional expression of grief,
sudden death, strained relationship between survivor and deceased and lack of
adequate port of survivor

Forms of Complicated grief

1. Unresolved or chronic grief- extended in length and severity
2. Inhibited grief- many of normal symptoms of grief are suppressed and other effects
including somatic, are experienced.
3. Delayed grief- occurs when feelings are purposely or subconsciously suppressed
until a much later time
4. Exaggerated grief- appears to be using dangerous activities as a method to lessen
pain of grieving.

Factors influencing the loss and grief responses

1. Age- affects person's understanding of and reaction to loss. With familiarity, people
usually increase their understanding and acceptance of life, loss and death

-differs from adult not only in understanding but also how they are affected by the loss of
-it can threaten a child's ability to develop, and regression sometimes results.
-they can feel afraid, abandoned, and lonely
-it can a serious effects later in life

Early and Middle Adulthood

-as people grow, they come to experience loss as part of normal development

Late adulthood
-losses experienced by older adults include loss of health, mobility, independence, and
work role.
-for older adults, the loss through a death of a long time mate is profound

2. Significance of the loss

-depends on the perceptions of the individual experiencing loss
-factors: important of the person, object or function; degree lf change required because
of loss; the person's belief and values
3. Culture
-influences individuals reaction to loss.
-Some persons have adopted the belief that grief is a private matter to be endured
-some cultural groups value social support and expression of loss.
-some groups expressions of grief is through wailing, crying, physical prostration and
other outward demonstrations are acceptable and encouraged
-other groups favour a more quiet and stoic expression of grief
4. Spiritual belief
-spiritual beliefs and practices greatly influence both peoples reaction to loss and

subsequent behaviour.
-most religious groups have practices related to dying and these are often important to
the client and support people
-to provide support at a time of death, nurses need to understand the client's particular
belief and practices.
5. Gender
-men are frequently expected to "be strong" and show very little emotion during grief,
whereas acceptable for women to show grief by crying
6. Socioeconomic status
-it often affects the support system available at the time of the loss
7. Support system
-the people closest to the grieving individual are often the first to recognize and provide
needed emotional, physical, and functional assistance
8. Cause of Loss or Death
-individual and societal views on the cause of loss or death may significantly influence
the grief response.