possibility of the loss or death in the near future
Mourning is the outward expression of grief.
TYPES OF LOSSES
A helpful way to examine different types of
losses is to use Abraham Maslow’s hierarchy
of human needs.
According to Maslow (1954), a hierarchy of
needs motivates human actions.
1. Physiologic loss.
Examples include amputation and loss of
adequate air exchange or pancreatic
2. Safety loss. Loss of a safe environment such as following domestic or public violence. A person may perceive a breach of confidentiality in the professional relationship as a loss of psychological safety secondary to broken trust between client and provider.
3. Loss of security and a sense of belonging. The loss of a loved one affects the need to love and be loved.
4. Loss of self-esteem. Any change in how a person is valued at work or in relationships can
threaten his or her need for self-esteem.
5. Loss related to self-actualization. An
external or internal crisis that blocks or inhibits
strivings toward fulfillment may threaten personal
goals and individual potential (Parkes,1998).
GRIEVING PROCESS 1. Nurses interact with clients responding to a myriad
of losses along the continuum of health and illness.
2. Nurses must have a basic understanding of what is involved to meet the challenge that grief brings to clients.
3. Nurses may promote the expression and release of emotional as well as physical pain, thus supporting the grieving process.
4. Active listening are paramount when assisting grieving clients.
5. Recognizing the verbal and nonverbal communication content of the various stages of grieving.
Theory of the Grieving Process Elisabeth Kubler-Ross (1969) five stages to explain
what people experience as they grieve and mourn:
1. Denial is shock and disbelief regarding the loss.
2. Anger may be expressed toward God, relatives,
friends, or health care providers.
3. Bargaining occurs when the person asks God or
fate for more time to delay the inevitable loss.
4. Depression results when awareness of the loss
5. Acceptance occurs when the person shows
evidence of coming to terms with death.
DIMENSIONS OF GRIEVING
People have many and varied responses to loss.
They express their bereavement in their thoughts,
words, feelings, and actions as well as their
Nurses must use a holistic model of grieving that
encompasses cognitive, emotional, spiritual,
behavioral, and physiologic dimensions.
Cognitive Responses to Grief
viewing the world more realistically, and re-evaluating religious or spiritual beliefs
Emotional Responses to Grief
• “He should have stopped smoking years ago.”
• “If you had taken her to the doctor earlier,
this might not have happened.”
• “It took you too long to diagnose his illness.”
Behavioral Responses to Grief
Nurse must provide a context of acceptance in which the client can explore his or her behavior.
Spiritual Responses to Grief
Finding explanations and meaning through religious or spiritual beliefs, the client may begin to identify positive aspects of grieving
Diverse cultural environment, offers the
sensitive nurse many opportunities to
individualize care when working with grieving
1. Nurse should understands a particular
culture’s appropriate grieving behaviors,
2. Nurse must encourage clients to discover
and use what is effective and meaningful for
Disenfranchised grief is grief over a loss that
is not or cannot be acknowledged openly,
mourned publicly, or supported socially. Three
categories of circumstances can result in
• 1. A relationship has no legitimacy.
• 2. The loss itself is not recognized.
• 3. The griever is not recognized.
Complicated grieving to be a response outside
the norm and occurring when a person is void of
emotion, grieves for prolonged periods,
has expressions of grief that seem disproportionate
to the event.
People may suppress emotional responses to the
loss or become obsessively preoccupied with the
deceased person or lost object.
People who are vulnerable to
1. Low self-esteem
2. Low trust in others
3. A previous psychiatric disorder
4. Previous suicide threats or attempts
5. Absent or unhelpful family members
6. An ambivalent, dependent, or insecure
attachment to the deceased person.
Nursing Mgt. to grieving
clients: Nurse to support and facilitate the grief process for
He or she must observe and listen for cognitive, emotional, spiritual, behavioral, and physiologic cues.
Nurse must be familiar with the phases, tasks, and dimensions of human response to loss,
he or she must realize that each client’s experience is unique.
Skillful communication is key to performing assessment and providing interventions.
Nurse must examine his or her own personal
Maintain an attentive presence, and provide a
psychologically safe environment for deeply
Awareness of one’s own beliefs and attitudes.
assuring the client of confidentiality, refraining