GRIEF &

LOSS

Dr. James M. Alo,

RN,MAN,MAPsycho,PhD.

“Experiences of

loss are normal

and essential in

human life. Letting

go, relinquishing,

and moving on

happen continually

as a person

travels through the

stages of growth

and development.”

Grief refers to the subjective emotions and

affect that are a normal response to the

experience of loss.

Grieving, also known as bereavement,

refers to the process by which a person

experiences the grief.

Anticipatory grieving is when people facing an

imminent loss begin to grapple with the very real

possibility of the loss or death in the near future

(Zilberfein, 1999).

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

functioning.

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

becomes acute.

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

physiologic responses.

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

Nurse’s Role

Diverse cultural environment, offers the

sensitive nurse many opportunities to

individualize care when working with grieving

clients.

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

them.

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

disenfranchised grief:

• 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

complicated grieving

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

clients,

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

attitudes,

Maintain an attentive presence, and provide a

psychologically safe environment for deeply

intimate sharing.

Awareness of one’s own beliefs and attitudes.

assuring the client of confidentiality, refraining

from judging or giving specific advice, and

Allowing the client to share thoughts and

feelings freely.

S A M P L E C A R E P L A N GRIEF

ASSESSMENT

DATA Nursing

Diagnosis

EXPECTED

OUTCOMES

IMPLEMENTATION

Intervention

Rationale

Cognitive

Responses

•

Questioning

and trying to

make sense

of the loss

•

Experiencing

disillusionme

nt

•

Attempting

to make

sense of the

loss

➤ Grieving A normal

response in

the human

experience

of loss.

The client will

• Identify the

loss and its

meaning for

self

(adequate

perception)

• Express

feelings,

verbally and

nonverbally

- Talk with the

client

realistically

about his

or her loss;

discuss

concrete

changes that

the

client must

now begin to

make as a

result of

the loss.

-

Discussing

the loss on

this level

may help

to make

it more

real for

the client.

Tears are the silent language of grief.

-Voltaire

Thank you.

- Dr. james m. alo