Introduction

Differentiate Loss, Grieving and Bereavement and learn how you, as a nurse, can identify the normal processes and how to intervene.

Loss

Absence of an object, person, body part, emotion, idea or function that was valued

1. Actual Loss is identified and verified by others.
2. Perceived Loss cannot be verified by others.
3. Maturational Loss occurs in normal development.
4. Situational Loss occurs without expectations.
5. Ultimate Loss or Death results in a lost for a dying person as well as for those left behind, can be viewed as a time of growth for all who experienced it.

Grieving Process

3 Phases of Grief

• Protest. Lack of acceptance, concerning the loss, characterized by anger, ambivalence and crying
• Despair. Denial and acceptance occurs simultaneously causing disorganized behavior, characterized by crying and sadness
• Detachment. Loss is realized; characterized by hopelessness, accurately defining the relationship with the lost individual and energy to move forward in life.

Kubler’s 5 Stages of Grieving

[box type=”shadow” align=”alignright” width=”200″ ] Mnemonic Tip: “DABDA”

Denial
Anger
Bargaining
Depression
Acceptance[/box]

• Denial. Characterized by shock and disbelief, serves as a buffer to mobilize defense mechanism.
• Anger. Resistance of the loss occurs, anger is typically directed toward others.
• Bargaining. Deals are sought with God or other higher power in an effort to postpone the loss
• Depression. Loss is realized; may talk openly or withdraw.
• Acceptance. Recognition of the loss occurs disinterest may occur; future thinking may occur.

Worden’s 4 Tasks of Mourning

• Accept the reality of the loss, the loss is accepted.
• Experience the pain of grief, healthy behaviors are accomplished to assist in the grieving process.
• Adjust to the environment without the deceased, task are accomplished to reorient the environment, i.e. removing the clothes of the deceased from the closet.
• Emotionally relocate the deceased and move forward with life, correctly align the past, the present & look towardsthe future

Anticipatory Grief

• Expression of the symptoms of grief prior to the actual loss, grief period following the lost may be shortened and the intensity lessened because of the previous of grief; for example, a child told that a family move is expected may grieve about losing friends prior to actually living

Complications of Bereavement

1. Chronic Grief – symptoms of grief occur beyond the expected time frame and the severity of symptoms is greater; depression may result.
2. Delayed Grief – when symptoms of grief are not expressed and are suppressed, a delayed reaction of grief occurs, the nurse should discuss the normal process of grieving with the client and give permission to express these symptoms

Symptoms of Normal Grief

1. Feelings include sadness, exhaustion, numbness, helplessness, loneliness, and disorganization, preoccupation with the lost object or person, anxiety, depression.
2. Thought patterns include fear, guilt, denial, ambivalence, anger
3. Physical sensations include nausea, vomiting, anorexia, weight loss or gain, constipation or diarrhea, Diminished hearing or sight, chest pain, shortness of breath, tachycardia
4. Behaviors include crying, difficulty carrying out activities of daily living and insomnia

Nursing Diagnosis

1. Anticipatory Grieving

Nursing Health Promotion

1. Help client accept that the loss is real by providing sensitive, factual information concerning the loss
2. Encourage the expression of feelings to support people; this build relationships and enhances the grief process
3. Support efforts to live without the diseased person or in the face of disability; this promotes a client’s sense of control as well as a healthy vision of the future
4. Encourage establishment with new relationships to facilitate healing.
5. Allow time to grief, the work of grief may take longer for some; observe for a healthy progression of symptoms.
6. Interpret “normal” behavior by teaching thoughts, feelings, and behaviors that can be expected in the grief process
7. Provide continuing support in the form of the presence for therapeutic communication and resource information.
8. Be alert for signs of ineffective coping such as inability to carry out activities of daily living, signs of depression, or lack of expression of grief.

Introduction

Differentiate Loss, Grieving and Bereavement and learn how you, as a nurse, can identify the normal processes and how to intervene.

Loss

Absence of an object, person, body part, emotion, idea or function that was valued

1. Actual Loss is identified and verified by others.
2. Perceived Loss cannot be verified by others.
3. Maturational Loss occurs in normal development.
4. Situational Loss occurs without expectations.
5. Ultimate Loss or Death results in a lost for a dying person as well as for those left behind, can be viewed as a time of growth for all who experienced it.

Grieving Process

3 Phases of Grief

• Protest. Lack of acceptance, concerning the loss, characterized by anger, ambivalence and crying
• Despair. Denial and acceptance occurs simultaneously causing disorganized behavior, characterized by crying and sadness
• Detachment. Loss is realized; characterized by hopelessness, accurately defining the relationship with the lost individual and energy to move forward in life.

Kubler’s 5 Stages of Grieving

[box type=”shadow” align=”alignright” width=”200″ ] Mnemonic Tip: “DAB
Anger
Bargaining
Depression
Acceptance[/box]

• Denial. Characterized by shock and disbelief, serves as a buffer to mobilize defense mechanism.
• Anger. Resistance of the loss occurs, anger is typically directed toward others.
• Bargaining. Deals are sought with God or other higher power in an effort to postpone the loss
• Depression. Loss is realized; may talk openly or withdraw.
• Acceptance. Recognition of the loss occurs disinterest may occur; future thinking may occur.

Worden’s 4 Tasks of Mourning

• Accept the reality of the loss, the loss is accepted.
• Experience the pain of grief, healthy behaviors are accomplished to assist in the grieving process.
• Adjust to the environment without the deceased, task are accomplished to reorient the environment, i.e. removing the clothes of the deceased from the closet.
• Emotionally relocate the deceased and move forward with life, correctly align the past, the present & look towardsthe future

Anticipatory Grief

• Expression of the symptoms of grief prior to the actual loss, grief period following the lost may be shortened and the intensity lessened because of the previous of grief; for example, a child told that a family move is expected may grieve about losing friends prior to actually living

Complications of Bereavement

1. Chronic Grief – symptoms of grief occur beyond the expected time frame and the severity of symptoms is greater; depression may result.
2. Delayed Grief – when symptoms of grief are not expressed and are suppressed, a delayed reaction of grief occurs, the nurse should discuss the normal process of grieving with the client and give permission to express these symptoms

Symptoms of Normal Grief

1. Feelings include sadness, exhaustion, numbness, helplessness, loneliness, and disorganization, preoccupation with the lost object or person, anxiety, depression.
2. Thought patterns include fear, guilt, denial, ambivalence, anger
3. Physical sensations include nausea, vomiting, anorexia, weight loss or gain, constipation or diarrhea, Diminished hearing or sight, chest pain, shortness of breath, tachycardia
4. Behaviors include crying, difficulty carrying out activities of daily living and insomnia

Nursing Diagnosis

1. Anticipatory Grieving

Nursing Health Promotion

1. Help client accept that the loss is real by providing sensitive, factual information concerning the loss
2. Encourage the expression of feelings to support people; this build relationships and enhances the grief process
3. Support efforts to live without the diseased person or in the face of disability; this promotes a client’s sense of control as well as a healthy vision of the future
4. Encourage establishment with new relationships to facilitate healing.
5. Allow time to grief, the work of grief may take longer for some; observe for a healthy progression of symptoms.
6. Interpret “normal” behavior by teaching thoughts, feelings, and behaviors that can be expected in the grief process
7. Provide continuing support in the form of the presence for therapeutic communication and resource information.
8. Be alert for signs of ineffective coping such as inability to carry out activities of daily living, signs of depression, or lack of expression of grief.