Absence of an object, person, body part, emotion, idea or function that was valued
Actual loss is identified and verified by others
Perceived Loss cannot be verified by others
Maturational Loss occurs in normal development
Situational Loss occurs without expectations
Ultimate Loss (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 (Theories of Grief, Dying and Mourning)
1. 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.
2. Kubler-5 Stages of Grieving
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.
3. 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
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
Chronic Grief – symptoms of grief occur beyond the expected time frame and the severity of symptoms is greater; depression may result.
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
Feelings include sadness, exhaustion, numbness, helplessness, loneliness, and disorganization, preoccupation with the lost object or person, anxiety, depression.
Thought patterns include fear, guilt, denial, ambivalence, anger
Physical sensations include nausea, vomiting, anorexia, weight loss or gain, constipation or diarrhea, Diminished hearing or sight, chest pain, shortness of breath, tachycardia
Behaviors include crying, difficulty carrying out activities of daily living and insomnia
Nursing Health Promotion (to facilitate mourning)
Help client accept that the loss is real by providing sensitive, factual information concerning the loss
Encourage the expression of feelings to support people; this build relationships and enhances the grief process
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
Encourage establishment with new relationships to facilitate healing.
Allow time to grief, the work of grief may take longer for some; observe for a healthy progression of symptoms.
Interpret “normal” behavior by teaching thoughts, feelings, and behaviors that can be expected in the grief process
Provide continuing support in the form of the presence for therapeutic communication and resource information.
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.