The Experience The Experience of Loss, of Loss, Death, Death, and Griefand Grief

Chapter 29Chapter 29

The five categories of lossThe five categories of loss• Necessary lossNecessary loss – loss that is the result of – loss that is the result of

the natural growth and development the natural growth and development processprocess

• Actual lossActual loss – any loss of a person or – any loss of a person or object that can no longer be felt, heard, object that can no longer be felt, heard, known, or experienced by the individualknown, or experienced by the individual

• Perceived lossPerceived loss – any loss that is less – any loss that is less tangible and uniquely defined by the tangible and uniquely defined by the grieving client. grieving client.

• Maturational lossMaturational loss – any change in the – any change in the developmental process that is normally developmental process that is normally expected during a life time expected during a life time

• Give me some examples?Give me some examples?

• Situational lossSituational loss – loss of a person, thing, – loss of a person, thing, or quality resulting from a change in a life or quality resulting from a change in a life situation, including changes related to situation, including changes related to illness, body image, environment, and illness, body image, environment, and deathdeath

• Death is the ultimate loss. Tell me your Death is the ultimate loss. Tell me your thoughts and feelings about your own thoughts and feelings about your own death?death?

GriefGrief

Grief – is the emotional response to a loss. It Grief – is the emotional response to a loss. It includes includes

• Mourning – the outward, social expression of a Mourning – the outward, social expression of a loss. It involves working through grief until the loss. It involves working through grief until the person can adapt to the loss and return to usual person can adapt to the loss and return to usual activitiesactivities

• Bereavement – response to loss through death; Bereavement – response to loss through death; a subjective experience that a person suffers a subjective experience that a person suffers after losing a person with whom there has been after losing a person with whom there has been a significant relationshipa significant relationship

• Bereavement – Person may move back Bereavement – Person may move back and forth through a series of stages that and forth through a series of stages that may last years before the process is may last years before the process is completedcompleted

TheoriesTheories of Griefof Grief

• Kubler-Ross’s stages of dying - behavioral Kubler-Ross’s stages of dying - behavioral oriented, 5 stagesoriented, 5 stages

denial – refuses to believe or understand the loss denial – refuses to believe or understand the loss has occurredhas occurredanger – resists the loss by striking out at anger – resists the loss by striking out at everyone and everythingeveryone and everythingbargaining – postpones awareness of the reality bargaining – postpones awareness of the reality of the loss and may try to deal in a subtle or of the loss and may try to deal in a subtle or overt way as though the loss can be prevented overt way as though the loss can be prevented

depression – mood disturbance depression – mood disturbance characterized by feelings of sadness and characterized by feelings of sadness and discouragement. The person finally discouragement. The person finally realizes the full impact and significance of realizes the full impact and significance of the lossthe lossacceptance – a person accepts the loss acceptance – a person accepts the loss and begins to look to the futureand begins to look to the future

Bowlby’s phases of mourningBowlby’s phases of mourning

Numbing – the response to grief as a stunned or unreal Numbing – the response to grief as a stunned or unreal feeling. It is the briefest phase of mourningfeeling. It is the briefest phase of mourning

Yearning and searching – emotional outburst of tearful Yearning and searching – emotional outburst of tearful sobbing and acute distress in most personssobbing and acute distress in most persons

Disorganization and despair – endless Disorganization and despair – endless examination of how and why the loss examination of how and why the loss occurred.occurred.

Reorganization – the person begins to Reorganization – the person begins to accept unaccustomed roles, acquire new accept unaccustomed roles, acquire new skills and build new relationshipsskills and build new relationships

Worden’s four tasks of mourningWorden’s four tasks of mourning

Task 1: To accept the reality of the lossTask 1: To accept the reality of the lossTask 2: To work through the pain of griefTask 2: To work through the pain of griefTask 3: To adjust to the environment in Task 3: To adjust to the environment in which the deceased is missingwhich the deceased is missingTask 4: To emotionally relocate the Task 4: To emotionally relocate the deceased and move on with lifedeceased and move on with life

Types of GriefTypes of Grief• Anticipatory grief – grief response in which a Anticipatory grief – grief response in which a

person begins the grieving process before the person begins the grieving process before the actual loss actual loss

• Complicated grief – when a person has difficulty Complicated grief – when a person has difficulty progressing through the normal phases or stages progressing through the normal phases or stages of grieving, bereavement becomes complicated (of grieving, bereavement becomes complicated (

- chronic, - chronic, - delayed, - delayed, - exaggerated, - exaggerated, - masked)- masked)• Disenfranchised grief – person experiences grief Disenfranchised grief – person experiences grief

when a loss is experienced and cannot openly when a loss is experienced and cannot openly acknowledge itacknowledge it

Factors Influencing Loss Factors Influencing Loss and Griefand Grief

• Human developmentHuman development• Psychosocial perspectivesPsychosocial perspectives• Socioeconomic statusSocioeconomic status• Personal relationshipsPersonal relationships• Nature of the lossNature of the loss• Culture and ethnicityCulture and ethnicity• Spiritual beliefsSpiritual beliefs

AssessmentAssessment

• Type and stage of griefType and stage of grief• Grief reactionsGrief reactions• Factors that affect griefFactors that affect grief• End-of-life decisionsEnd-of-life decisions• Nurse’s experiencesNurse’s experiences• Client expectationsClient expectations

Nursing DiagnosesNursing Diagnoses

• Anticipatory grievingAnticipatory grieving• Dysfunctional grievingDysfunctional grieving• HopelessnessHopelessness• PowerlessnessPowerlessness• Spiritual distressSpiritual distress

PlanningPlanning

• Goals and outcomesGoals and outcomes• Setting prioritiesSetting priorities• Continuity of careContinuity of care

ImplementationImplementation

• Therapeutic communicationTherapeutic communication• Promoting hopePromoting hope• Facilitating mourningFacilitating mourning

Palliative CarePalliative Care

• Symptom controlSymptom control• Maintaining dignity and self-esteemMaintaining dignity and self-esteem• Preventing abandonment and isolationPreventing abandonment and isolation• Providing a comfortable and peaceful Providing a comfortable and peaceful

environmentenvironment

Supportive CareSupportive Care

• Support for the grieving familySupport for the grieving family• Hospice careHospice care• Care after death (postmortem care)Care after death (postmortem care)• Grieving nurseGrieving nurse

EvaluationEvaluation

• Client careClient care• Client expectationsClient expectations

Am I helping you in the way you have Am I helping you in the way you have hoped?hoped?Would you like me to assist you in a Would you like me to assist you in a different way?different way?Do you have a specific request that I have Do you have a specific request that I have not been able to meet?not been able to meet?

• Client careClient care• Client expectationsClient expectations

What is most important for us to do for you What is most important for us to do for you at this time?at this time?Are we dealing with your problems in a Are we dealing with your problems in a timely manner?timely manner?