Loss and Grieving

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Loss and Grieving

• George Ann Daniels, MS, RN

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• Grief can take care of itself,
• but to get the full
• value of a joy you must have somebody
• to divide it with.
• Mark Twain

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Terms

• Loss
• Experience of parting with an object, person,
  belief, or relationship that one values
• Grief
• Pattern of psychological and physiologic
  responses a person experiences after a loss of
  person, object, belief, or relationship

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• Bereavement
• State of desolation that occurs as the result of
  a loss
• Mourning
• Socially prescribed behaviors after the death of
  a significant other
• Varies with cultures
• Anticipatory grief
• Characteristic pattern of psychological and
  physiologic responses a person makes to the
  impending loss
• Real or imagined

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Functions of grieving

• To make outer reality of the loss into an
  accepted reality
• To sever the emotional attachment to the lost
  person or object
• To make possible for the bereaved person to
  become attached to other people or objects

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Models of grieving

• No model has clear cut stages with appropriate
  time tables
• Kubler-Ross
• Denial, anger, bargaining, depression, and
  acceptance
• Parks
• Numbness, yearning, disorganization, and
  reorganization
• Grief cycle
• Shock, protest, disorganization, reorganization

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Lifespan

• Newborn/infant
• No concepts of life or death
• Death or loss is related to feelings of
  separation when caregiver is out of sight
• Toddler
• Fear loss as abandonment
• Preschoolers
• Perceive death as reversible, avoidable,
• Books, media, TV

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• Child
• Perceive death as unnatural, reversible, and
  avoidable
• By school age has experienced same death
• Adolescents
• View life and death like an adult
• Can grieve fully
• Greater risk for poor grieving outcomes
• Holding things in

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• Adults
• Grieve more intensely
• May hold grieve for many years
• Young adults
• Multiple losses over a short time
• Death of family member, ending schooling, peer
  breakups
• Middle adults
• Better acceptance
• Except with loss of a child of spouse
• Other losses, menopause, aging, debility parents,
  empty nest

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• Older adults
• Numerous losses

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Altered grieving

• Display 47-1 normal and abnormal grief
  manifestations
• 1 year and 3 year limits
• Adverse impact on ADL and family life

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Dysfunctional grieving

• Dysfunctional grief is outside the normal
  response range and may be manifested as
  exaggerated grief, prolong grief, or absence of
  grief.
• May be stuck in one stage of grief
• Grief is extended, unsuccessful use of
  intellectual and emotional responses by which
  individuals attempt to work through the process
  of modification

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Assessment

• Note severity of symptoms
• Patterns over time
• Compare to normal pattern
• Identify risk
• Physical and psychosocial
• Dysfunctional identification
• Physical signs and symptoms

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NDX

• Anticipatory grieving
• Dysfunctional grieving

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Outcomes

• The client will move toward resolution of diverse
  emotions
• The client will accept the reality of the loss
• The client will reinvest emotional and physical
  energy into meaningful activities

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Interventions

• Client teaching
• Loss education
• Grief stages
• Working through
• Support groups
• Referrals

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