loss and grief

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LOSSThefact orprocessof losingsomething or someone. -oxford dictionaryUnrecoverable and usually unanticipated and non- recurringremovalof, or decrease in, anasset or resource.


GRIEFGrief is an emotional response to a loss. Grief is a deep emotional and mental anguish that is a response to the subjective experience of loss of something significant.

Mourning is the psychological process through which the individual passes on to successful adaptation to the loss of a valued object.Bereavement includes grief and mourning-the inner feeling and outward reactions of survivor



The sadness of losing someone you love never goes away completely, but it shouldnt remain center stage. If the pain of the loss is so constant and severe that it keeps you from resuming your life, you may be suffering from a condition known ascomplicated grief. .


Chronic grief Delayed grief Exaggerated grief Masked grief Disenfranchised grief

Symptoms of complicated grief Intrusive thoughts or images of your loved oneDenial of the death or sense of disbeliefImagining that your loved one is aliveSearching for the person in familiar placesAvoiding things that remind you of your loved oneExtreme anger or bitterness over the lossFeeling that life is empty or meaningless

STAGES OF LOSS AND GRIEF 1. Denial and IsolationThe first reaction to learning of terminal illness or death of a cherished loved one is to deny the reality of the situation. It is a normal reaction to rationalize overwhelming emotions. It is a defense mechanism that buffers the immediate shock. We block out the words and hide from the facts. This is a temporary response that carries us through the first wave of pain.

2. Anger As the masking effects of denial and isolation begin to wear, reality and its pain re-emerge. We are not ready. The intense emotion is deflected from our vulnerable core, redirected and expressed instead as anger. The anger may be aimed at inanimate objects, complete strangers, friends or family. Anger may be directed at our dying or deceased loved one. Rationally, we know the person is not to be blamed.

3. BargainingThe normal reaction to feelings of helplessness and vulnerability is often a need to regain control.If only we had sought medical attention soonerIf only we got a second opinion from another doctor.If only we had tried to be a better person toward them.Secretly, we may make a deal with God or our higher power in an attempt to postpone the inevitable. This is a weaker line of defense to protect us from the painful reality.

4. DepressionTwotypes of depressionare associated with mourning. The first one is a reaction to practical implications relating to the loss. Sadness and regret predominate this type of depression. This phase may be eased by simple clarification and reassurance. We may need a bit of helpful cooperation and a few kind words. The second type of depression is more subtle and, in a sense, perhaps more private. It is our quiet preparation to separate and to bid our loved one farewell.

5. AcceptanceReaching this stage of mourning is a gift not afforded to everyone. Death may be sudden and unexpected or we may never see beyond our anger or denial. It is not necessarily a mark of bravery to resist the inevitable and to deny ourselves the opportunity to make our peace. This phase is marked by withdrawal and calm. This is not a period of happiness and must be distinguished from depression.



Shock and disbeliefSadnessGuiltAngerFearPhysical symptoms

Major tasks of the grief process:

(1) Acceptance of the loss, (2) Acknowledgment of the intensity of the pain,(3) Adaptation to life after the loss, and(4) Cultivation of new relationships and activities.


Coping with death, one's own or a loved one's, is considered the ultimate challenge. The idea of death is threatening and anxiety provoking to many people. Kubler-Ross stated, 'The key to the question of death unlocks the door of life. For those who seek to understand it, death is a highly creative force.Common fears of dying people are fear of the unknown, pain, suffering, loneliness, loss of the body, and loss of personal control.

patterns of living The first is referred to as peaks and valleys or periods of hope and periods of depression. The second pattern is one described as distinct but descending plateaus. The third pattern is a clear downward slope with many physiologic parameters indicating that death is imminent. The last pattern is a downward slant that reveals a crisis event, such as a severe cerebral hemorrhage with almost no hope of recovery.

NURSING IMPLICATIONS Nursing care involves providing comfort ,maintaining safety ,addressing physical and emotional needs ,and teaching coping strategies to terminally ill patients and their families .More than ever ,the nurse must explain what is happening to the patient and the family and be a confident who listens to them talk about dying.Hospice care , attention to family and individual psychosocial issues ,and symptom and pain management are all part of the nurse's responsibilities.


The nurse must also be concerned with ethical considerations and quality-of-life issues that affect dying people. Of utmost importance to the patient is assistance with the transition from living to dying, maintaining and sustaining relationships, finishing well with the family, and accomplishing what needs to be said and done.In the hospital, in long-term care facilities, and in home settings, the nurse explores choices and end-of-life decisions with the patient and family.

Referrals to home care and hospice services, as well as specific referrals appropriate for the management of the situation, are initiated.The nurse is also an advocate for the dying person and works to uphold that person's rights. The use of living wills and advance directives allows the patient to exercise the right to have a"good death or to die with dignity.

NURSING IMPLICATIONS The nurse assesses spiritual strength by inquiring about the person's sense of spiritual well-being, hope, and peace. The nurse assesses current and past participation in religious or spiritual practices and notes the patient's response to questions about spiritual needs. Another simple assessment technique is to inquire about the patient's and family's desire for spiritual support.For nurses to provide spiritual care, they must be open to be present and supportive when patients experience doubt, fear, suffering, despair, or other difficult psychological states of being.

Interventions that foster spiritual growth or reconciliation include being fully present; listening actively; conveying a sense of caring, respect, and acceptance; using therapeutic communication techniques to encourage expression; suggesting the use of prayer, meditation, or imagery; and facilitating contact with spiritual leaders or performance of spiritual rituals.Nurses can alleviate distress and suffering and enhance wellness by meeting their patients' spiritual needs.

BIBLIOGRAPHYPotter and Perry (2005) Fundamentals of nursing published by most by an imprint of Elsevier, 6th edition. New Delhi. Page no 1068 1071Shabeer.p.Basheer, A concise text book of advanced nursing practice, EMMESS medical publications,1st edition , page no:638-643Sreevani R A Guide to mental health and psychiatric nursing jaypee medical publishers (p) ltd third edition page no 46-51Mary c Townsend mental health nursing concepts of care in evidenced based practice jaypee publications fifth edition page no 24-27Gail W Stuart principles and practice of psychiatric nursing mosby publications 9th edition page no 33,35-38

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