1. GRIEF & LOSS Dr. James M. Alo, RN,MAN,MAPsycho,PhD.
2. Experiences of loss are normal and essential in human life. Letting go, relinquishing, and moving on happen continually as a person travels through the stages of growth and development.
3. Grief refers to the subjective emotions and affect that are a normal response to the experience of loss. Grieving, also known as bereavement, refers to the process by which a person experiences the grief.
4. Anticipatory grieving is when people facing an imminent loss begin to grapple with the very real possibility of the loss or death in the near future (Zilberfein, 1999). Mourning is the outward expression of grief.
5. TYPES OF LOSSES A helpful way to examine different types of losses is to use Abraham Maslows hierarchy of human needs. According to Maslow (1954), a hierarchy of needs motivates human actions. 1. Physiologic loss. Examples include amputation and loss of adequate air exchange or pancreatic functioning.
6. 2. Safety loss. Loss of a safe environment such as following domestic or public violence. A person may perceive a breach of confidentiality in the professional relationship as a loss of psychological safety secondary to broken trust between client and provider. 3. Loss of security and a sense of belonging. The loss of a loved one affects the need to love and be loved. 4. Loss of self-esteem. Any change in how a person is valued at work or in relationships can threaten his or her need for self-esteem.
7. 5. Loss related to self-actualization. An external or internal crisis that blocks or inhibits strivings toward fulfillment may threaten personal goals and individual potential (Parkes,1998).
8. GRIEVING PROCESS 1. Nurses interact with clients responding to a myriad of losses along the continuum of health and illness. 2. Nurses must have a basic understanding of what is involved to meet the challenge that grief brings to clients. 3. Nurses may promote the expression and release of emotional as well as physical pain, thus supporting the grieving process. 4. Active listening are paramount when assisting grieving clients. 5. Recognizing the verbal and nonverbal communication content of the various stages of grieving.
9. Theory of the Grieving Process Elisabeth Kubler-Ross (1969) five stages to explain what people experience as they grieve and mourn: 1. Denial is shock and disbelief regarding the loss. 2. Anger may be expressed toward God, relatives, friends, or health care providers. 3. Bargaining occurs when the person asks God or fate for more time to delay the inevitable loss. 4. Depression results when awareness of the loss becomes acute. 5. Acceptance occurs when the person shows evidence of coming to terms with death.
10. DIMENSIONS OF GRIEVING People have many and varied responses to loss. They express their bereavement in their thoughts, words, feelings, and actions as well as their physiologic responses. Nurses must use a holistic model of grieving that encompasses cognitive, emotional, spiritual, behavioral, and physiologic dimensions.
11. Cognitive Responses to Grief Emotional Responses to Grief He should have stopped smoking years ago. If you had taken her to the doctor earlier, this might not have happened. It took you too long to diagnose his illness. Behavioral Responses to Grief viewing the world more realistically, and re-evaluating religious or spiritual beliefs Nurse must provide a context of acceptance in which the client can explore his or her behavior. Spiritual Responses to Grief Finding explanations and meaning through religious or spiritual beliefs, the client may begin to identify positive aspects of grieving
12. Nurses Role Diverse cultural environment, offers the sensitive nurse many opportunities to individualize care when working with grieving clients. 1. Nurse should understands a particular cultures appropriate grieving behaviors, 2. Nurse must encourage clients to discover and use what is effective and meaningful for them.
13. Disenfranchised grief is grief over a loss that is not or cannot be acknowledged openly, mourned publicly, or supported socially. Three categories of circumstances can result in disenfranchised grief: 1. A relationship has no legitimacy. 2. The loss itself is not recognized. 3. The griever is not recognized.
14. Complicated grieving to be a response outside the norm and occurring when a person is void of emotion, grieves for prolonged periods, has expressions of grief that seem disproportionate to the event. People may suppress emotional responses to the loss or become obsessively preoccupied with the deceased person or lost object.
15. People who are vulnerable to complicated grieving 1. Low self-esteem 2. Low trust in others 3. A previous psychiatric disorder 4. Previous suicide threats or attempts 5. Absent or unhelpful family members 6. An ambivalent, dependent, or insecure attachment to the deceased person.
16. Nursing Mgt. to grieving clients: Nurse to support and facilitate the grief process for clients, He or she must observe and listen for cognitive, emotional, spiritual, behavioral, and physiologic cues. Nurse must be familiar with the phases, tasks, and dimensions of human response to loss, he or she must realize that each clients experience is unique. Skillful communication is key to performing assessment and providing interventions.
17. Nurse must examine his or her own personal attitudes, Maintain an attentive presence, and provide a psychologically safe environment for deeply intimate sharing. Awareness of ones own beliefs and attitudes. assuring the client of confidentiality, refraining from judging or giving specific advice, and Allowing the client to share thoughts and feelings freely.
18. S A M P L E C A R E P L A N GRIEF ASSESSMENT DATA Nursing Diagnosis EXPECTED OUTCOMES IMPLEMENTATION Intervention Cognitive Responses Questioning and trying to make sense of the loss Experiencing disillusionme nt Attempting to make sense of the loss Grieving A normal response in the human experience of loss. The client will Identify the loss and its meaning for self (adequate perception) Express feelings, verbally and nonverbally Rationale - Talk with the client realistically about his or her loss; discuss concrete changes that the client must now begin to make as a result of the loss. Discussing the loss on this level may help to make it more real for the client.
19. Tears are the silent language of grief. -Voltaire Thank you. - Dr. james m. alo