INTRODUCTION
- Succession of losses common to nurses and often may not have time to resolve losses before another loss occurs
- Bereavement is a state of being deprived of something which doesn't have to refer to death but usually does.
- Grief is the reaction to bereavement which has many dimensions- physical, emotional, cognitive and spiritual response and it is a normal and healthy reaction. Grief is one of the powerful emotional states occur often with loss of a person, thing or place to which we are emotionally attached.
- Most stressful life event: death of spouse -Holmes and Rahe (1967).
- Cultural and Gender Differences must be taken care of when dealing with grief and loss.
TYPES OF GRIEF REACTION
- Delayed Grief Reaction- delay in beginning of mourning process or slowing the process once started (Anniversary reaction; incomplete mourning at the time of loss )
- Distorted Grief Reaction -depression or melancholia
- Anticipatory Grief (Lindemann, 1944) -Reactions to losses that have not yet occurred and are not yet in process. For example, Spouse becomes so concerned with their adjustment in the face of a potential death and go through all the phases of grief prior to the actual death
FEATURES OF GRIEF REACTION
- Common Grief Responses
Feelings - Sadness
- Anger
- Guilt & self-reproach
- Anxiety
- Loneliness
- Fatigue
- Helplessness
- Shock
- Yearning
- Emancipation
- Relief
- Numbness
COMMON GRIEF RESPONSES
Physical Sensations
- Tightness in the chest
- Shortness of Breath
- Lack of Energy
- Panic Attack-like symptoms
Cognitions
- Disbelief
- Confusion
- Sense of Presence
- Lack of Concentration
Behaviors
- Sleep disturbances
- Appetite disturbances
- Social withdrawal
- Dreams of the deceased
- Absent-minded behavior
THEORIES ON BEREAVEMENT
- Elizabeth Kubler-Ross: Stages
- William Worden: Four tasks of grieving
- Robert Neimeyer: Rebuilding life and search for meaning
The Four Tasks of Mourning-Worden, 1991
- To Accept the Reality of the Loss
- To Work Through to the Pain of Grief
- To Adjust to an Environment in Which the Deceased is Missing
- To Emotionally Relocate the Deceased and Move on With Life
Seven Stages of Grief (Robert Kavanaugh)
- 1. Shock
- 2. Disorganization
- 3. Volatile Emotion
- 4. Guilt
- 5. Sense of loss & loneliness
- 6. Relief
- 7. Reestablishment *
NURSING PROCESS
Grief Assessment
- What was the relationship
- Nature of the Attachment
- Mode of Death
- Historical Antecedents
- Personality Variables
- Social Variables
Interventions
- Help the survivor actualize the loss
- Help the survivor to identify and express feeling
- Assist Living Without the Deceased
- Facilitate Emotional Relocation of the Deceased
Counseling Principles
- 1. Provide time to grieve
- 2. Interpret "normal" behavior
- 3. Allow for individual differences
- 4. Provide continuing support
- 5. Examine defense & coping styles
- 6. Identify pathology and refer
Predictors of Negative Bereavement Outcome
- Age and education
- Social support
- Opportunities for anticipatory grieving
- Relationship with spouse
- Number of concurrent life stressors
- Time since death
- Financial status
CONCLUSION
- Loss, grief and bereavement need to be assessed with ongoing intervention
- Nurses must recognize and respond to their own grief
- Interdisciplinary care is required for better results
- Completion of the Grieving Process
- No one can predict completion
- Grief work is never completely finished
- Healing occurs when the pain is less
"Mourning never ends. Only as time goes on, it erupts less frequently."
- AWidow in her 60s
REFERENCES
- Therese A. Rando Treatment of Complicated Mourning. Research Press, Champaign, IL; 1993.
- Worden W . Grief Counseling and Grief Therapy, New York: Springer Publishing Company: 1982
- American Family Physician Article (www.aafp.org/afp/20020301/883.html</a>)
- Lindemann E. Symptomatology and management of acute grief. Am J Psychiatry. 1944; 101: 141-8.
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