GRIEF AND LOSS

Loss is a universal experience that occurs throughout life span

Grief is a form of sorrow involving feelings, thoughts, and behaviors caused by bereavement

GRIEF AND LOSS

Responses to loss are strongly influenced by one’s cultural background

The grief process involves a sequence of affective, cognitive, and psychological states as a person responds to, and finally accepts a loss.

Loss and grieving

LOSS= something valuable is goneGRIEF= total response to emotional

experience related to lossBEREAVEMENT= Subjective

response by loved-onesMOURNING= behavioral response

GRIEF AND LOSSGRIEF AND LOSSStages of Grieving (Kubbler-Ross)Stages of Grieving (Kubbler-Ross) Denial- refuses to believe that the loss Denial- refuses to believe that the loss

has occurredhas occurred Anger- the individual resists the loss Anger- the individual resists the loss

and may “act out” feelings.and may “act out” feelings. Bargaining- the individual attempts to Bargaining- the individual attempts to

make a deal in an attempt to postpone make a deal in an attempt to postpone the reality of loss.the reality of loss.

Depression- overwhelming feeling of Depression- overwhelming feeling of loneliness and withdrawal from othersloneliness and withdrawal from others

Acceptance- the individual comes to Acceptance- the individual comes to terms with loss, or impending loss, terms with loss, or impending loss, psychological reactions to loss to the psychological reactions to loss to the loss cease, and the interaction to other loss cease, and the interaction to other people resumedpeople resumed..

Loss and grieving

Stages of Grieving by Kubbler-RossDABDADENIAL= refusal to believeANGER= hostilityBARGAINING= feeling of guilt, fear of

punishmentDEPRESSION= withdrawn behaviorACCEPTANCE= comes to terms with loss

Loss and grievingStages Behaviors

D Refuses to believe that loss is happening

A Retaliation

B Feelings of guilt, punishment for sins

D Laments over what has happened

A Begins to plan like wills, prosthesis

Death and Dying (Kozier)AGE Beliefs

Infancy to 5 years old NO clear concept of Death

It is Reversible, temporary sleep

5 to 9 years Understands DEATH is FINAL but can be AVOIDED

9-12 years Death is INEVITABLE

Understands own mortality

12-18 years Fears a lingering Death

18-45 Attitude is influenced by religion

45-65 years Experiences peak of death anxiety

65 and above Death as multiple meanings

Nursing responsibilities In Death and dyingNurses need to take time to analyze

their own feelings about death before they can effectively help others with terminal illness

Nursing responsibilities In Death and dying

The major goals for the dying clients are:1. To maintain PHYSIOLOGIC and

PSYCHOLOGIC support2. To Achieve a dignified and peaceful death3. To maintain personal control

Loss and Death RESPONSIBILITIES

Provide Relief from loneliness, fear and depression

Help clients maintain sense of security Help clients accept losses Provide physical comfort

LOSS ,GRIEVING AND DEATH DEATH CONCEPTS

– 1-5 – IMMOBILITY AND INACTIVITY Wishes and unrelated action responsible for action

– 5-10 – final but can be avoided– 9-12 – understands own mortality and fears death– 12 – 18 – fears and fantasizes avoidance– 18-45 – increased attitude awareness– 45-65 – accepts mortality– Above 65 – multiple meanings, encounters and fears

Interventions

D – SUPPORTIVE

A- PROVIDE STRUCTURE AND CONTINUITY

B – LISTEN AND ENCOURAGE

D- ALLOW EXPRESSION AND PROVIDE FOR SAFETY

A- ENCOURAGE PARTICIPATION