1. Loss and Grief.ppt

University of Gondar
College of Medicine and Health Sciences
school of Nursing
Department of comprehensive Nursing
By: Tadesse T.(BSc, MSc)
Introduction To Loss and Grief
August, 2022
Gondar, Ethiopia
8/25/2022 Loss and Grief by - Tadesse T. 1

Objectives
 At the end of this session the learners will be able
to:
 Explain the type of loss, and grief
 Describe the manifestations of normal grief
 Explain the stages of grief
 Describe the nursing care of the grieving person

Loss
 Definition: Loss is any situation (either
actual, potential, or perceived) in which a
valued object is changed or is no longer
accessible to the individual.
 Because change is a major constant in life,
everyone experiences losses.

Types of Loss
 Not everyone responds to loss in the same
way because the significance of the lost object
or person is determined by individual
perceptions.
 There are many types of loss, including:
Actual loss: Death of a loved one, theft of
one’s property.

Types of Loss…
Perceived loss: Occurs when a sense of loss is
felt by an individual but is not tangible to others
Physical loss: Loss of an extremity in an
accident, scarring from burns, permanent injury
Psychological loss: Such as a woman feeling
inadequate after menopause and resultant
infertility

Types of Loss…
 There are four major categories of loss
A. Loss of an External Object
 loss occurs when an object that a person highly
values is damaged, changes, or disappears.
 The significance of the lost object to the
individual determines the type and amount of
grieving that occurs.

Types of Loss…
A. Loss of an External Object…
 The valued object may be a person, pet,
prized possession, or one’s home.
 The loss of a pet, especially for those who
live alone, can be devastating.

Types of Loss…
B. Loss of Familiar Environment
 The loss of a familiar environment occurs when a
person moves to another home or a different
community, changes schools, or starts a new job.
 Also, a client who is hospitalized or institutionalized
experiences loss when faced with new surroundings.
 This type of loss evokes anxiety caused by fear of the
unknown.

Types of Loss…
C. Loss of Aspect of Self
 Loss of an aspect of self can be physiological or
psychological.
 A psychological aspect of self that may be lost is
ambition, a sense of humor, or enjoyment of life.
 An example of physiological loss is loss of
physical function as a result of illness or injury.

Types of Loss…
C. Loss of Aspect of Self…
 Loss also occurs when there is
disfigurement or disappearance of a body
part, such as having an amputation or
mastectomy. Loss of an aspect of self can
result from illness, trauma, or treatment
methodologies (e.g., surgery).

Types of Loss…
D. Loss of Significant Other
 The loss of a loved one is a significant loss.
 Such a loss can be the result of separation, divorce,
running away, moving to a different area, or death.
 Responses to loss are highly individualized, as each
person perceives the meaning of loss differently. For
example, the death of a spouse is generally perceived
differently by men and women.

Grief
 Definition: Grief is a series of intense physical and
psychological responses that occur following a loss.
 It is a normal, natural, necessary, and adaptive response to
a loss.
 Loss leads to the adaptive process of mourning, the period
of time during which the grief is expressed and resolution
and integration of the loss occur.
 Bereavement is the period of grief following the death of a
loved one.

Types of Grief
 Grief is a universal, normal response to loss.
 Grief drains people, both emotionally and physically.
 Because grief consumes so much emotional energy,
relationships may be impaired and health status may
become altered.
 There are d/t types of grief including uncomplicated
(‘‘normal’’), dysfunctional, and anticipatory.

Types of Grief…
1. Uncomplicated/normal Grief
 Uncomplicated grief runs a fairly predictable
course that ends with the relinquishing of the lost
object and resumption of the previous life.
 Even though the bereaved person’s life is changed
forever, the person is able to regain the ability to
function.

Types of Grief…
 Many grieving people experience feelings of
anger or blame; these feelings may be directed
toward those perceived to have caused or
contributed to the death.
 Often the anger associated with grief is directed at
one’s self, that is, expressed as guilt or
depression.

Types of Grief…
 Some survivors have a strong need to assign
blame.
 If someone else can be blamed, then the survivors
can rid themselves of any responsibility.
 Those who are experiencing grief must be
provided an opportunity to express feelings—both
positive and negative—in order to alleviate guilt.

Manifestations of Normal Grief (Worden)
A. Emotions:
• Sadness, Anxiety, Guilt, Relief, Emancipation, Self-
blame, Fatigue, Numbness, Shock, Helplessness,
Yearning, Loneliness.
B. Physical Settings:
• Increased sensitivity to noise, Constricted feeling in
throat, and chest, Shortness of breath, Hollow feeling
in stomach, Dry mouth, Muscular weakness,Lethargy

Manifestations of Normal Grief (Worden)
C. Behaviors:
• Disrupted sleep patterns, Dreaming about the
Deceased, Forgetfulness, Crying, Avoiding reminders of the
deceased, Treasuring objects belonging to the deceased,
Social withdrawal
D. Thought processes:
• Disbelief, Preoccupation, Confusion, Sense of presence of
the deceased, Hallucinations (e.g., as seeing or hearing the
deceased)

Reactions Commonly Experienced during Grief
A. Physical reactions:
• Loss of appetite, Weight loss, Insomnia,
Fatigue, Decreased libido, Decreased
immune functioning(increased susceptibility
to illness), Multiple somatic complaints
(e.g., headache, backache), Restlessness.

B. Psychosocial reactions:
• Profound sadness, Helplessness,
Hopelessness, Denial, Anger, Hostility, Guilt,
Nightmares, Ennui (overwhelming sense of
emptiness), Preoccupation with lost object,
Loneliness.

C. Cognitive reactions:
• Inability to concentrate, Forgetfulness,
Impaired judgment, Decreased problem
solving ability, Impaired decision making
ability.

D. Behavioral reactions:
 Social withdrawal
 Distancing
 Crying
 Impulsivity
 Indecisiveness

Types of Grief…
2. Dysfunctional Grief
 Persons experiencing dysfunctional grief
do not progress through the stages of
overwhelming emotions associated with
grief, or they may fail to demonstrate any
behaviors commonly associated with grief.

Types of Grief…
Dysfunctional Grief…
 The person experiencing pathologic grief
continues to have strong emotional
reactions, does not return to a normal sleep
pattern or work routine, usually remains
isolated, and has altered eating habits.

Types of Grief…
 The bereaved may have the need to
endlessly tell and retell the story of loss but
without subsequent healing.
 Visits to the grave site or mausoleum may
be made often or not at all.

Types of Grief…
 Dysfunctional grief is a demonstration of a
persistent pattern of intense grief that does not
result in reconciliation of feelings.
 A person experiencing chronic grief continues to
focus on the deceased, may overvalue objects that
belonged to the deceased, and may engage in
depressive brooding.

Types of Grief…
 The pathologically grieving person is
unable to reestablish a routine.
 Several factors predispose a person to
experience dysfunctional grieving,
including:

Types of Grief…
• Uncertain, sudden, or overcomplicated circumstance
surrounding the loss
• A loss that is socially unspeakable or socially
negated (e.g., suicide)
• A relationship with the deceased characterized by
ambivalence or excessive dependency.

Types of Grief…
3. Anticipatory Grief
 Anticipatory grief is the occurrence of grief
work before an expected loss.
 Anticipatory grief may be experienced by
the terminally ill person as well as family.

Types of Grief…
3. Anticipatory Grief…
 This phenomenon promotes adaptive grieving
by freeing up the mourner’s emotional energy.
 Although anticipatory grieving may be helpful
in adjusting to the loss, it may also result in
some disadvantages.

Types of Grief…
 For example, for the dying client,
anticipatory grieving may lead to family
members’ distancing themselves and not
being available to provide support.

Types of Grief…
 Also, if the family members have separated
themselves emotionally from the dying client, they
may seem cold and distant and thus may not meet
society’s expectations of mourning behavior.
 This response can prevent the mourners from
receiving their own much-needed support from
others.

Factors Affecting Grief
 The experience of grief is individual and is
influenced by various factors.
 Factors that influence grief include
• The person’s developmental level,
• Religious and cultural beliefs,
• Relationship to the lost object, and
• The cause of death.

Stages of Grief
 There are five stages of grief. These are:
 Denial and isolation,
 Anger,
 Bargaining,
 Depression, and
 Acceptance

Nursing Care of the Grieving Person
 Resolution of a loss is a painful process and
must be done by clients in their own way.
 Grief changes people by affecting self-
esteem, triggering the development of new
ways of coping, and precipitating a change in
lifestyle without the deceased.

Nursing Care of the Grieving Person…
 Nurses can play an active role in assisting people to
grieve.
 Encourage clients to do their grief work, that is, to
experience their feelings to the fullest in order to
work through them.
 Provide support and explain to the bereaved that it
will take time to grieve the loss and to gain some
closure to the relationship.

Assessment:
 A thorough assessment of the grieving client
and family begins with a determination of the
personal meaning of the loss.
 Another key assessment area is deciding
where the person is in terms of the grieving
process.

Assessment…
 The nurse understands that the stages of grieving
are not necessarily mastered sequentially, but that
instead individuals may vacillate in progression
through the stages of grief.
 assessment be done to differentiate the signs of
healthy grieving from at-risk behavior.

1. Acceptance of the loss
 Only by going through grief work are individuals
able to reach some acceptance and, ultimately,
resolution of feelings about the loss.
 Often, people try to find some meaning in their
situations.
 This search involves introspection in which
spiritual support is of therapeutic value.

2. Renewal of activities and relationships
 The very core of grief work revolves around
acceptance of the fact that the needs met by key
people in one’s life can be met in other ways and by
other people.
 The deceased cannot be replaced; however, enough
healing must occur so that new relationships can be
initiated.

2. Renewal of activities and relationships…
 How long does the process of adaptive
grieving take?
 Grief work takes time.
 There are no definite time frames in which
grief should occur.

2. Renewal of activities and relationships…
 The length of time for grief to be resolved is
as individual as the person experiencing it and
its intensity.
 Each person grieves in his or her own way and
at his or her own pace.

Caring for grieving clients
• Approach the client with a nonjudgmental attitude.
• Understand that each person’s expression of grief is
individualized.
• Encourage clients to express feelings at their own
pace.
• Demonstrate compassion.
• Employ empathy, not sympathy.

Loss and Grief by - Tadesse T. 44
Thank you
8/25/2022

1. Loss and Grief.ppt

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