2. Grief is a series of intense physical and
psychological response that occur following a loss.
It is manifested in variety of ways that are unique to
an individual and based on personal experiences,
cultural expectation and spiritual beliefs. It is
normal, natural, necessary and adaptive response
to a loss.
3. TYPES OF GRIEF
A nurse’s knowledge on the types of grief, which
are based on characteristics or signs and
symptoms of grief, allows for implementation of
appropriate bereavement therapies.
4. Normal grief: Normal or uncomplicated grief
consists of the normal findings, behaviours and
reactions to a loss. These might include
resentments, sorrow, anger, crying, loneliness and
temporarily withdrawal from activities. Often the
normal grief response to a loss can prove positive,
helping one to mature and develop as a person. As
people mature they develop ways of dealing with
losses and learn to maintain and enhance their
feelings of safety and security.
5. Anticipatory grief: The process of disengaging or
“letting go” that occurs before an actual loss or
death has occurred is called anticipatory grief. For
example, once a person or family receives a
terminal diagnosis, they begin the process of saying
good bye and completing life affairs. The process
become more stressful when the client is unable to
make decisions due to deterioration in health.
Unless guided by a client’s explicit decision
regarding end of life care, the family assumes the
responsibility of deciding whether to continue life
sustaining measures.
6. Complicated grief: When a person has a difficulty
processing through the normal phases or stages of
grieving, bereavement becomes complicated. In
these cases bereavement appears to “go wrong”
and loss never resolves.
7. THEORIES OF GRIEVING PROCESS
RANDO’S PROCESS MODEL:
Rando contributes a model of the grief
process that she observed people to experience
while adjusting to significant loss. She called her
model the “Six R’s”
8. a) Recognize the loss: First, people must
experience their loss and understand that it has
happened.
b) React : People react emotionally to their loss
c) Recollect and Re-experience: people may
review memories of their lost relationship (event
that occurred, places visited together or day to
day moments that were experienced together)
9. d) Relinquish: People begin to put their loss behind
them, realizing and accepting that the world has
truly changed and that there is no turning back.
e) Readjust: People begin the process of returning
to daily life and the loss starts to feel less acute
and sharp
f) Reinvest : Ultimately, people re-enter the world,
forming new relationships and commitments.
They accept the changes that have occurred.
11. The way of an individual perceived a loss and
respond to it during bereavement is heavily
influenced by several factors.
1. Human development: persons of different ages
and stages of development will show different and
unique symptoms of grief.
2. Socioeconomic status: Socioeconomic status
influence a person’s ability to obtain options and
use support mechanism when coping with loss.
Generally an individual feels greater burden from
a loss when there is lack of financial, educational
or occupational resources.
12. 3. Personal relationship: When loss involves a loved
one, the quality and meaning of relationship are critical
in understanding a person’s grief experience. The
support that the client receives from the family and
friends is based on part of their relationship with
members of their social network and the manner and
circumstances of their loss.
4. Nature of the loss: The ability to resolve grief
depends on meaning of the loss and the situation
surrounding the loss. The ability to accept help from
others influences whether the bereaved will be able to
cope effectively. The visibility of the loss influences the
support a person receives.
13. 5. Culture and ethnicity: Culture affects how clients
and their support system or families respond to
loss.
6. Spiritual beliefs: Individual’s spirituality
significantly influences their ability to cope with
loss. Client who have a strong interconnections
with a higher power or others are often very
resilient and able to face death with relatively
minimal discomfort.
15. STAGES OF GRIEF
Kubler-Ross (1969) having done extensive
research with terminally ill patients identified 5
stages of feelings and behaviour that individuals
experience in response to a real, perceived or
anticipated loss:
16. STAGE 1 : DENIAL
This is a stage of shock and disbelief. The
response may be one of “No it cannot be true” .
Denial is a protective mechanism that allows the
individual to cope with in an immediate timeframe
while organizing more effective defense strategies.
17. STAGE 2 : ANGER
“Why me” and “It is not fair” are comments often
expressed during the anger stage. Anger may be
directed at self or displaced on loved ones,
caregivers and even God. There may be a
preoccupation with an idealized image of the lost
entity.
18. STAGE 3 : BARGAINING
“If God will help me through this, I promise I will go
to church every Sunday and volunteer my time to
help others”. During this stage, which is generally
not visible or evident to others, a bargain is made
with God in an attempt to reverse or postpone the
loss.
19. STAGE 4 : DEPRESSION
During this stage, the full impact of the loss is
experienced. This is a time of desperation and
disengagement from all associations with the lost
entity
20. STAGE 5 : ACCEPTANCE
The final stage brings a feeling of peace regarding
the loss that has occurred. Focus is on the reality of
the loss and its meanings for the individuals
affected.
