The fact or process of losing something
Unrecoverable and usually unanticipated
and non- recurring removal of, or
decrease in, an asset or resource.
Grief is an emotional response to
Grief is a deep emotional and
mental anguish that is a response
to the subjective experience of
loss of something significant.
Mourning is the psychological
process through which the
individual passes on to successful
adaptation to the loss of a valued
Bereavement includes grief and
mourning-the inner feeling and
outward reactions of survivor
The sadness of losing someone you
love never goes away completely, but
it shouldn’t remain center stage.
If the pain of the loss is so constant
and severe that it keeps you from
resuming your life, you may be
suffering from a condition known
as complicated grief .
Intrusive thoughts or images of your loved
Denial of the death or sense of disbelief
Imagining that your loved one is alive
Searching for the person in familiar places
Avoiding things that remind you of your
Extreme anger or bitterness over the loss
Feeling that life is empty or meaningless
1. Denial and Isolation
The first reaction to learning of terminal illness or
death of a cherished loved one is to deny the reality
of the situation.
It is a normal reaction to rationalize overwhelming
It is a defense mechanism that buffers the
We block out the words and hide from the facts.
This is a temporary response that carries us through
the first wave of pain.
As the masking effects of denial and isolation
begin to wear, reality and its pain re-emerge. We are
The intense emotion is deflected from our
vulnerable core, redirected and expressed instead as
The anger may be aimed at inanimate objects,
complete strangers, friends or family.
Anger may be directed at our dying or deceased
loved one. Rationally, we know the person is not to
The normal reaction to feelings of helplessness and
vulnerability is often a need to regain control.
If only we had sought medical attention sooner
If only we got a second opinion from another
If only we had tried to be a better person toward
Secretly, we may make a deal with God or our
higher power in an attempt to postpone the
inevitable. This is a weaker line of defense to
protect us from the painful reality.
Two types of depression are associated with
The first one is a reaction to practical implications
relating to the loss. Sadness and regret predominate
this type of depression.
This phase may be eased by simple clarification and
reassurance. We may need a bit of helpful
cooperation and a few kind words.
The second type of depression is more subtle and,
in a sense, perhaps more private. It is our quiet
preparation to separate and to bid our loved one
Reaching this stage of mourning is a gift
not afforded to everyone.
Death may be sudden and unexpected or
we may never see beyond our anger or
denial. It is not necessarily a mark of
bravery to resist the inevitable and to deny
ourselves the opportunity to make our
This phase is marked by withdrawal and
calm. This is not a period of happiness and
must be distinguished from depression.
Shock and disbelief
(1) Acceptance of the loss,
(2) Acknowledgment of the intensity
of the pain,
(3) Adaptation to life after the loss,
(4) Cultivation of new relationships
Coping with death, one's own or a loved
one's, is considered the ultimate challenge.
The idea of death is threatening and anxiety
provoking to many people.
Kubler-Ross stated, 'The key to the question
of death unlocks the door of life. For those
who seek to understand it, death is a highly
Common fears of dying people are fear of
the unknown, pain, suffering, loneliness,
loss of the body, and loss of personal
The first is referred to as peaks and valleys or
periods of hope and periods of depression.
The second pattern is one described as distinct
but descending plateaus.
The third pattern is a clear downward slope
with many physiologic parameters indicating
that death is imminent.
The last pattern is a downward slant that
reveals a crisis event, such as a severe cerebral
hemorrhage with almost no hope of recovery.
Nursing care involves providing comfort
,maintaining safety ,addressing physical and
emotional needs ,and teaching coping strategies
to terminally ill patients and their families .
More than ever ,the nurse must explain what is
happening to the patient and the family and be a
confident who listens to them talk about dying.
Hospice care , attention to family and individual
psychosocial issues ,and symptom and pain
management are all part of the nurse's
The nurse must also be concerned with ethical
considerations and quality-of-life issues that
affect dying people.
Of utmost importance to the patient is
assistance with the transition from living to
dying, maintaining and sustaining
relationships, finishing well with the family,
and accomplishing what needs to be said and
In the hospital, in long-term care facilities, and
in home settings, the nurse explores choices
and end-of-life decisions with the patient and
Referrals to home care and hospice services,
as well as specific referrals appropriate for the
management of the situation, are initiated.
The nurse is also an advocate for the dying
person and works to uphold that person's
rights. The use of living wills and advance
directives allows the patient to exercise the
right to have a"good death or to die with
The nurse assesses spiritual strength by inquiring
about the person's sense of spiritual well-being, hope,
The nurse assesses current and past participation in
religious or spiritual practices and notes the patient's
response to questions about spiritual needs.
Another simple assessment technique is to inquire
about the patient's and family's desire for spiritual
For nurses to provide spiritual care, they must be open
to be present and supportive when patients experience
doubt, fear, suffering, despair, or other difficult
psychological states of being.
Interventions that foster spiritual growth or
reconciliation include being fully present; listening
actively; conveying a sense of caring, respect, and
acceptance; using therapeutic communication
techniques to encourage expression; suggesting the
use of prayer, meditation, or imagery; and facilitating
contact with spiritual leaders or performance of
Nurses can alleviate distress and suffering and
enhance wellness by meeting their patients' spiritual
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