This document discusses coping with loss and grief. It begins by defining actual and maturational loss, and describing physical manifestations when approaching death. It then discusses outward expressions of loss, the period of mourning, and common symptoms experienced during grief including physical, psychological, cognitive, and behavioral reactions. It describes complicated grief and factors that influence coping with loss like human development, personal relationships, and culture. Techniques for grief counseling are provided, emphasizing letting the grieving talk about the deceased, distinguishing grief from depression, and helping organize their grief.

1. COPING WITH LOSS
DEATH AND GRIEF
PRESENTED BY
Mrs. SOUMYA SUBRAMANI, M.Sc.(N)
LECTURER, MSN DEPARTMENT
CON- SRIPMS, COIMBATORE.

4. 1. ACTUAL LOSS

6. MATURATIONAL LOSS

7.  LOSS OF AN EXTERNAL OBJECT
 LOSS OF FAMILIAR ENVIRONMENT
 LOSS OF ASPECT OF SELF
 LOSS OF SIGNIFICANT OTHERS
 LOSS AS CRISIS

8.  Death is present if an individual has sustained (1)
irreversible cessation of circulatory & respiratory
functions (2) irreversible cessation of all functions of
entire brain including the brain stem.

10. Physical manifestations when approaching
death
Sensory system
Hearing
Touch
vision
Smell
Cardiovascular system
Respiratory system
usually the last sense to disappear
Decreased sensation.
Decreased perception of pain & touch.
blurring of vision
Sinking & glazing of eyes
Blink reflex absent
decreased
increased HR, pulse, compromises peripheral circulation, cyanosis
Irregular rhythm
Decreased BP. Decreased cardiac output
increased RR, cheyne – stroke respiration
Inability to cough or clear secretions resulting in grunting, gurgling or
noisy congested breathing.
Irregular breathing gradually going down to terminal gasps.

11. CNS
Urinary system
GI system
Musculoskeletal system
Integumentary system
With hypoxia, brain is less sensitive to accumulating levels of
CO2 thus client may experience periods of apnea. Pain
perception is decreased. Sensory function impaired.
gradual decrease in urine output
Incontinence of urine.
slowing or cessation of GI function
Accumulation of gas.
Distention & nausea
Loss of sphincter control
Bowel movement before imminent death or at time of death.
gradual loss of a ability to move
Difficulty in speaking & swallowing
Loss of gag reflex. loss of sphincture control
Mottling hands, feet arms & legs cold & Clammy skin.
Loss of skin turgor

17. “I just want to see my grandchild’s birth, then I will be ready….”

18. “I just don’t know how my kids are going to get along after I’m gone.”

19. “I have lived a good life and I have no regrets”

20. HOSPICE CARE

21. END OF LIFE CARE

23. Outward social expression of loss

24. PERIOD DURING
WHICH MOURNING
TAKESPLACE

25. Physical reactions Psychological
reactions
Cognitive reactions Behavioral reactions
Loss of appetite
Weight loss
Insomnia
Fatigue
Decreased libido
Decreased immune function
Multiple somatic complaints
Profound sadness
Helplessness
Hopelessness
Denial
Anger
Hostility
Guilt
Nightmares
Loneliness
Inability to
concentrate
Forgetfulness
Impaired judgment
Decreased problem
solving ability
Social withdrawal
Distancing
SYMPTOMS COMMONLY EXPERIENCED DURING GRIEF:

27.  CHRONIC GRIEF
 EXAGGERATED/ HYPERTROPHIC GREIF
 DELAYED GRIEF

28. Symptoms of complicated grief include:
 Intense longing and yearning for the deceased
 Intrusive thoughts or images of your loved one
 Denial of the death or sense of disbelief
 Imagining that your loved one is alive
 Searching for you deceased loved one in familiar places
 Avoiding things that remind you of your loved one
 Extreme anger or bitterness over the loss
 Feeling that life is empty or meaningless

30.  HUMAN DEVELOPMENT
 PSYCHOLOGICAL PERSPECTIVE OF LOSS AND GRIEF
 SOCIO- ECONOMIC STATUS
 PERSONAL RELATIONSHIP
 NATURE OF LOSS
 CULTURE AND ETHININCITY
 SPIRITUAL BELIEFS

32.  Coping is the cognitive and behavioural
efforts to manage specific external and or
internal demands that are appraised as
taxing or exceeding the resources of the
person.
-Folk man and Lazarus

33. ADJUSTMENT
DISORDERS
ACUTE STRESS
DISORDER
DISSOCIATIVE
DISORDERS
DISSOCIATIVE
AMNESIA
DISSOCIATIVE FUGE
DISSOCIATIVE
IDENTITY DISORDER
DEPERSONALIZATION

39.  SPIRITUAL BELIEF
 SUPPORT FROM OTHERS
 MATERIAL ASSET
 KNOWLEDGE AND INTELLIGENCE

40.  Often, a counsellor's job in grief therapy is just to
stop the client getting stuck.

41.  Help your clients escape the prison of self-
limiting beliefs and negative self-attributions
with Conversational Reframing

42.  Accepting the loss and talking about it.
 Identifying and expressing feelings related to the
loss (anger, guilty, anxiety, helpless& sadness)
 Living without the deceased and making decisions
alone.
 Separating emotionally and forming new
relationships.
 The provision of support.

43. 3 TECHNIQUES FOR GOOD GRIEF COUNSELLING
 1. Let them talk about the deceased
 2. Distinguish grief from depression
 3. Deal with guilt and help them organize
the grief