This document discusses grief and the role of nurses in assisting with the grief process. It defines grief and bereavement and outlines various types of grief reactions. Several theories of grief are described, including stages of grief, tasks of mourning, and responses to loss. The document then provides guidance for nurses in assessing and managing grief through nursing diagnoses, interventions, counseling principles and techniques.

2. GRIEF & GRIEF
REACTION :ROLE
OF NURSE

3. •What is your experience of grief

4. INTRODUCTION
•Grief is a natural and normal reaction
•Multifaceted response
•Descends on everyone ,regardless of
age or status

5. BEREAVEMENT AND GRIEF
•Grief: Normal process of reacting to
loss that is sometimes felt in response
to physical losses or in response to
symbolic or social losses
•Bereavement: It is the period
following a loss during which grief is
experienced and mourning occurs

6. TYPES
• Broad category of grief includes
• Anticipatory grief
• Acute Grief Traumatic
Grief
• Dysfunctional Grief
• Chronic Grief Absent grief
Conflicted
Grief
Chronic Grief

7. ANTICIPATORY GRIEF
•Pre mourning
•Grief associated with anticipation of
predicted loss or developing loss
•Eg: Loved one develops dementia
•Research findings
•Grief begins when a serious physical or
mental illness occur
•It involves pain
•Lack of emotional response is
indication to dysfunctional grief

8. ACUTE GRIEF
•Prototype
•No agreement on how long it
lasts
•Theory suggests 1year
•It can be the process of healing

9. DYSFUNCTIONAL GRIEF
•Unresolved issues in the relationship
• Inhibited expression of grief
•Lack of social support
• Uncertain loss
• Traumatic loss
•Multiple losses
• Loss that is seldom discussed

10. DYSFUNCTIONAL GRIEF
•Lasts longer than other types of grief
•Characterized by greater disability
•Traumatic Grief
•Occurs when a traumatic loss happens
unexpectedly
•PTSD is a concurrent or complicating
factor
•Characterized by psychic
numbing,Intrusive thoughts,Avoidance of
stimuli and Increased arousal.

11. •Absent or Inhibited grief
• Characterized by minimal emotional
expression of grief
• Absent grief sometimes convert to
delayed grief
• After years of loss

12. •Conflicted grief
• Occurs when the relationship with the
deceased was ambivalent
•Initial responses are minimal
•Intense to the extent that the survivors
are haunted by the deceased

13. •Chronic Grief
•Unending grief after a loss
•In highly co dependent relationship

14. THEORIES AND MODELS OF GRIEF
• Freud (1961)
• He viewed grief as a solitary process, whereby
mourners withdrew from the world so that
detachment from the deceased could be a
gradual process.
• The psychological function of grief was thought
to release the individual from his or her bond
with the deceased.
• This was achieved by looking back at the past
and reliving memories of the deceased person.

15. •Detaching from the deceased involved
working through the loss so that the grief
could be overcome.
•This was often termed ‘grief work’.
•This focus on letting go of, or detaching
from, the deceased to accommodate grief
is still debated among theorists (Payne et
al1999)

16. • Bowlby’s (1973)
• Theory of attachment emphasizes the
importance of human attachments and
bonds that are developed early in life.
• Grief evolves through a sequence of four
overlapping, flexible phases. These are:
• 1.Shock.
• 2.Yearning and protest.
• 3.Despair.
• 4.Recovery.

17. DUAL PROCESS MODEL
•DUAL PROCESS MODEL

18. KUBLER ROSE

19. GEORGE ENGEL
•Initial response is shock and disbelief
•Awareness and meaning of loss
develops in first year
•Eventually the relationship is resolved
and put in perspective

20. LINDEMANN
• He identified parameters for ‘normal’ and
‘pathological’ grief, such as duration,
intensity and changes in social functioning.
• Many of the pathological factors identified
are now known to be relatively common and
are accepted as ‘normal’ reactions to grief.
• Based on his clinical experience focusing on
people who have been bereaved as a result
of disasters, Lindemann (1944) developed a
theory of grief with five distinct phases,
including:

21. • Somatic disturbance,
• for example, tightness in the throat, shortness
of breath or choking.
• Preoccupation with the image of the deceased.
• Guilt,
• for example, reviewing behaviour that
occurred before the death for evidence of
negligence and/or failure.
• Feelings of hostility or anger.
• Difficulty in carrying out everyday routines.

22. SHNEIDMAN
•Expression of grief as being dependent
primarily on individuals personality or
style of living
•Individual who has depressive traits
•One who avoids emotion avoids grief too

23. WORDEN
•Worden (1991) adopts a different approach
to loss by setting tasks that have to be
worked through if grief is to be resolved.
•In Worden’s (1991) model the emphasis
moves from passive phases of grief to
active tasks of mourning. These tasks
include:
•Task one – to accept the reality of loss.
•Task two – to work through and experience
the pain of grief.

24. • Task three – to adjust to an environment
without the deceased person.
• The bereaved person must embrace new
roles and adjust to the changing dynamics of
his or her environment.
• Task four – to withdraw emotionally from or
relocate the deceased and move on.
• Relocation requires that the bereaved person
forms an ongoing relationship with his or her
memories of the deceased in such a way that
he or she is able to continue with his or her
life.

25. STAGES OF GRIEVING PROCESS
• Period of Shock
• The reality stage
•Recovery stage

26. RESPONSES TO GRIEF
• Physical Responses to Grief
• Back, neck, or general muscle pain
•Headaches
• Dry mouth
•Stomach pain, diarrhea, constipation
• Inability to eat, weight loss
• Fatigue

27. RESPONSES TO GRIEF
•Restlessness
• Chills, sweats
• Chest pain, difficulty breathing
•Nervousness
• Nightmares
•Clinging
• Crying

28. COGNITIVE MANIFESTATIONS
• Pre occupation with the deceased
person
•Difficulty concentration
• Hallucinations
• Isolation Excessive guilt

29. BEHAVIORAL AND RELATING
MANIFESTATIONS
•Disruptions in patterns of conduct
•Disorganized behaviour
•Obsessive reflections and
reminiscence
•Intense sense of isolation

30. AFFECTIVE MANIFESTATIONS
• Guilt
• Sadness
•Loneliness
• Hopelessness

31. MAL ADAPTIVE RESPONSE TO GRIEF
•Delayed or Inhibited Grief
•Distorted grief response
•Chronic or Prolonged grieving

32. GUIDELINES FOR DEALING WITH GRIEF
•Find support
• Give it time
• Express your feelings
•Take care of health
• Accept that life is for the living
•Postpone major life changes
• Be patient
• Seek help

34. INTRODUCTION
•Worden: The over all goal of Grief
counseling is to help survivor adapt to
the loss of a loved one and be able to
adjust to a new reality without him or her
• To support bereaved, basic counselling
skills are required along with an
appreciation to the process of grief

35. SYSTEMIC APPROACH TO
COUNSELLING
•Defining the problem
•Encourage client to describe their
emotions related to unresolved grief
•Therapist gain understanding as to how
much clients construct their views of
the context within which emotions arise

36. • Exploring the context
•Affirm the client’s view, highlight their
strengths and utilize creative
resources to express unresolved grief
•Some clients may relate their problem
to another cause other than loss
•Deconstruct client’s view
•Offering another context

37. •Options for the future
• Mutual reconstruction of a context
which offers autonomy, Increased
options, Free emotional expression
creative and holistic thinking and new
direction towards a more rewarding
life

38. COUNSELLING PRINCIPLES
•Help the survivor to actualize the loss
• Identify and experience feelings
• Assist living without the deceased
•Help find meaning in the loss
• Facilitate emotional relocation of the
deceased
• Provide time to grieve

39. • Interpret normal behaviour
• Allow the individual differences
•Examine defenses and coping styles
• Identify pathology and refer

40. Useful Techniques
• Evocative language
• Use of symbols
• Writing letter
• Drawing
• Role playing
• Cognitive restructuring
• Memory books
• Directed imagery

41. Nursing Management
•Assessment
•Nursing Diagnosis
•Acute grief
•Disturbed personal identity
•Situational low self esteem
•Impaired social interaction
•Complicated Grief
•Risk for self directed violence
•Complicated grieving

42. •Others
•Risk for other directed violence
•Ineffective individual and family
coping
•Ineffective denial
•Fatigue
•Hopelessness
•Powerlessness

43. •Interventions
•Problem oriented Grief therapy
•Interventions for children

44. Journal
• Guilt in Bereavement,Role of self
blame
• Bereaved spouses 4 to 7 months
investigation
• Self blame was associated with grief
in the initial stages and reduced over
time

45. •Researching Grief in cultural
context
•19th century diaries on grief
•Strong cultural difference
•People cycle into and out of
intense grief even years after
death