Grief is a multifaceted response to loss, particularly to the loss of someone or something that has died, to which a bond or affection was formed. Although conventionally focused on the emotional response to loss, it also has physical, cognitive, behavioral, social, and philosophical dimensions. While the terms are often used interchangeably, bereavement refers to the state of loss, and grief is the reaction to loss.

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Loss and Grief
Loss
 Absence of an object, person, body part, emotion, idea or function that was
valued
1. Actual loss is identified and verified by others
2. Perceived Loss cannot be verified by others
3. Maturational Loss occurs in normal development
4. Situational Loss occurs without expectations
5. Ultimate Loss (Death) results in a lost for a dying person as well as for those
left behind, can be viewed as a time of growth for all who experienced it
Grieving Process (Theories of Grief, Dying and Mourning)
1. 3 Phases of Grief
 Protest- lack of acceptance, concerning the loss, characterized by anger,
ambivalence and crying
 Despair- denial and acceptance occurs simultaneously causing disorganized
behavior, characterized by crying and sadness
 Detachment- loss is realized; characterized by hopelessness, accurately
defining the relationship with the lost individual and energy to move forward
in life.
2. Kubler-5 Stages of Grieving
 Denial – characterized by shock and disbelief, serves as a buffer to mobilize
defense mechanism
 Anger– resistance of the loss occurs, anger is typically directed toward others
 Bargaining – deals are sought with God or other higher power in an effort to
postpone the loss
 Depression– loss is realized; may talk openly or withdraw.
 Acceptance– recognition of the loss occurs disinterest may occur; future
thinking may occur.
3. Worden’s 4 Tasks of Mourning
 Accept the reality of the loss, the loss is accepted
 Experience the pain of grief, healthy behaviors are accomplished to assist in
the grieving process.

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 Adjust to the environment without the deceased, task are accomplished to
reorient the environment, i.e. removing the clothes of the deceased from the
closet.
 Emotionally relocate the deceased and move forward with life, correctly align
the past, the present & look towardsthe future
Anticipatory Grief
 Expression of the symptoms of grief prior to the actual loss, grief period
following the lost may be shortened and the intensity lessened because of the
previous of grief; for example, a child told that a family move is expected may
grieve about losing friends prior to actually living
Complications of Bereavement
1. Chronic Grief – symptoms of grief occur beyond the expected time frame and
the severity of symptoms is greater; depression may result.
2. Delayed Grief – when symptoms of grief are not expressed and are
suppressed, a delayed reaction of grief occurs, the nurse should discuss the
normal process of grieving with the client and give permission to express
these symptoms
Symptoms of Normal Grief
1. Feelings include sadness, exhaustion, numbness, helplessness, loneliness, and
disorganization, preoccupation with the lost object or person, anxiety,
depression.
2. Thought patterns include fear, guilt, denial, ambivalence, anger
3. Physical sensations include nausea, vomiting, anorexia, weight loss or gain,
constipation or diarrhea, Diminished hearing or sight, chest pain, shortness of
breath, tachycardia
4. Behaviors include crying, difficulty carrying out activities of daily living and
insomnia
Nursing Health Promotion (to facilitate mourning)
1. Help client accept that the loss is real by providing sensitive, factual
information concerning the loss
2. Encourage the expression of feelings to support people; this build
relationships and enhances the grief process
3. Support efforts to live without the diseased person or in the face of disability;
this promotes a client’s sense of control as well as a healthy vision of the
future
4. Encourage establishment with new relationships to facilitate healing.

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5. Allow time to grief, the work of grief may take longer for some; observe for a
healthy progression of symptoms.
6. Interpret “normal” behavior by teaching thoughts, feelings, and behaviors
that can be expected in the grief process
7. Provide continuing support in the form of the presence for therapeutic
communication and resource information.
8. Be alert for signs of ineffective coping such as inability to carry out activities of
daily living, signs of depression, or lack of expression of grief.