COPING WITH LOSS

Introduction
• Coping refers to a person’s efforts
through action and thought to deal
with demands perceived as taxing or
overwhelming.
• It refers to the cognitive and
behaviour efforts used to manage
stressful encounters.

COPING LOSS
Exceeding the resources
of the person
Situation in which valued
object is changed

Coping strategies fall into two
categories –

Coping strategies fall into two categories –
Problem focused
• Problem focused coping
is direct; it consists of
reducing or eliminating
the source of stress
itself.
Emotion focused
• involves trying to
reduce the negative
emotional responses
associated with stress
such as
embarrassment, fear,
anxiety, depression,
excitement and
frustration.

Problem focused coping
It consists of –
• Reducing
• Eliminating
the source of stress
itself.

For example (?)
• If you are getting
poor in history
and appraise this
as a threat, what
you will do in
that kind of
situation?

Problem focused coping contd…
1. You may study harder
2. Talk over your problem
with your professor

Problem focused coping contd…
3. Form a study group 4. Get a tutor

But what can
people do when
they face stress
(loss) that they
cannot fight,
escape from, avoid
or modify in any
way?

For example (?)
• If you lose your
job, what you
will do ???

Emotion focused coping
contd…
• To cope emotionally, people may
use anything from
 religious faith
wishful thinking
humour or denial
to alcohol, drugs etc.

Emotion focused strategies include:
• Keeping yourself busy to take your mind off
the issue
• Letting off steam to other people
• Praying for guidance and strength
• Ignoring the problem in the hope that it will
go away
• Distracting yourself (e.g. TV, eating)
• Building yourself up to expect the worse

PROACTIVE COPING
• Dealing with stress in advance
• It is all about ‘taking aim, getting ready, then firing’.
• Mentally it is about thinking differently about the
stressful situation.
• It means efforts or actions taken in advance of a
potentially stressful situation to prevent its occurrence
or to minimize its consequences.
• Its important feature is action itself.
• Self-talk is a popular approach used by athletes to
refocus themselves. In the case of cricket, this can be
“keep the bat straight” or “keep my eye on the ball”.

Loss
• Throughout our lives, from birth to death, we form
attachments and suffer losses. We develop
independence from our parents, start and leave
school, change friends, begin careers, and form
relationships.
• The more significant the loss, the more intense the
grief. Grief is a natural response to loss.

Loss Contd..
• It is the emotional suffering you feel when
something or someone you love is taken
away. However, even subtle losses can lead to
grief. For example, you might experience grief
after moving away from home, graduating
from college, changing jobs, selling your family
home, or retiring from a career you loved.

LOSS
• Loss can be tangible or
intangible. Loss is any
situation in which a
valued object is
changed or is no longer
accessible to the
individual.

Loss of external object
• It is a type of perceived loss which occurs
when a sense of loss is felt by an individual
but is not tangible to others. When an object
that a person highly values is damaged,
changed, or disappears, loss occurs. The
valued object may be a person, pet, prized
possession, or one’s home.

Loss of familiar environment
• The loss of familiar environment occurs when
a person moves to another home or a
different community, changes schools, or
starts a new job.

Loss of aspect of self
Psychological Aspect
It may be loss of-
• Ambition
• A sense of humour
• Entertainment of life
Physiological Aspect
• Loss of physical function as a
result of injury or illness
Psychological loss is such as a
woman feeling inadequate after
menopause and resultant
infertility.
For example loss of an extremity
in an accident, scarring from
burns permanent injury.

Loss of significant others
• It is a type of actual loss
• Such a loss can be the
result of
 separation
 divorce
 running away
 moving to different area
 theft of one’s property
 death.

EXERCISE – (?)
TYPE OF LOSS
1. Change of school
loss of familiar environment
2. Divorce
loss of significant others
3. Scaring from burns
loss of physiological aspect of self
4. Infertility
loss of psychological aspect of self
5. New job
loss of familiar environment

TERMINOLOGY
• GRIEF- Grief is a normal process of reacting to
the loss. Grief reactions may be felt in
response to physical losses (for example, a
death) or in response to symbolic or social
losses (for example, divorce or loss of a job).

TERMINOLOGY CONTD….
• BEREAVEMENT- It is the period after a loss during
which grief is experienced and mourning occurs.
The time spent in a period of bereavement depends
on how attached the person was to the person who
died, and how much time was spent anticipating
the loss.

TERMINOLOGY CONTD….
• MOURNING- It is the process by which people
adapt to a loss. Mourning is also influenced by
cultural customs, rituals, and society’s rules
for coping with loss.

THEORIES OF GRIEVING PROCESS
• There are four theories who are well known in
the field of loss.
Erich Lindemann
George L Engle
John Bowlby
J. William Worden

Erich Lindemann
• Lindemann coined the phrase “grief work”
Grief work includes the processes that a
mourner needs to complete before resuming
daily life. These processes include separating
from the person who died, readjusting to a
world without him or her, and forming new
relationship (Lindemann, 1944)

George L Engle
• Engle gave the theory of mourning. According
to him a mourner goes through three stages:
Shock and disbelief
Developing awareness
Restitution and resolution

J. William Worden
• Worden (1982) had identified four tasks that
an individual must perform in order to
successfully deal with a loss:
Accept the fact that the loss is real.
Experience the emotional pain of grief.
Adjust to an environment without the
deceased.

How does coping works on all domains of
life?
Domains
Adaptations
Biological
domain
Psychological
domain
Social
domain

Adaptation
• Conceptualised as a person’s capacity to survive & flourish.
Adaptations or lack of its effects on three important areas:
 health
 psychological wellbeing and
 social functioning
• If a person’s copes successfully with stress he or she returns
to a previous level of adaptation. Successful coping results
in an improvement in health, wellbeing, & social
functioning

Biological domain
• Biologic Assessment:- The nurse should include a
careful health history, focusing on past and
present illness & traumas.
• Gender Difference: Males are more likely to
respond to stressor with a fight or flight
response, whereas females has less aggressive
responses; they tend and be friend.

Review of system: can also provide important data on
the effect of chronic illnesses. These data are useful for
understanding the person environment situation and the
persons stress reaction, coping response and adaptation.
Physical functioning:- Physical functioning usually
changes during stress response. Typically, sleep is
disturbed, appetite either increases or decreases, body
languages expresses muscle tension ,which convey a state
of anxiety not usually present.

Pharmacological assessment:-
In assessing a person’s coping strategies, nurse needs to
ask about the use of alcohol, tobacco, marijuana &
other addictive substances.
Knowing the details about the person’s use of these
substances (number of times a day or week, amount,
characteristics’, circumstances, side effects ) helps in
determining the role of substances play in overall stress
reduction or management .

Psychological domain
Psychological Assessment:
Psychological assessment focuses on the
-person’s emotions & their severity as
well as his or her coping strategies by
using therapeutic communication
technique.

Social domain
Social Assessment
• Assessment include Recent Life Changes Questionnaire to
determine the number & importance of life changes that
patient has experienced within the past year.
• Size & extent of the network, both relatives & nonrelatives,
professional & nonprofessional & how long known.
• Functions that the network serves (guidance & advice,
access to new contacts)

COPING EFFECTIVELY
• The most effective approach is to deal
directly with the problem, taking some
direct action to change or eliminate it. In
fact direct action is the only method of
really solving the problem.
• If the problem is insoluble, then indirect
methods must be used and there are
several indirect, positive methods of coping.

COPING EFFECTIVELY contd…
• One such method is to think about the
problem differently.
• In refraining the problem, also called
cognitive restructuring, the individual
looks at the problem from a new
perspective.
• It is defined as more tolerable, less
disruptive or simply unimportant.

In addition, the individual can attempt to relive stress
reaction. These techniques include two rather
opposite approaches.
1. Complete relaxation
• Muscle relaxation
• Breathing control
• Visualization technique
in which one imagines
relaxation scenes

Contd…
2. Vigorous exercises
• Weight training
• Aerobics
• Athletic competition

Suggestions to help you cope with stress
• Exercise- Physical exercise (sports, yoga, dancing
and walking)

Suggestions to help you cope with stress
contd….
• Meditate- To quiet the body and promote
relaxation

Suggestions to help you cope with stress
contd….
• Relax- Relax your body regularly through a
systematic method of tension and relaxing all
of our muscles.
• Slow down your pace of life- Move more
slowly and deliberately.

Suggestions to help you cope with stress
contd…
• Organize your life activities with priority- so that
you always accomplish what must be done at the
right time.
• Balance- Balance your life activities with work and
play, family and fiends & time for yourself.

Suggestions to help you cope with stress
contd…
• Make your goals realistic- Understand and accept
what you can and cannot do or be.
• Develop healthy social relationship- People will
support and help you in stressful situation.

Suggestions to help you cope with stress
contd…
• Practice coping statements- These are things you say
to yourself when in a stressful situation. When you are
ready to take an examination, for example, “you may
be thinking, I am scared”, “I won’t remember the right
things”, or “I’m not smart enough to pass”. You would
use your coping statements to replace your negative
thoughts. Then you would think, I ‘m keyed up & ready
to go, “if I forgot something I will just wait for a
moment or I will do my very best”. These mental
statements are very helpful but must be practiced to
be of value.

INEFFICIENT COPING-
• Though we respond to everyday problems of
adjustment in diverse way but some problems
may be inefficient. They may drain our energy,
cause needless expenditure of time, prevent
us from finding better solutions, and even
make us more troubled.

Defence mechanisms
• Acting out
• Altruism
• Anticipation
• Denial
• Displacement
• Dissociation
• Distortion
• Fantasy
• Humour
• Hypochondriasis
• Idealism
• Identification
• Intellectualization
• Introjections
• Isolation
• Passive aggression
• Projection
• Rationalization
• Reaction formation
• Regression
• Repression
• Sublimation

REMEMBER THE BASIC WHEN
COPING WITH LOSS
Healthy strategies when facing a life challenge.
Many healthy ways to manage and cope with
loss, but they all require change.
Change the situation or change your reaction.
Unique response to stress, there is no “one size
fits all” solution to managing it.
Different techniques and strategies for different
individuals.

When deciding which option to choose, it’s helpful to
think of the four As: avoid, alter, adapt, or accept.
Management strategy #1: Avoid unnecessary stress
Learn how to say “no
Avoid people who stress you out
Take control of your environment
Avoid hot-button topics
Pare down your to-do list

b) Management strategy #2: Alter the situation
Express your feelings instead of bottling them up
Be willing to compromise
Be more assertive
Manage your time better.
c) Management strategy #3: Adapt to the stressor
Reframe problems.
Look at the big picture.
Adjust your standards.
Focus on the positive.
Adjusting Your Attitude.

d) Management strategy #4: Accept the things you can’t
change
Don’t try to control the uncontrollable
Look for the upside
Share your feelings
Learn to forgive
e) Management strategy #5: Make time for fun and
relaxation
Healthy ways to relax and recharge
Go for a walk.

Spend time in nature.
Call a good friend.
Sweat out tension with a good workout.
Write in your journal.
Take a long bath.
Light scented candles
Savour a warm cup of coffee or tea.
Play with a pet.
Work in your garden.
Management strategy #5: Make time for fun and relaxation
contd…

Management strategy #5: Make time for fun and relaxation
contd…
 Curl up with a good book
 Get a massage.
 Listen to music.
 Watch a comedy
 Set aside relaxation time
 Connect with others
 Do something you enjoy every day
 Keep your sense of humour

Management strategy #6: Adopt
a healthy lifestyle
 Exercise regularly
 Eat a healthy diet
 Reduce caffeine and sugar
 Avoid alcohol, cigarettes,
and drugs
 Get enough sleep

OTHER MOST IMPORTANT
THINGS TO REMEMBER ABOUT
COPING WITH LOSS
• Be patient with yourself.
• Find healthy ways to let your feeling out.
• Let people who are close to you offer their support.
• See a counsellor if you feel like you could use help
getting through your loss.
Written by CYWH Staff at children’s hospital Boston.

NURSING IMPLICATIONS FOR
COPING WITH LOSS
Loss is a part of life, it may varies from one
person to another or even same,
 Coping pattern are some coping strategies will
be effective for one.
Others will be appropriate for different person.
 A nurse who is sensitive can choose methods of
interventions that will be more effective for each
individual.

Assessment
Nursing assessment of a client’s stress & coping patterns.
– Nursing history
– Physical examination of client for indicator of loss.
• When obtaining the nursing history, the nurse poses
questions related to clients other perception to loss &
past & present coping strategies.

• During physical examination, the nurse
observes for verbal, motor, cognitive or
other physical manifestation of loss.
• Remember , however that clinical signs
& symptom may not occur when
cognitive coping is effective.

NANDA diagnosis related to adaptation & coping
Compromised Family Coping: - Usually Supportive
primary person provides insufficient, ineffective or
compromised support, comfort, assistance or
encourage that may be needed by client to manage
or master adaptive tasks related to his or her
health challenge.

Decisional conflict:- Uncertainly about course of
action taken when choice among competing action
involves risks, loss or challenge to personal life
values.
Impaired adjustment:- Inability to modify lifestyles
in a manner consistent with the change in health
status.

Disabled family coping:- Behaviour of significant
persons (family or other primary person) that
disables his/her capacities & the client’s capacities
to effectively address tasks essential to either
person’s adaption to health challenge.
Fear:- Response to perceived threat i.e. Consciously
recognised as danger.

Ineffective coping:- inability to a valid appraisal of
stressors, inadequate choices of practice response or
inability to use responses.
Post trauma syndrome:- sustained maladaptive
response to a traumatic, overwhelming event.

Planning
According to the client’s
• state of health ,level of anxiety, support, resources,
coping mechanism & sociocultural & religious
affiliation .
The overall goal for experiencing loss related response.
• Decrease or resolve anxiety.
• Increase ability to manage or cope with loss.
• Improve role performance.

Implementation
Encouraging health promotion strategies
• Exercise:- promote both physical and
emotional health.
• Nutrition:- optimal nutrition is essential
for health and increasing resistance of
the body to stress(loss).

Implementation contd…
• Rest and Sleep:- It helps to restore the
body’s energy levels.
• Using Relaxation Techniques:-
• To quiet the mind,
• Release tension.
• Counteract the flight & fight response .

Implementation contd…
There are various relaxation techniques
• Breathing exercise
• Massage
• Progressive relaxation
• Imagery guidance
• Yoga
• Meditation

Implementation contd…
• Therapeutic touch
• Music therapy
• Humour & laughter therapy
• Biofeedback

Conclusion
• Coping helps us to realize the importance
of intimacy, job role or death or any
type of loss.
• Life and its daily activities never stops.
Coping with loss provides opportunity to
deal with life in difficult situation.
• Foundation of stress management.

• Managing stress is all about
 taking charge of your thoughts,
 Emotions & schedule,
 Our environment, and the way you deal with
problems.
• The ultimate goal is a balanced life,
 with time for work,
 relationships, relaxation, and fun –
 plus the resilience to hold up under pressure and
meet challenges head on.

Bibliography
• Boyd Ann Mary, Psychiatric Nursing,4th edition,
published by Lippincott Williams & Wilkins, Pp
229-234
• Neeb Kathy, Fundamentals Of Mental Health
Nursing, Second Edition, Published by F.A Davis
Company, Philadelphia. Pp 89-90
• Kozier Barbara, ERB Glenora, Berman Audrey,
Fundamental of Nursing, Seventh Edition,
Published by pearson education, Pp 1058-1066

Bibliography contd…
• http://www.psychologyfitness.com/defense-
mechanisms/ retrieved on 19-2-2012
• http://www.psychologytoday.com/articles/200303/
good-grief-coping-after-loss retrieved on 19-2-2012
• http://en.wikipedia.org/wiki/Coping_(psychology)
retrieved on 20-2-2012
• http://www.simplypsychology.org/emotion-
focused-coping.html retrieved on 20-2-2012

Bibliography contd…
• http://www.stillerhughes.com.au/wp-
blog/archives/367 retrieved on 20-2-2012
• http://helpguide.org/mental/grief_loss.htm
retrieved on 25-2-2012

THANK YOU!