1. GRIEF &
LOSS
Dr. James M. Alo,
RN,MAN,MAPsycho,PhD.

2.  “Experiences
of
loss are normal
and essential in
human life. Letting
go, relinquishing,
and moving on
happen continually
as a person
travels through the
stages of growth
and development.”

3.  Grief
refers to the subjective emotions and
affect that are a normal response to the
experience of loss.
 Grieving, also known as bereavement,
refers to the process by which a person
experiences the grief.

4.  Anticipatory
grieving is when people facing an
imminent loss begin to grapple with the very real
possibility of the loss or death in the near future
(Zilberfein, 1999).
 Mourning
is the outward expression of grief.

5. TYPES OF LOSSES
 A helpful
way to examine different types of
losses is to use Abraham Maslow’s hierarchy
of human needs.
 According to Maslow (1954), a hierarchy of
needs motivates human actions.
 1. Physiologic loss.

Examples include amputation and loss of
adequate air exchange or pancreatic
functioning.

6.  2.
Safety loss. Loss of a safe environment
such as following domestic or public
violence. A person may perceive a breach
of confidentiality in the professional
relationship as a loss of psychological safety
secondary to broken trust between client
and provider.
 3. Loss of security and a sense of belonging.
The loss of a loved one affects the need to
love and be loved.
 4. Loss of self-esteem. Any change in how a
person is valued at work or in relationships can
 threaten his or her need for self-esteem.

7.  5.
Loss related to self-actualization. An
external or internal crisis that blocks or inhibits
strivings toward fulfillment may threaten personal
goals and individual potential (Parkes,1998).

8. GRIEVING PROCESS





1. Nurses interact with clients responding to a myriad
of losses along the continuum of health and illness.
2. Nurses must have a basic understanding of what is
involved to meet the challenge that grief brings to
clients.
3. Nurses may promote the expression and release of
emotional as well as physical pain, thus supporting the
grieving process.
4. Active listening are paramount when assisting
grieving clients.
5. Recognizing the verbal and nonverbal
communication content of the various stages of
grieving.

9. Theory of the Grieving Process
 Elisabeth
Kubler-Ross (1969) five stages to explain
what people experience as they grieve and mourn:
 1. Denial is shock and disbelief regarding the loss.
 2. Anger may be expressed toward God, relatives,
 friends, or health care providers.
 3. Bargaining occurs when the person asks God or
fate for more time to delay the inevitable loss.
 4. Depression results when awareness of the loss
becomes acute.
 5. Acceptance occurs when the person shows
evidence of coming to terms with death.

10. DIMENSIONS OF GRIEVING
 People
have many and varied responses to loss.
They express their bereavement in their thoughts,
words, feelings, and actions as well as their
physiologic responses.

Nurses must use a holistic model of grieving that
encompasses cognitive, emotional, spiritual,
behavioral, and physiologic dimensions.

11. 
Cognitive Responses to Grief


Emotional Responses to Grief





• “He should have stopped smoking years ago.”
• “If you had taken her to the doctor earlier,
this might not have happened.”
• “It took you too long to diagnose his illness.”
Behavioral Responses to Grief


viewing the world more realistically, and re-evaluating
religious or spiritual beliefs
Nurse must provide a context of acceptance in which the
client can explore his or her behavior.
Spiritual Responses to Grief

Finding explanations and meaning through religious or
spiritual beliefs, the client may begin to identify positive
aspects of grieving

12. Nurse’s Role
 Diverse
cultural environment, offers the
sensitive nurse many opportunities to
individualize care when working with grieving
clients.
 1. Nurse should understands a particular
culture’s appropriate grieving behaviors,
 2. Nurse must encourage clients to discover
and use what is effective and meaningful for
them.

13.  Disenfranchised
grief is grief over a loss that
is not or cannot be acknowledged openly,
mourned publicly, or supported socially. Three
categories of circumstances can result in
disenfranchised grief:
 • 1. A relationship has no legitimacy.
 • 2. The loss itself is not recognized.
 • 3. The griever is not recognized.

14.  Complicated
grieving to be a response outside
the norm and occurring when a person is void of
emotion, grieves for prolonged periods,


has expressions of grief that seem disproportionate
to the event.
People may suppress emotional responses to the
loss or become obsessively preoccupied with the
deceased person or lost object.

15. People who are vulnerable to
complicated grieving
 1.
Low self-esteem
 2. Low trust in others
 3. A previous psychiatric disorder
 4. Previous suicide threats or attempts
 5. Absent or unhelpful family members
 6. An ambivalent, dependent, or insecure
attachment to the deceased person.

16. Nursing Mgt. to grieving
clients:





Nurse to support and facilitate the grief process for
clients,
He or she must observe and listen for cognitive,
emotional, spiritual, behavioral, and physiologic
cues.
Nurse must be familiar with the phases, tasks, and
dimensions of human response to loss,
he or she must realize that each client’s experience
is unique.
Skillful communication is key to performing
assessment and providing interventions.

17.  Nurse
must examine his or her own personal
attitudes,
 Maintain an attentive presence, and provide a
psychologically safe environment for deeply
intimate sharing.
 Awareness of one’s own beliefs and attitudes.
 assuring the client of confidentiality, refraining
from judging or giving specific advice, and
 Allowing the client to share thoughts and
feelings freely.

18. S A M P L E C A R E P L A N GRIEF
ASSESSMENT
DATA
Nursing
Diagnosis
EXPECTED
OUTCOMES
IMPLEMENTATION
Intervention
Cognitive
Responses
•
Questioning
and trying to
make sense
of the loss
•
Experiencing
disillusionme
nt
•
Attempting
to make
sense of the
loss
➤ Grieving
A normal
response in
the human
experience
of loss.
The client will
• Identify the
loss and its
meaning for
self
(adequate
perception)
• Express
feelings,
verbally and
nonverbally
Rationale
- Talk with the
client
realistically
about his
or her loss;
discuss
concrete
changes that
the
client must
now begin to
make as a
result of
the loss.
Discussing
the loss on
this level
may help
to make
it more
real for
the client.

19. Tears are the silent language of grief.
-Voltaire
Thank you.
- Dr. james m. alo