chapter 28: grief: in loss and death copyright © 2012, 2007 mosby, inc., an affiliate of elsevier...

Chapter 28:Chapter 28:

Grief: In Loss and DeathGrief: In Loss and Death

Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

22Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

GriefGrief

Natural and normal reaction to loss; part of Natural and normal reaction to loss; part of the human experience the human experience

Grief descends on everyone regardless of Grief descends on everyone regardless of age, status, or circumstanceage, status, or circumstance

Bereavement: the period after the loss, Bereavement: the period after the loss, usually an intense emotional responseusually an intense emotional response

Mourning: process where people adapt to Mourning: process where people adapt to lossloss


Types of LossesTypes of Losses

Death of loved oneDeath of loved one Self-esteem/self-worthSelf-esteem/self-worth IdentityIdentity DignityDignity Psychiatric illnessPsychiatric illness

SurgerySurgery IllnessIllness Birth defectBirth defect Change of locale Change of locale Job lossJob loss


Responses to Grief and Responses to Grief and Bereavement Bereavement

Physical manifestationsPhysical manifestations Cognitive manifestationsCognitive manifestations Behavioral and relating manifestationsBehavioral and relating manifestations Affective manifestations: guilt and angerAffective manifestations: guilt and anger


Physical ManifestationsPhysical Manifestations

WeaknessWeakness NumbnessNumbness AnorexiaAnorexia Feelings of chokingFeelings of choking Shortness of breathShortness of breath Tightness in chestTightness in chest GI disturbancesGI disturbances Sleep disturbancesSleep disturbances Increased vulnerabilityIncreased vulnerability


Cognitive ManifestationsCognitive Manifestations

Preoccupation with thoughts and memories Preoccupation with thoughts and memories of the departed of the departed

Difficulty concentratingDifficulty concentrating Longing for the deceasedLonging for the deceased Rumination, isolation, excessive guiltRumination, isolation, excessive guilt


Behavioral and Relating Behavioral and Relating ManifestationsManifestations

Disruptions in patterns of conductDisruptions in patterns of conduct Inability to perform ADLsInability to perform ADLs Restless disorganizationRestless disorganization Excessive ruminationExcessive rumination

IsolationIsolation Lack of meaning in old life patternsLack of meaning in old life patterns


Affective ManifestationsAffective Manifestations

Emotional: sadness, guilt, anxietyEmotional: sadness, guilt, anxiety Cognitive: preoccupied, ruminatingCognitive: preoccupied, ruminating Physical: somatic complaints, lowered Physical: somatic complaints, lowered

immune functionimmune function Existential: disruption in life’s certainties, Existential: disruption in life’s certainties,

questioning beliefsquestioning beliefs


Stages of and Process of GriefStages of and Process of Grief

1.1. AvoidanceAvoidance Numbing Numbing BluntingBlunting DenialDenial

2.2. ConfrontationConfrontation Period of active mourningPeriod of active mourning DisorganizationDisorganization DespairDespair

3.3. ReestablishmentReestablishment GradualGradual ReorganizationReorganization RecoveryRecovery


Process of GriefProcess of Grief

May include some or all:May include some or all: Shock and disbeliefShock and disbelief Protest and despairProtest and despair Emotionless cognitive activityEmotionless cognitive activity Waves of despairWaves of despair Yearning, despair, and disorganizationYearning, despair, and disorganization Rebuilding processRebuilding process


Tasks of GriefTasks of Grief

Telling the death storyTelling the death story Expressing/accepting the sadness, guilt, Expressing/accepting the sadness, guilt,

anger, and negative feelingsanger, and negative feelings Reviewing the relationshipReviewing the relationship Exploring possibilities for life after lossExploring possibilities for life after loss Understanding common processes and Understanding common processes and

problems in griefproblems in grief Being understood or accepted by othersBeing understood or accepted by others


Complicating FactorsComplicating Factors

Pain of great intensityPain of great intensity Attempts to avoid the painAttempts to avoid the pain

Work is contradictoryWork is contradictory Pain demands expressionPain demands expression Fear of loss of control if expressedFear of loss of control if expressed

Cultural values support avoiding expression Cultural values support avoiding expression of griefof grief


Types of GriefTypes of Grief

AnticipatoryAnticipatory Catastrophic diagnosisCatastrophic diagnosis

Acute griefAcute grief Painful experience after lossPainful experience after loss

Dysfunctional griefDysfunctional grief TraumaticTraumatic Absent/inhibitedAbsent/inhibited ConflictedConflicted ChronicChronic

Chronic sorrowChronic sorrow


Bereavement CareBereavement Care

Before lossBefore loss Primary prevention (e.g., family involvement in Primary prevention (e.g., family involvement in

community, improved parenting)community, improved parenting) When loss is impendingWhen loss is impending

Assist toward reconciliationAssist toward reconciliation Promote participation in carePromote participation in care Support groups/hospiceSupport groups/hospice Preventive grief therapyPreventive grief therapy

After lossAfter loss

chapter 28: grief: in loss and death copyright © 2012, 2007 mosby, inc., an affiliate of elsevier...

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