c




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à

à 
Loss, grieving, and death are experienced by everyone at some time during their life. People may
suffer the loss of valued relationship through life changes, letting go, relinquishing, and moving on
are unavoidable passages as a person moves through stages of growth and development. People
frequently say goodbye to places, people, dreams and familiar objects. To support and care for the
grieving client, the nurse must understand these phases as well as cultural responses to loss.
 à à
à  


:

a? 

: A person, thing or relationship that is killed, wounded, taken or lost.

a? a
 Deep and poignant distress caused by suffering from a loss.
a? Ê  : The state or fact of being deprived of something or having something taken
away, especially by force.
a?   

: To feel or express grief or sorrow or to show customary signs of grief for a death.
:
Throughout our lives from birth to death, we form attachments and suffer losses. Experience of loss
is essential in human life. Letting go, relinquishing, and moving on are unavoidable passages as the
person moves through the stages of growth and development. Loss allows a person to change,
develop and fulfill innate human potential. It may be planned, expected or sudden. Although it can be
difficult, loss sometimes is beneficial. Other times, it is devastating and debilitating.

 A helpful way to examine different types of losses is to use 
 


   of human needs.

a? 





: Examples include amputation of limb, loss of adequate air exchange, or
decrease in pancreatic functioning etc.
a?  

: Loss of safe environment is evident in domestic or public violence. A person may
perceive a breach of confidentiality in a professional relationship as a loss of psychological
safety secondary to broken trust of self and health care provider.
a? 

 



  


: The loss of a loved one affects the need to love
and be loved. Loss accompanies changes in relationships, such as birth, marriage, divorce,
illness and death; as the meaning of a relationship changes, a person may lose role within the
family and group.
a? 

 

: Any change in how a person is valued at work or in a relationship can
threaten his or her self esteem needs. A change in self perception can challenge sense of self
worth. A loss of role function and the self-perception and worth tied to that role may
accompany the death of a loved one.
a? 

   
 

: An external or internal crisis that blocks or inhibits striving
towards fulfillment may threaten personal goals and individual potentials. A change in goals or
 direction will precipitate an inevitable period of grief. E.g.: having to give up plans to attend
graduate school or losing the hope of marriage and family.
aà aàà a
a
 is a multi-faceted response to loss. It includes the emotion numbness, disbelief, separation,
anxiety, despair, sadness, and loneliness that accompany the loss of someone or something loved.
Although conventionally focused on the emotional response to loss, it also has physical, cognitive,
behavioral, social, and philosophical dimensions. Common to human experience is the death of a
loved one, whether it be a friend, family, or other companion. While the terms are often used
interchangeably, bereavement often refers to the state of loss, and grief to the reaction to loss.

 aà 
1.? 

It is said to occur when a person¶s emotional and behavioral responses to a loss are
expected ones, according to the individuals experience, culture, social status, and relationship to
that which has been lost. Often the normal grief response to a loss can prove positive µhelping one
to mature and develop as a person.
 



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2.? m

 

 It occurs before a death, usually at the time of diagnosis. A patient may
anticipate loss of good health, independence, and life itself. Family members, friends and
caregivers may grieve for the patient¶s losses as well as their own.
This grief provides time to acknowledge that the patient is dying, to prepare for the death, to
adapt to changes, to tend to matters left unsettled and to resolve conflicts. When families are
prepared and support services are used before the death, healthy adaptation during bereavement is
more likely to occur.
There are risk in this type as family members may withdraw emotionally from the client too soon,
leaving the client with no emotional support as death approaches. Sometimes if the person nearing
death survives, family members may have difficulty reconnecting and may even be resentful that
the person has lived past life expectancy.
3.?  
 

 When a person has difficulty progressing through the normal phases of
grieving it becomes complicated. This can threaten a person¶s relationship with others. It includes
the following types.
a? ÷

  Active acute mourning that is characterized by normal grief reaction that do
not subsides and continue over very long period of time. It is highlighted by bitterness and
idealization of the dead. It is more likely to occur when the relationship between the
bereaved and the deceased had been extremely close, ambivalent or dependent and when
social supports are lacking and friends and relatives are not available to share the sorrow
over the extended period of time needed for most mourners.
a? ›
 
  characterized by normal grief reactions that are suppressed or postponed
and the survivor consciously or unconsciously avoids the pain of the loss. Active grieving
is held back only to resurface later usually in response to a trivial loss or upset. For e.g.: a
wife may only bereave a few weeks after the death of her spouse, only to become hysterical
and sad a year later when she attends a family gathering. This extreme sadness is a delayed
response to death of her husband.
a? | 
 
  Persons become overwhelmed by the grief, and they cannot function.
This may be reflected in the form of severe phobias or self destructive behavior such as
alcoholism, substance abuse or suicide.
a? Y 
  survivors are not aware that behaviors that interfere with normal functioning
are a result of their loss. For e.g.: a person who has lost a pet may develop alterations in
sleeping or eating patterns.
4.? 

 



 Persons experience grief when a loss is experienced and cannot be openly
acknowledged, socially sanctioned, or publically shared (ELNEC, 2000). An e.g.: includes the
loss of partner from HIV OR AIDS, children experiencing the death of a step-parent, or the
mother whose child dies in utero or at birth.

aà 

àm 
 a




the father of psychoanalysis was the first to publish a bereavement theory. 
 a
psychiatrist, studied acute grief reactions experienced by individuals bereaved by natural causes,
disaster, and war. Based on his observations, Lindeman differentiated normal from abnormal
reactions to loss. Ê  was the first bereavement theorist to base his conclusions on empirical
evidence. Bowlby, a psychoanalyst and the father of attachment theory, empirically studied how
the intensity of the grief could be influenced by the type of attachment that one had to the
deceased
 a 
a
 

 
, a student and colleague of Bowlby, conducted bereavement research in Europe and the
United States. He conceptualized grief as a series of shifting pictures that presented for a time and
then faded out while the next phase faded in, only to peak and give way to the next wave. The
 work of Worden extended bereavement theory by emphasizing the role that counselors and
therapists play in offering care and comfort to grieving clients. Based on research with children
and adults, Worden presented a unique conceptualization of "the mourning process
 


Ê 

 
Hospice nurses often hear bereaved family members describe a continued but changed
relationship with the deceased, which was not addressed by early psychoanalytical theories of
grief. Findings from a study by nurse-researchers,



, based on data from 186
adolescents bereaved of a sibling, established that instead of emancipating, bereaved adolescents
actively maintained an ongoing attachment to their dead siblings. 
  


published a study showing that parentally bereaved children and adolescents maintained a
continuing connection to the deceased parent. Findings from this study revealed that the bereaved
children and adolescents made an effort to reach out for a connection to their dead parent and
maintained their attachment through transitional objects.

 

 
Psychologists   introduced the "Dual Process Model of Coping with
Bereavement" to address the limitations of earlier models that presented grief as a series of stages,
phases, or tasks. For hospice nurses, the Dual Process Model provides an explanation of why the
bereft either avoid the reality of the loss or dwell in suffering.


 



 a

A subsequent study of bereavement resulted in the generation of the Experiential Theory of
Bereavement. The theory has two components; the first describes how survivors witness the
illness course of a loved one. The second component defines the bereavement process from the
time of loss, through suffering, emerging from the intensity of grief, and, finally, experiencing
personal growth. The Grief to Personal Growth Theory was subsequently tested empirically using
structural equation modeling. The pathway ended when the bereft had more good than bad days
and had reached a point where they could let go of some of the intensity of their grief and begin to
experience personal growth. For decades, grief counselors and healthcare providers have
encouraged the bereft to sever ties with the deceased to achieve healing. Today, it is understood
that relationships with the deceased can be continued in new ways and that grief can spur personal
growth.
Ê
ma aàà a
 
 Ê
 
 

  









 Refuses to believe that loss is Verbally support client but do not reinforce
happening. denial.
Is unready to deal with practical Examine your own behavior to ensure that
problems, such as prosthesis after loss of you do not share in client¶s denial.
 leg.
May assume artificial cheerfulness to
prolong denial.
m
  Client or family may direct anger at
nurse or staff about matters that
normally would not bother them.
Ê



 Seeks to bargain to avoid loss. May Listen attentively, and encourage clients to
express feelings of guilt or fear of
punishment for past sins, real or
imagined.
 


 Grieves over what has happened and
what cannot be.
May talk freely or may withdraw.
m  Comes to terms with loss.
May have decreased interest in
surroundings and support people.
May wish to begin making plans (e.g.,
will, prosthesis etc)
Help clients understand that anger is normal
response to feelings of loss and
powerlessness.
Avoid retaliation or withdrawal; do not take
anger personally.
Deal with needs underlying any angry
reaction.
Provide structure and continuity to promote
feelings of security.
Allow clients as much control over their
life.
talk to relieve guilt and irrational fear.
If appropriate, offer spiritual support.
Allow clients to express sadness.
Communicate nonverbally by sitting quietly
without expected conversation.
Help family and friends understand client¶s
decreased need to socialize.
Encourage client to participate as much as
possible in the treatment program.

 a
ma aàà a

 
 Ê
 
 

  Refuses to accept loss.



 Has stunned feelings.
Accepts the situation intellectually, but denies it emotionally.
 

 Reality of loss begins to penetrate consciousness.
 

 Anger may be directed at agency, nurses or others.



 Conducts rituals of mourning( e.g., funeral, wake etc)



 

 Attempts to deal with painful void.
Still unable to accept new love object to replace lost person or object.
May accept more dependent relationship with support person.
 Thinks over and talks about memories of lost object.
à

 Produces image of the lost object that is almost devoid of undesirable
features.
Represses all negative and hostile feelings towards lost object.
May feel guilty and remorseful about past inconsiderate or unkind acts to lost
person.
Unconsciously internalizes admired qualities of lost object.
Reminders of lost object evoke fewer feelings of sadness.
Reinvests feelings in others.
   Behavior influenced by several factors: importance of lost object as a degree
of support, degree of dependence on relationship, degree of ambivalence
toward lost object, number and nature of other relationships, and number and
nature of previous grief experiences.


ÊÊ

m  à a
a? 

: it may last from a few hours to a week or more and may be interrupted by
periods of extremely intense emotion. The grieving person may describe the phase as
felling stunned or unreal. It may serve to protect the body from the onslaught or
consequences of loss.
a?
 


 

: it arouses emotional outbursts of tearful sobbing and acute
distress in most persons. The phase is painful, but must be endured. The hopeless yet
intense desire to restore the bond with the lost person compels the bereaved to search for
and recover him/her. As hopes for the lost one¶s return diminish, sadness and loneliness
become constant.
a? 







the bereaved person begins to understandthe loss¶s
permanence. They recognize that patterns of thinking feeling, and acting attached to life
with the deceased must change. Night is a time of acute loneliness during this phase.
a? 



 The bereaved person begins to re-establish a sense of personal identity,
direction and purpose for living. He or she regains independence and confidence. The
person still misses the deceased but thinking of him no longer evokes painful feelings.

  
m  à a 
a?


   
 

. Even when a death has been expected, there is always
some period of disbelief and surprise that the event has really happened. This task involves the
processes required to accept that the person or object is gone and will not return.
 a?

 :
   
 
 

. Even though people respond to loss differently, it
is impossible to experience a loss and work through grief without emotional pain. Individuals
who deny or shut off the pain prolong their grief.
a?

!:

 
 

 







. A person does not
realize the full impact of loss for at least 3 months. At this point many friends and associates
stop calling and the person is left to ponder the full impact of loneliness. People completing this
task must take on roles formerly filled by the deceased, including some tasks that they never
fully appreciated.
a?

:

    
  

. The goal of this task is
not to forget the deceased or to give up the relationship with the deceased but to have the
deceased take a new, less prominent place in a person¶s emotional life. A person completes t
his stage after realizing that it is possible to love other people without loving the deceased
person less.

m 
m Êm


 


 Ê
 
 

  Survivors are left with the feelings of
confusion, unreality and disbelief
that the loss has occurred. They are
often unable to process the normal
thought sequences. Phase may last
from a few minutes to many days
m 

  Friends and family resume normal


 activities. The bereaved experience
the full significance of their loss.
 
 
 During this phase, survivors feel a
Disbelief
Confusion
Restlessness
Feelings of unreality
Regression and helplessness
State of alarm
Physical symptoms: dryness of mouth and
throat, sighing, weeping, loss of muscular
control, uncontrolled trembling, sleep
disturbance and loss of appetite.
Psychological symptoms: preoccupation
with thought s of deceased and psychologic
distancing.
Separation anxiety
Conflicts
Acting out emotional expectations
Prolonged stress
Physical symptoms crying and sleep
disturbance
Psychological symptoms: anger, guilt,
frustration, shame, oversensitivity, disbelief
and denial, dreaming, sense of presence of
the deceased and fear of death.
Physical symptoms: weakness, fatigue, need

  need to be alone to conserve and
replenish both physical and
emotional energy. The social support
available to the bereaved has
decreased, and they may experience
despair and helplessness.


  The bereaved move from distress
 


  about living without their loved ones
to learning to live more
independently.
 Survivors move onto a new self
awareness, an acceptance of
responsibility for self, and learning to Assumption of responsibility for self care
live without the loved one.



for more sleep, and a weakened immune
system.
Psychologic symptoms: withdrawal,
obssesional review, grief work, and
ultimately a renewal of hope.
Assuming control
Identity restructuring
Relinquishing roles, such as spouse, child,
or parent.
Physical symptoms: increased energy, sleep
restoration, immune system restoration and
physical healing.
Psychologic symptoms: forgiving,
forgetting, searching for meaning and hope
Functional stability
Revitalization
needs
Psychologic symptoms: loneliness,
anniversary reactions, and a reaching out to
others.

àm  
m à aaà 


 

   "
Loss oriented coping includes concentrated thinking about life before the loss or with the person and
circumstances and events surrounding the death or loss. Restoration oriented coping includes doing
new things, distracting oneself from grief, avoiding or denying grief, assuming new roles and
transcendence. The changes can result in new perspectiveness in self-actualization. Oscillation and
mental and physical health are necessary for optimal adjustment overtime. Overtime, repeated
exposure and confrontation may lead to the reaction response weakening and the individual no longer
thinks about the specific aspects of loss.
This model has the potential to be applicable to different culture, as well as gender differences, and
emphasize coping with bereavement rather than outcome.


 



 



    
a
 

  
!
  


 
 

"
  #
#
    #    

  #    $
 


  
 





 
 
 # " 

When loss occurs within the system, the
 is experienced as acute grief. The system¶s
equilibrium is in chaos, and is seen as a 



 i.e. the system can¶t perform its usual
activities; either the person or the members are in a state of disequilibrium. The family or individual
then searches for meaning why this happen to them. The family then may become active in

 

 
. It may involve 





that may have been previously withheld or
subdued. The expression of emotion can release energy that can be seen to 

 


  . Someone else steps up to perform the role of dead person e.g. elder son in the father¶s role.
Finally if the system is to survive it must redefine itself by  





i.e. families
accept the portraits and reunions are still possible, just different from how they were before loss. 














 










  informin

 g others


m aàà a 
Ú? Undoing psychosocial bonds to the loved one and eventually creating new ties.
Ú? Adding new roles, skills, and behaviors and revising old ones into a ³new identity and sense of
self´.
Ú? Pursuing a healthy life style that includes people and activities.
Ú? Integrating the loss into life, this does not mean ending the grieving but accommodating the
reality of the loss.
m
à  à am aà 

  : Persons of different ages and stages of development will display different and
unique symptoms of grief. For e.g.:

a? Toddlers are unable to understand loss or death, but they feel great anxiety over loss of objects
and separation from parents.
a? School age children experience grief over the loss of a body part or function.
a? Middle age adults usually began to reexamine life and are sensitive to their own physical
changes.
a? Malkinson and BarTur (1999) older adults often express anticipatory grief because of aging
and the possible loss of self care abilities. They are at increased risk of negative outcomes
related to grief. Lund (1989) found that older adults are often resilient in responding to grief
despite it being a highly stressful process.





 



Thevaluing of individuals is a unique, learned response
of a specific culture and society. Age, gender, status, race, spirituality, religious beliefs, intellect,
achievement, self expression and cultural opportunities are the basis for an individual to define and
qualify the definition of life and death. An individual¶s expression of grief evolves as the person
matures. Personal experiences shape the coping mechanism that the individual use to cope with
stressors. When older coping mechanisms are unsuccessful newer ones are attempted. Professional
assistance is often required to help the client and family understand and deal realistically with losses.
 
  

 
It influences a person¶s ability to obtain options and use support mechanism
when coping with loss. Generally a person feels greater burden with loss when there is a lack of
financial, educational or occupational resources. For e.g. a client with limited financial resources may
not be able to buy necessary medications to a newly diagnosed disease.

 



 When loss involves a loved one, the quality and meaning of a relationship
are critical in understanding a person¶s grief experience. It has been said that to lose your parents is to
lose your past; to lose the spouse is to lose your present and to lose a child is to lose your future.
When a relationship between two individuals has been very close and well connected, it can be very
difficult for the one left behind to cope. When clients do not receive supporting understanding and
compassion from others, they become unable to handle grief and look to the future.
   

The ability to resolve grief depends on the meaning of loss and the situation
surrounding the loss. The visibility of loss influences the support a person receives. For e.g. loss of
one¶s house in floods brings support from the community whereas a private loss of an important
possession may bring less support. The suddenness of a loss can often cause slower resolution from
grief. For e.g.: a sudden unexpected death in family is more difficult to accept compared to a one
following a long term chronic illness.
   

: Interpretation of loss and the expression of grief arise from cultural
background and family practices. Culture affects how client and their support systems or families
respond to loss. For e.g. in the western hemisphere the grieving process is usually personal and
people show restrained emotions, whereas in eastern nations like India, China etc wailing and
physical demonstration of grief is seen. Nurses must be able to support and guide clients and families
in a culturally informed and acceptable manner. Research has shown that ethnicity is strongly related
to attitudes towards life sustaining treatment during terminal illness.




: Individual¶s spirituality significantly influences their ability to cope with loss. Loss
can sometimes cause internal conflicts about spiritual values and the meaning of life. Clients who
have a strong interconnectedness with a higher power are often very resilient and able to face death
with relatively minimum discomfort.
à à m  
 aàà aà

Ú? 



 


a
: The pain that accompanies grieving results from a
disturbance in the person¶s beliefs. The loss disrupts, if not shatters, basic assumptions about
life¶s meaning and purpose.




 

 

 

: the grieving person needs to make sense of
the loss. The loss challenges old assumptions about life. For e.g. when a loved one dies
prematurely, the grieving person often questions the belief that life is fair. The nurse might
hear questions like why did such a young person have to die? Questioning may help the person
 accept the reality of why someone died. It may result in realizing that loss and death are
realities that everyone must face one day.
m 

  
  
 : Belief in an afterlife and the idea that the lost one
has become a personal guide are cognitive responses that serve to keep the lost one present.
Ú? 
 
 

 

: Anger, sadness, and anxiety are the predominant emotional
responses to loss. The grieving person may direct anger and resentment towards the deceased
and his health practices, family members or health care providers. Guilt over things not done
or said in the lost relationship is another painful emotion. Feelings of hatred and revenge are
common when death has resulted from extreme circumstances such as suicide, murder, or war.

 
: A study to assess the short-term grief responses after elective abortion,
Williams (2001) noted that some women experience feelings of loss of control, death anxiety,
and dependency as well as feelings of despair and anger.
Ú? 

 
 

 

The deeply embedded personal values that give meaning and
purpose to life and the belief systems that sustain them are the central components of
spirituality and the spiritual response to grief. During loss, it is within the spiritual dimension
of human existence that a person may be lost comforted, challenged or devastated. The
grieving person may become disillusioned and angry with God. The anguish of abandonment,
loss of hope or loss of meaning can cause deep spiritual suffering. Ministering to the spiritual
needs of those grieving is an essential part of nursing care. Nurses can promote a sense of
wellbeing by providing opportunities for clients to share their sufferings and assists in the
psychological and spiritual transformation that can evolve through grieving.
Ú? Ê
 
 

 

 By recognizing behaviors common to grieving, the nurse can
provide supportive guidance for the client¶s journey of emotionally and cognitively rough
terrain. The symptoms include:
ù? Functioning automatically.
ù? Tearful sobbing ; uncontrollable crying
ù? Great restlessness; searching behaviors
ù? Irritability and hostility
ù? Seeking and avoiding places and activities with the lost one
ù? Geeping valuables of lost one while wanting to discard them
ù? Possibly abusing drugs or alcohol
ù? Possible suicidal or homicidal gestures or attempts
ù? Seeking activity and personal reflection during phase of reorganization.

Ú? 



 
 

: those grieving may complain of : headaches, insomnia, impaired
appetite, weight loss, lack of energy, palpitations, indigestion. Changes in immune and
endocrine glands.

à amm
àà aà

aà m 

   
a 
 


a? Do set goals for yourself. Start with small, short term ones.
a? Do accept that what you are feeling is real and may be painful.
 a? Do remember that the pain of loss may manifest itself in many different ways.
a? Do cry if and when you feel like it.
a? Don¶t allow yourself to become reclusive and avoid the people who care about you.
a? Don¶t allow guilt or fear to set you back.
a? Do experience your thoughts and feelings 1 day at a time.

 

 




a? Don¶t try to rush through your grief.
a? Don¶t be too hard on yourself by thinking you should be feeling better or µover it¶ in a month
or two.
a? Don¶t allow others to define the loss for you.
a? Do allow yourself to backslide. Just because you felt better yesterday doesn¶t mean you will
feel the same today.
a? Do know it is OG to feel angry, betrayed, fearful, tired, confused or ill. These symptoms can
be normal grief responses.
a? Don¶t be surprised if you find yourself repeating the story of loss over and over again
a? Do eat nutritiously, exercise, and get adequate rest , although you may not feel like it.
à  

  




a? Do contact a grief counselor or health care provider if you feel you need help.
a? Do join a support group, which can provide an opportunity for you to speak with others who
can relate to what you are going through.
a? Do accept the help of family and friends.
a? Don¶t allow others to talk you into making any major decisions.




   


a? Œou can talk about the loss without feeling overwhelmed or crying.
a? Œour energy level is improved, and you feel like participating in work, school, or social
activities.
a? Œour sleep and dietary pattern comes to normal.
a? Œour life feels more organized.
a? Decision making is easier.
 
  


a? Œour inner pain begins to disappear.
a? Œour sense of humor returns.
a? Œour sleep and dietary pattern returns to normal.
a? Œour personal relationships are renewed.

  


a? If the long term achievements apply to you, then you are successfully navigating the grief
process.
a? Inner healing occurs over time. It will be completed when you find yourself reinvesting in life.
a? Don¶t be ashamed or surprised to find yourself saddened during holidays, family gatherings.
a? As healing progresses, the saddening may decrease, but may never completely go away.
a? The goal of healthy grief is not to try forget the loss but to put the loss into perspective in your
own particular life history and reinvest in your life.


à  
à m 

Adaptive responses Maladaptive responses
Emotional Uncomplicated Suppression of Delayed grief Depression/ Mania
responsiveness grief reaction emotion reaction

aà " aà "m à 

Feelings of sadness and depression are an integral part of grief, but grief itself is not considered a
disorder. The ›
 
 

  



›  ›
 considers the
depression associated with bereavement a "normal" reaction to loss, provided it is does not linger too
long. There is no way to define a "normal" length of bereavement since it varies from person to
person and culture to culture. According to the ›
, a diagnosis of Major Depressive Disorder is
generally not given unless symptoms have lasted beyond two months.
Depression which lingers beyond what is expected could be a sign that the stress of grieving has
triggered a Major Depressive Episode. Studies have shown that the extreme stress associated with
grief can trigger both medical illnesses, such as heart disease, cancer and the common cold, as well as
psychiatric disorders like depression and anxiety.
 



 



 
  :

a? Symptoms may meet syndromal criteria for major depressive episode but survivor rarely has
morbid feelings of guilt and worthlessness, suicidal ideation or psychomotor retardation.
a? Considers self bereaved.
a? Dysphoria often triggered by thoughts or reminders of the deceased.
a? Onset is within 2months of bereavement.
a? Duration of depressive symptoms is < 2 months.
a? Functional impairment is transient and mild.
a? No family or personal history of major depression.
  
$? m



 
U? Assess the meaning of loss for the patient.
U? Observe behavior and other symptoms indicative of grief response.
U? Note quality and extent of patient¶s family support.
Ú? 

Caring for a patient who experienced a physical or emotional loss.
Caring for a patient who died.
Personal experience with loss or death of a significant others.
Ú? m


Take risk if necessary to develop a close relationship with the client to understand loss.
Ú?   

Demonstrate ethical principles of health care.
Apply individual standards of significance.
Ú?  
 :
Group process
Pathophysiology related illness threatening a loss.
Cultural perspectiveness
Therapeutic communication.
Family dynamics
$? 


U? Select communication strategies that assist the client/ family in accepting and adapting
to loss.
U? Select interventions designed to maintain the patient¶s dignity and self esteem.
U? Provide skills/ knowledge for the family to understand care for the dying patient.
Ú? 

Previous client responses to planned nursing interventions for pain and symptom management
or loss of a significant other.
Ú? m


Be responsible for delivering high quality supportive care.
Demonstrate an openness to participate in experiencing loss.
Ú?   

Provide privacy for the client and family.
Apply ethical principles of autonomy in supporting the client¶s choice regarding treatment.
Individualize therapies for the patients for the patient self esteem.
Apply appropriate professional standards for end of life care.
Ú?  
 :
Spirituality as a resource for dealing with loss.
Role other health professional play in helping clients deal with loss.
Services provided by the community agencies.
Principles of providing comfort.
Principles of grief support.
 !$? à


U? The skills relevant include attentive listening, silence, open ended questions,
paraphrasing clarifying and summarizing.
U? Communication with grieving client must be relevant to their stage.
U? Facilitate the grief work. Teach family members to encourage the client¶s expression of
grief.
U? Provide emotional support. Refer to support groups if needed.
$? 

U? Evaluate signs and symptoms of client¶s grief.
U? Evaluate family members¶ ability to provide supportive care.
U? Evaluate terminal client¶s level of comfort and symptoms relief.
U? Ask if patient¶s family expectations are being met.
Ú? 

Previous patient response to planned nursing intervention for symptom management or loss.
Ú? m


Persevere in seeking successful comfort measures for terminally ill clients.
  

Use establish patient outcomes to evaluate patients response to care
 
 :
Characteristics of resolution of grief.
Clinical symptom of an improved level of comfort.
Principles of palliative care.
 à
Bereavement, loss, grief and mourning are part of our lives although how we experience and act on
them will be influenced by the culture in which we live. There are many theories and models of grief
and grief counseling. Recent theories do not seek to help the bereaved to µcomplete¶ mourning and
µmove on¶. Instead they promote the possibility that grief may be never ending without being
hopeless as the lost object lives on within the mourner. Nurses have a vital role to play in listening to,
supporting and nurturing hope when they encounter grief, whether that grief is because of death,
shortening of life expectations or the multitude of other losses, which are part of human existence.

ÊàÊàam


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