GriefGrief is a reaction of an individual to a significant loss. Shock, disbelief, anger and depression are common feature in affected individuals.

Grief is defined as the emotional process of copying with loss. This can include death of a loved one, a separation or divorce, loss of body part, loss of job & losses that results from natural & imposed disaster.

All of these events and circumstances may leave the person with a sense of emptiness, hopelessness & detachment from the meaning that previously was found in life.

Anticipatory grief may be seen in individual and families who are expecting a major loss in the near future.

Conventional grief is 1° associated with the grief that is experienced following a loss. This process of adopting to loss may take days, weeks or years depending on the sense of loss for the person involved.

Each person response is based on the person’s level of development, past experiences and current coping strategies.

Theories of Grief :-

Kubler-Ross (1969) having done extensive research with terminally ill patient and identified 5 stages of feeling & behavior that individual experience in response to a real, perceived or anticipated loss.

Stage 1 denial:- This is a stage of shock & disbelief. The response may be one of ‘No, it can’t be true’. It is protective mechanism that immediate time frame.

Stage 2 Anger:- Why me? It is not fair are comments often expressed during the anger stage. It may be directed at self & displaced on loved ones, caregivers, & even god. There may be preoccupation with an idealized image of the lost.

Stage 3:-Bargaining:- If god will help me though this, I promise & will go to church every Sunday & give my time to help others.
During this stage which is generally not visible or evident to others & bargain is made with god in an attempt to reverse or postpone the loss.

Stage 4 Depression:- During this stage the full impact of the loss is experienced. This is a time of quiet disengagement from all association with the lost.

Stage 5 Acceptance:- Final stage bring a feeling of peace regarding the loss that are occurred. Focus is on the reality of the loss & its meaning for individual affected by it.

Grief Process :-

It describes a series of occurrence in the resolution of loss. This process provide support as an individual works through the feeling of anger hopelessness that accompany loss. Growth occurs as the perceived person comes to the point of letting off the past. This does not reduce the importance of loss but allow the person to continue living with new perspective.

Resolution of Grief :-

Result of the process of mourning is thought to have occurred when an individual can look back on the relationship with the lost entity and accept both the pleasure and the disappointment of the association.
Pre-occupation with loss is replaced with energy and desire to pursue new situation and relationship.
The length of the grief process may be prolonged by a number of factor.
If the relationship with the lost had been marked by ambivalence reaction to the loss may be burden with guilt, which lengthens the grief reaction.
In anticipatory grief where a loss is anticipated, individual begin the work of giving before the actual loss occur. Most will experience the grieving behaviour once the actual loss occurs, but have this time to prepare for the loss can facilitate the process of mourning decreasing the length and intensity of response.
The number of recent losses experienced by an individual also affect the length of grieving process & whether he is able to complete 1 grieving process before 1 loss occurs.
Maladaptive grief response:-

Maladaptive grief response to loss occur when an individual is not able to satisfactorily progress through the stage of grieving to achieve resolution. severe type of grief response are:-
1. Prolonged response:- It is characterized by an intense preoccupation with memories of the lost for many years after the loss has occurred.

2. Delayed & inhibited response:- The individual become fixed in the denial stage of the grieving process. The emotional pain associated with loss is not experienced, but there may be evidence of anxiety disorder or sleeping disorder. The individual may remain in denial for many years until the grief response is triggered by a reminder of the loss.

3. Distorted response:- The individual who experiences a response is fixed in the anger stage of grieving. The normal behavior associated with grieving such as helplessness, hopelessness, sadness, anger & guilt are exaggerated out of proportion to the situation.

Nursing intervention:-
– Provide an open accepting environment.
– Encourage ventilation of feeling and listen actively.
– Provide diversional activities.
– Provide teaching about common symptom of grief.
– Bring together similar aggrieved person to encourage communication, share experience of the loss to offer companionship, social & emotional    support.
– Assist patient to identify ambivalent feeling of guilt and anger towards loss of object.
– Assist in developing positive method of coping with the loss.
– Provide positive feedback for use of effective coping strategies.
– Encourage patient to utilize family, religious and cultural support that provide a meaning for the patient.
– Encourage participation in group activities.