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

Grief is defined as the emotional process of coping with loss. This can include the death of a loved one, a separation or divorce, loss of body part, loss of job & losses that result 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 individuals and families who are expecting a major loss in the near future.

Conventional grief is primarily associated with the grief that is experienced following a loss. This process of adapting 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.

Theory of Grief

Kubler-Ross (1969) having done extensive research with a 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 a 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 a preoccupation with an idealized image of the lost.

Stage 3 (Bargaining):- If God will help me through 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 brings a feeling of peace regarding the loss that is occurred. Focus is on the reality of the loss & its meaning for individuals affected by it.

Grief Process

It describes a series of occurrences in the resolution of loss. This process provides support as individual work through the feeling of anger, the hopelessness that accompanies 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 a new perspective.

Resolution of Grief

-The 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.

-Preoccupation with loss is replaced with energy and a desire to pursue a new situation and relationship.

-The length of the grief process may be prolonged by a number of factors.

-If the relationship with the lost had been marked by ambivalence (conflicting) reaction to the loss, it may be burdened with guilt, which lengthens the grief reaction.

-In anticipatory grief where a loss is anticipated, individuals begin the work of giving before the actual loss occurred.

-Most will experience the grieving behavior once the actual loss occurs, but have this time to prepare for the loss which can facilitate the process of mourning (sadness), decreasing the length and intensity of response.

-The number of recent losses experienced by an individual also affects the length of the grieving process & whether he is able to complete 1 grieving process before 1 loss occurs.

Maladaptive grief response

Maladaptive grief response to loss occurs when an individual is not able to satisfactorily progress through the stage of grieving to achieve resolution. A severe type of grief response is:-

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 becomes 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 is exaggerated out of proportion to the situation.

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

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