1. The Experience of Loss, Death, and Grief

2. 2 Loss Loss is any situation in which a valued object is changed or is no longer accessible to the individual.

3. 3 LOSS Actual Perceived External Objects Known Environment Significant Other Aspect of Self Life

4. 4 Loss occurs with the destruction of property. Think of the many losses that are experienced by the family whose home was destroyed in an earthquake

5. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.5 Types of Loss Maturational loss occurs as a result of moving from one developmental stage to another. Situational loss occurs in response to external events.

6. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.6 Types of Loss Actual loss Perceived loss Physical loss Psychological loss Categories of Loss  Loss of an external object  Loss of familiar environment  Loss of aspect of self  Loss of significant other

7. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.7 Types of Loss Loss as Crisis  Loss precipitates anxiety and a feeling of vulnerability, which may lead to crisis.  When an individual is overwhelmed and his or her usual coping mechanisms are no longer effective, crisis occurs.

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10. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.10 Grief Grief is a normal, natural, necessary, and adaptive response following a loss.  Bereavement is the period of grief following a significant loss, especially death of a person or pet.  Mourning is the period of time during which the grief is expressed.  Mourning is an adaptive response to loss.

11. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.11 Grief Theories of the Grieving Process  Lindemann coined the phrase grief work.  Engle described three stages of mourning. Shock and Disbelief Developing Awareness Restitution and Resolution  Worden identified four tasks in dealing with a loss.

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14. 14 Kubler-Ross Stages of Grief Denial Anger Bargaining Depression Acceptance

15. 15 Stages of Grief

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17. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.17 Grief Types of Grief  Uncomplicated grief  Dysfunctional grief  Anticipatory grief

18. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.18 Types of Grief Persons experiencing dysfunctional grief do not progress through the stages of overwhelming emotions associated with grief, or they may fail to demonstrate any behaviors commonly associated with grief.

19. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.19 Types of Grief Disenfranchised grief is grief experienced in situations where grief is discouraged and social supports are absent.

20. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.20 Types of Grief Anticipatory grief is the occurrence of grief work before an expected loss. Promotes adaptive grieving by freeing up the mourner’s emotional energy.

21. 21 Algorithm to help differentiate between preparatory grief and depression.

22. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.22 Factors Affecting Grief Developmental Considerations  Childhood  Adolescence  Early Adulthood  Middle Adulthood  Older Adulthood

23. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.23 Children Concept of death varies with the child’s developmental level. Children need to be included in mourning rituals as appropriate to their developmental level. Children need explanations about death that are honest and comprehensible.

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25. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.25 Adolescence Adolescents perceive themselves as being invulnerable and death as something that will not happen to them.

26. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.26 Middle Adulthood The death of peers forces acknowledgement of one’s own vulnerability to death. Other losses during middle age are those associated with changes in employment and relationships.

27. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.27 Older Adulthood Most older adults recognize the inevitability of death. Older adults commonly experience the loss of loved ones and friends, occupational role, material possessions, dreams and hopes, and physical and cognitive function.

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29. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.29 Factors Affecting Grief Religious and cultural beliefs Relationship with the lost entity Cause of Death  Anticipated death  Unexpected death  Traumatic death  Suicide

30. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.30 Nursing Care of the Grieving Person Assessment  Determination of the personal meaning of the loss  Understanding that the stages of grief the client is experiencing are not necessarily sequential

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32. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.32 Nursing Care of the Grieving Person Nursing Diagnoses  Dysfunctional Grieving  Anticipatory Grieving

33. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.33 Outcome Identification and Planning Verbalization of feelings of grief Sharing grief with significant others Acceptance of the loss Renewal of activities and relationships

34. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.34 Nursing Diagnoses Powerlessness Helplessness High Risk for Spiritual Distress Altered Family Processes