GRIEF

Pain, the human response to loss.

Is a complex interaction oI emotional, cognitive, spiritual, physiological and
behavioral responses to a situation oI signiIicant loss (RomanoII, 1993).
It is the individual experience oI the pain oI loss (Kane, 1990).
Is an emotion, whereas grieving is a coping process(Attig, 1996).

Normal Grief
Normal grieI is Iound in the majority oI survivors. It describes grieI that is eventually lessened as
a person readjusts to their loss. This is done with support as one moves through the Iour phases
and the Iour tasks oI the grieI process. GrieI is usually not something one 'recovers Irom
because the loss is never regained or replaced. A grieving individual doesn`t return to the person
they were beIore the loss; rather they usually describe their lives aIter loss as 'diIIerent. For
some, it changes their entire identity and they will divide their lives into 'beIore the loss and
'aIter the loss.

Abnormal Grief
Abnormal, oIten reIerred to as complicated grieI, is Iound in only 3 to 25 percent oI loss
survivors. There are diIIerent types oI abnormal grieI:
ronic grief - the grieving person has trouble Iinding closure and returning to normal
activities over an extended amount oI time.
elayed grief - the intentional postponement oI grieI. Sometime this is related to other
liIe events or losses that drain ones ability to work through the grieI process.
isenfrancised grief - oIten occurs when a grieving person`s loss can`t be openly
acknowledged or is one that society does not accept as a real. Examples include losses
related to AIDS, miscarriage, or loss oI a homosexual partner.
aggerated grief - intense reactions oI grieI that may include nightmares, delinquent
behaviors, phobias (abnormal Iears), and thoughts oI suicide.
$:dden grief - when death takes place very suddenly without warning. Sudden grieI can
lead to exaggerated reactions and posttraumatic stress disorder (PTSD).


LOSS
hat we once had and no longer have. It might have been physical, intellectual,
emotional, social, or spiritual in nature.
A physical or psychosocial loss that coincides with or develops as a consequence oI the
initial loss.
An actual or potential situation in which someone or something that is valued is changed,
no longer available, or gone
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FACTORS AFFECTING LOSS AND GRIEF
Developmental stage
Late adulthood.
Most individuals recognize the inability oI death during late adulthood. It is
challenging Ior elders to experience the death oI age old-Iriends or to Iind themselves the
last one oI their peer group leIt living. Older adults oIten turn to their children and
grandchildren as sources oI comIort and companionship. Cultivating Iriendships in all
age groups helps prevent loneliness and depression.
Religious and cultural belieIs
Relationship with the lost object
Cause oI death

FACTORS INFLUENCING THE LOSS AND GRIEF RESPONSES

SPIRITUAL BELIEFS
Spiritual belieIs and practices greatly inIluence both a person`s reaction to loss and subsequent
behavior. Most religious groups have practices related to dying, and these are oIten important to
the client and support people. To provide support at a time oI death, nurses need to understand
the client`s particular belieIs and practices.

GENDER
The gender roles into which many people are socialized in the United States and Canada aIIect
their reactions at times oI loss. Men are Irequently expected to "be strong" and show very little
emotion during grieI, whereas it is acceptable Ior women to show grieI by crying. OIten when a
wiIe dies, the husband, who is the chieI mourner, is expected to repress his own emotions and to
comIort sons and daughters in their grieving.
Gender roles also aIIect the signiIicance oI the body image changes to clients. A man might
consider his Iacial scar to be "macho", but a woman might consider hers ugly. Thus the woman,
but not the man, would see the change as a loss.

SOCIOECONOMIC STATUS
The socioeconomic status oI an individual oIten aIIects the support system available at the time
oI loss. A pension plan or insurance, Ior example, can oIIer a widowed or disabled person a
choice oI ways to deal with a loss; a person who is conIronted with both severe loss and
economic hardship may not be able to cope with either.

SUPPORT SYSTEM
The people closest to the grieving individual are oIten the Iirst to recognize and provide need
emotional, physical and Iunctional assistance. However, because many people are uncomIortable
or inexperienced in dealing with losses, the usual support people may instead withdraw Irom the
grieving individual. In addition, support may be available when the loss is Iirst recognized, but as
the support people return their usual activities, the need Ior ongoing support may be unmet.
Sometimes, the grieving individual is unable or unready to accept support when it is oIIered.

CAUSE OF THE LOSS OR DEATH
Individual and societal views on the cause oI loss or death may signiIicantly inIluence the grieI
response. Some diseases are considered "clean", such as cardiovascular disorders, and engender
compassion, whereas others may be viewed as repulsive and less unIortunate. A loss or death
that is beyond the control oI those involved may be more acceptable than one that is preventable,
such as drunk driving accident. Injuries or deaths occurring during respected activities, such as
"in the line oI duty", are considered honorable, whereas those occurring during illicit activities
may be considered the individual`s just rewards.

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MEASURES THAT FACILITATE THE GRIEVING PROCESS
Explore and respect ethnic, cultural, religious, and personal values
Teach what to expect in the grieI process
Encourage the client to express and share grieI with support people
Teach Iamily members to encourage the client`s expression oI grieI
Encourage the client to resume activities on a schedule that promotes physical and
psychologic health
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