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A. Definition of terms:

Loss is an actual or potential situation in which a valued object, person, or the like is
inaccessible or changed so that it is no longer perceived as valuable.
Bereavement The subject response to a loss through the death of a person with whom
there has been a significant relationship.
Grief The total response to the emotional experience of the loss and is manifested in
thoughts, feelings and behaviors.
Mourning The behavioral process through which grief is eventually resolved or
altered; it is often influenced by culture and custom.

B. Stages of Grieving by Kubler Ross

Denial Refuses to believe that loss is happening.

- Unready to deal with practical problems.
- May assume artificial cheerfulness

Anger Client or family may direct anger at nurse or hospital about matters that
normally would not bother them.

Bargaining Seeks to bargain to avoid loss.

- May express feeling of guilt or fear of punishment for pat sins, real
Or imagined

Depression Grieves over what has happened and what cannot be

-May talk freely or may withdraw.

Acceptance Comes to terms with loss

- May have decreased interest in surroundings and support persons.
- May wish to begin making plans.

C. Engels Stages of Grieving

Shock and Disbelief Refusal to accept loss

- Stunned feelings
- Intellectual acceptance but emotional denial

Developing awareness Reality of loss begins to penetrate awareness.

- Anger may be directed at hospital, nurses, etc.
- Crying and Self-blame

Restitution Rituals of mourning

Resolving the loss Attempts to deal with painful void

Still unable to accept new love object to replace lost person

May accept more dependent relationship with support person
Thinks over and talks about memories of the dead person.

Idealization Produces image of dead persons that is almost devoid of undesirable

- Represses all negative and hostile feelings toward the deceased.
- Unconsciously internalizes admired qualities of the deceased.
- Reinvest feelings in others

Outcome Behavioral influenced by several factors:


Importance of the lost object as source of support.

Degree of dependence on relationship
Degree of ambivalence toward deceased
Number and nature of other relationships
Number and nature of previous grief experiences

D. Symptoms of Grief:

Repeated somatic distress

Tightness in the chest
Choking or shortness of breath
Empty feeling in the abdomen
Loss of muscular power
Intense subjective distress.

E. Assisting Clients with their Grief:

1. Provide opportunity for the persons to tell story
2. Recognize and accept the varied emotions that people express in relation to a significant
3. Provide support for the expression of difficult feelings, such as anger and sadness
4. Include children in their grieving process
5. Encourage the bereaved to maintain established relationships
6. Acknowledge the usefulness of mutual-help groups
7. Encourage self-care by family members particularly, the primary caregivers.
8. Acknowledge the usefulness of counseling for especially difficult problems.