COPING

INTRODUCTION;

Loss is the part of life cycle. All people experiencing loss in the form of change, growth and transition. The experience of loss is
painful, frightening, and lonely and it triggers an array of emotional responses. In addition to normal life cycle stages these are the
potential losses of health, a body part, self image, self esteem and even one’s life. When the loss is not acknowledged or there are
multiple losses, anxiety, depression, and health problem may occur. Physical problems such as cardiac conditions, neurological
impairment, tend to respond to these illnesses with feeling of grief.

Definition of loss:

Loss is an actual or potential situation in which something that is valued is changed or no longer available. People can experience the
loss of body image, a significant other, a sense of well being, a job or beliefs.

TYPES OF LOSS:-

LOSS OF AN
LOSS OF KNOWN LOSS OF LIFE OR DEATH
ASPECT OF LIFE
ENVIRONMENT

NECESSARY LIFE LOSS OF KNOWN

TYPES OF LOSS ENVIORNMENT

ACTUAL LOSS
LOSS OF EXTERNAL
OBJECTS
PERCEIVED LOSS MATURATIO-NAL
LOSS

1. NECESSARY LOSSES
It is an integral part of each person’s life. Necessary losses are something natural and positive. For example: the growing up process.
We develop independence from our parents, start and leave school, change friends, begins career and form relationships. These losses
are recovered and replaced by something different or better.

2. ACTUAL LOSSES:
Actual losses are any loss of the individual or object at can no longer be felt, heard or experienced by the individual. Examples
include: loss of a body part or role at work.

3. PERCEIVED LOSSES:
Any loss that uniquely defined by the grieving client. Perceived losses are easily overlooked or misunderstood, yet the process of grief
follows the same sequencing and progression as actual losses. Example; loss of confidence
.
4. MATURATIONAL LOSSES:
Any change in the developmental process that is normally expected during a life time. Events associated with maturational loss are
part of normal life transition, but feeling helps a person cope with the change

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 .
5. SITUATIONAL LOSSES:
It includes any sudden, unpredictable external event. Often this type of loss include multiple losses rather than a single loss such as
automobile accident that leaves a driver paralyzed, unable to return to work and grieving over the loss of the passenger in the accident.

6. LOSS OF EXTERNAL OBJECTS:

Extend of grieving depends on object’s value, sentiments attached to it, and its usefulness. E.g. loss or misplacement

7. LOSS OF KNOWN ENVIRONMENT:

Loss occurs through maturational or situational event and through injury or illness. Loneliness or new unfamiliar setting threatens self-
esteem and makes grieving difficult. E.g. moving from neighborhood, a new job, a new job etc
.
8. LOSS OF SIGNIFICANT OTHERS:
Loss of a family members, friend, trusted nurse or animal companion.

9. LOSS OF AN ASPECT OF LIFE:

Illness, injury or development changes results in loss of aspect of self that causes grief and permanent changes in the body image and
self concept. E.g. body part, psychological or physiological function.

10. LOSS OF LIFE:

loss of life creates grief for those left behind. Person facing death often fears pain, loss of control and dependency on others. E.g.
death of family member, friend or own death.

FACTORS AFFECTING LOSS

I. HUMAN DEVELOPMENT:
 Person of differing ages and stages of development will display different and unique symptoms of grief. E.g. toddlers are
unable to understand loss or death but they feel great anxiety over loss for an individual to define and quality the definition
of life or death.

II. PSYCHOLOGICAL PERSPECTIVES OF LOSS AND GRIEF:

 Age, gender, status, race, religious beliefs, achievement, self expression and cultural opportunity are the basis for an
individual to define and quality the definition of life or death.

III. SOCIO-ECONOMIC STATUS:

 It influences a person’s ability to obtain and use support mechanisms when coping with loss. Generally an individual feels
greater burden of loss when there is lack of financial, educational or occupational recourses. These clients require referral to
community social service agencies that can provide needed resources.

IV. PERSONAL RELATIONSHIPS:

 when the loss involves a loved one, the quality and meaning of relationship are critical in understanding a person’s grief
experience. It has been said that to lose your parents is to lose your past; to lose your spouse is to lose your present and to
lose your child is to lose your future. when a relationship between two individuals has been very close and well connected, it
can be very difficult for the one left behind to cope.

V. NATURE OF LOSS:
 the ability to resolve grief depends on the meaning of the loss and situation surrounding the loss. The visibility of the loss
influences the support a person’s receives. E.g. the total loss of one’s home from a tornado will bring support from the
community, where as private loss of an important possession may bring less support from others.

VI. SPIRITUAL BELEIFS:

 individual’s spirituality influences their ability to cope with loss. Clients who have a strong power are able to face death with
relatively minimal discomfort.
SIGNIFICANCE OF THE LOSS

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  the significance of loss depends on the perceptions of the individual experiencing the loss. One person may experience a
great sense of loss over a divorce; another may find it only mildly disrupting. A number of factors affect the significance
loss.

VII. CULTURE:
 culture influences an individual’s reaction to loss. How grief is expressed is often determined by the customs of the culture.
Unless an extended family structure exists, grief is handled by the nuclear family. in cultures where several generations and
extended family members either reside in the same household or are physically close, the impact of a family member’s death
may be softened because the roles of the deceased are quickly filled by other relatives.

VIII. GENDER:
 the gender roles into which the people are socialized in the United States affect their reactions at times of loss. Men are
frequently expected to be strong and show very little emotion during grief, whereas it is acceptable for women to show grief
by crying. When wife dies, who is the chief mourner may repress his feelings and to comfort sons and daughters in their
grieving.
IX. SUPPORT SYSTEM: the people closest to grieving individual are often the first to recognize and provide needed emotional,
physical, and functional assistance. However, because many people are uncomfortable or inexperienced in dealing with losses, the
usual support people may instead withdraw from the grieving individual.

X. AGE: age affects persons understanding of and reaction to loss. With familiarity people usually increase their understanding and
acceptance of life, loss and death.
 Childhood: children differ from adults not only in their understanding of loss and death but also in how they are affected by the loss
of others. The loss of a parent or other significant person can threaten the child’s ability to develop, and regression sometimes
develops.
 Early and middle adulthood: as people grow, they come to experience loss as a part of normal development. By middle age for
example the loss of a parent through death seems a more normal occurrence compared to the death of a younger person.
 Late adulthood: losses experienced by older adults include loss of health, mobility, independence and work role. Limited income and
the need to change one’s living accommodation can also lead to feelings of loss and grieving.

THEORIES OF LOSS

A.The Multidimensional Model

Le Poidevin’s model conceptualizes grief as a process of simultaneous change explained by seven dimensions in terms of emotional,
social, physical, lifestyle, practical, spiritual and identity.  By identifying the main areas of each dimension that are affected,
individuals and those offering support can gain understanding of the grieving person’s circumstances and their grief reactions. This
model can also help the support network understand what resources are available to the bereaved as a way of helping them cope. The
dimensions of loss:

1. EMOTIONAL
 Characterized by very strong emotions. How comfortable is the individual with their emotional responses? Are they at ease
with showing emotions or do they believe in emotional control?

2. PHYSICAL
 There are numerous physical symptoms related to grief reactions. What has been the impact on physical health?

3. LIFESTYLE
 Loss may lead to major changes in lifestyle. Changes in lifestyle as a result of loss.

4. PRACTICAL
 Loss may affect the ability to cope with everyday practicalities. How is everyday living being managed?

5. Spiritual:
 Loss may result in people questioning their beliefs in the world resulting in loss of meaning and purpose. In what ways has
the bereavement affected the belief system of an individual

6. IDENTITY
 Loss may affect identity, self-esteem and self-worth. To what extent has the loss affected individual self-concept and self-
esteem?
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 B.Strobe’s Dual Process Model
 This model suggests that avoiding grief may be both helpful and detrimental whereby Bereavement is seen to involve: Loss
of Orientation and Restoration Orientation.
 Loss orientation involves grief work, including preoccupation with the loss, yearning and ruminating for the deceased
whereas restoration orientation encompasses mastering the tasks and the roles fulfilled by the deceased and making lifestyle
adjustments, building a new identity without the deceased etc. This enables the individual to change their assumptions about
the world in keeping with the new situation that now exists.
 The model suggests that bereaved people oscillate between these two orientations as they are both necessary in the grief work
process. Although the model provides useful information on loss and grief, it has been criticized for placing too much
emphasis on the psychology of grieving omitting the social factors and also in not considering key interpersonal relationships
in helping people cope with loss.

STEPS OF COPING WITH LOSS

1. Take time out. In many ways, the experience of loss is similar to recovery from a serious illness; some days will be darker,
and some will be brighter. Recognize the limits, and separate the things that must be done from those that can wait. Don't
worry about keeping up with the usual schedule.

2. Avoid making major decisions. Loss can cloud our judgment and make it difficult to see beyond the pain we are feeling at
the moment. Impulsive decisions – to move or change jobs.

3. Talk. Painful feelings held inside are like an infection festering in a wound – they need to come out in order to heal.

4. Express creatively. Writing is another excellent way to express our feelings. Try keeping a journal or writing letter.. When
words won't come, artistic outlets like painting or sculpting can help us to communicate what's in heart and soul.

5. Take care of physical health. Loss takes a physical troll as well as an emotional troll. Rest, exercise, and proper nutrition
are essential to healing. Counteract a poor appetite by eating small amounts of healthy foods rather than large meals. If you
have difficulty sleeping, try taking brief naps or just putting your feet up and relax.

6. Avoid using chemicals to numb the feelings. A glass of wine can be good for the soul and help to settle jangled nerves, but
overdoing it can bring a host of new problems. Attempting to numb the feelings with alcohol, illicit drugs, or prescription
medications will only prolong the pain.

7. Have fun. Loss is difficult, but it doesn't mean we have to feel bad all the time; in fact, it's important to take a break from
focusing on loss. Have fun by reading a good book, watching a movie, playing cards.

8. Talk to a therapist or counselor – the loss feels like too much to bear, call a mental health professional with experience in
counseling. An experienced therapist can help you work through intense emotions and overcome obstacles.

NURSING IMPLICATIONS
Nurses identify patients and family members who are loss and work with them to accomplish throgh four major tasks of the coping
process
 Acceptance of the loss
 Acknowledgement of the intensity of the pain
 Adaptation to life after the loss
 Cultivation of new relationships and activities.
 The other functions or responsibilities of a nurse is to assess and differentiate between loss and depression by knowing the common
thoughts, feelings, physical or bodily reactions, and behavior associated with loss compared with depression. The physical responses
to loss includes the sensation of somatic distress, a tightness in the throat followed by a choking sensation or shortness of breath, an
empty inside the abdomen, lack of muscular power and disabling stress.
 CARING OF THE BELIEVED
 Have contact physically and emotionally with the person.
 Demonstrate genuine compassion and caring.
 Mention the loss or the deceased person’s name.

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 Tell the patient to expect mood swings, pain, and various life changes.
 Allow the patient to take a break from loss and focus on self care.
 Encourage source of comfort such as religion or nature.
 Encourage medical care

MANAGEMENT:
1.Meditation:-

1. Tell client to take comfortable position. Sit upright for 15 to 20 minutes in a noise free environment. Take mattress and
pillow under for convince.
2. Begin to breathe slowly and deeply, and place attention on how the feeling—both emotionally and physically. Try not to
analyze the feeling and rather, just be in the experience. Acknowledge the emotions in a gentle and
3. When finished, take a few slow, deep breaths. Sit quietly for a few minutes and bring the meditation to an end. Do this
meditation as often as per need.

2. COUNSELLING:-
Counseling is more often used to refer to sessions focused on assisting clients who are dealing with everyday stressors and looking for
ways to cope with normal issues and problems, while therapy is more frequently used to describe sessions in which clients are battling
more difficult, more pervasive, and/or more chronic problems, like depression, anxiety, or addiction.

3.GET SUPPORT
The single most important factor in healing from loss is having the support of other people. Wherever the support comes from others,
accept it and do not feel alone. Connecting to others will help in heal.
finding support after a loss
Turn to friends and family members – Now is the time to lean on the people who care about it. Draw loved ones close, rather than
avoiding them, and accepts the assistance that’s offered. Oftentimes, people want to help but don’t know how, so tell them.
join a support group
Grief can feel very lonely, even when we have loved ones around. Sharing our sorrow with others who have experienced similar
losses can help.
talk to a therapist or grief counselor –
If the loss feels like too much to bear, call a mental health professional with experience in loss counseling. An experienced therapist
can help you work through intense emotions and overcome obstacles to your coping.

BIBLIOGRAPHY
 Khan.S.Basheer.S. A Concise Text Book Of Advanced Nursing Practice. Edition 1st. Emmess Medical Publishers; Pg 638-642
 Www.Google.Com
 Perry Potter, “Fundamental Of Nursing”, 6th Edition, Elsevier Publishers,
 www.slideshare.com
 http://www.beyondblue.org.au>the facts
 https://www.webmd.com