COPING WITH LOSS, DEATH AND GRIEVING

INTRODUCTION:-
Loss is a part of the life cycle. All people experience 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. Life is a series of losses and gains. Everyone experiences losses at
various points in the life continuum. Birth, loss and death are universal and individually unique
events of the human experience. At any stage of one's life, there is the potential for loss, grief
and death.
Death was defined in 1981 by the president commission for the study of ethical problems in
medicine and biomedical and behavioral research as: Death is present if an individual has
sustained . Irreversible cessation of circulatory and respiratory functions. Death is irreversible
cessation of all functions of entire brain, including the brainstem.
Grief is an emotional response to a loss. Grief is a deep emotional and mental anguish that is a
response to the subjective experience of loss of something significant. It is manifested in a
variety of ways that are unique to an individual and based on personal experiences, cultural
expectations and spiritual beliefs.

DEFINITIONS:-
LOSS
Loss is any situation, either actual, potential or perceived, in which a valued object is changed or
is no longer accessible to individual. Because change is major constant in life, everyone
experiences.
DEATH
In United States, three definitions of death are there:
 Heart-lung death: The irreversible cessation of spontaneous respiration and circulation,
the accepted criteria of death until. 1960s
 Whole brain death: Irreversible cessation of all functions of entire brain, including the
brainstem, this definition emerged in 1960s
 Higher brain death Irreversible loss of all higher functions of brain, of cognitive
functions, this definition was suggested in 1970s.
GRIEF
It is a form of sorrow that follows the perception or anticipation, loss of one or more valued or
significant object. These response often include helplessness, loneliness, hopelessness sadness,
guilt and anger.

1
MOURNING
Mourning is the psychological process through which the individual passes on to successful
adaptation to the loss of a valued object.
BEREAVEMENT
Bereavement includes grief and mourning-the inner feeling and outward reactions of survivor.
People grieve in different ways, and there is no time limit for completing the grief process. The
time of grieving often depends on the significance of the loss, the length of time the person was
known and loved, the anticipation of or preparation for the loss, the person's emotional stability
and maturity, and the person's coping ability.

TYPES OF LOSS:-
1. Necessary losses
2. Actual losses
3. Perceived loss
4. Maturational losses
5. Situational losses
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, begin career and form relationships.These losses are
discovered and replaced by L something different or better. But losses make I unbearable
change.
2. ACTUAL LOSSES:-
Actual losses are any loss of a person or object that can no longer be felt, heard,
known or experienced by the individual. Examples include: the loss of a body part, child
relationship, or role at work.
3. PERCEIVED LOSS:-
Any loss that is uniquely defined by the grieving client. It may be less obvious to
others. 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 or prestige.
4. MATURATIONAL LOSS:-
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.

2
5. SITUATIONAL LOSS:-
It includes any sudden, unpredictable external event. Often this type of loss
includes 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.

CATEGORIES OF LOSS
1. Loss of external objects
2. Loss of known environment.
3. Loss of an aspect of life
4. Loss of life or death.
5. Loss of significant others
1. LOSS OF EXTERNAL OBJECTS:-
Extend of grieving depends on object's value, sentiment attached to it, and its
usefulness. Eg: loss, misplacement, deterioration, destruction by natural causes.
2. 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.
Eg: moving from a neighbourhood, hospitalization, a new job etc.
3. LOSS OF SIGNIFICANT OTHERS:-
Loss of family member, friend, trusted nurse, acquaintance, or animal companion.
4. LOSS OF AN ASPECT OF LIFE:-
Illness, injury or developmental changes results in loss of aspect of self that
causes grief and permanent changes in the body image and self concept. Eg: body part,
psychological or physiological function.
5. 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. Eg: death of family members, friend or
acquaintance, own death.

3
FACTORS INFLUENCING LOSS AND GRIEF
The way an individual perceives a loss and responds to it during bereavement is
heavily influenced by many factors.
1. Human development:-
Person of differing ages and stages of development will display different and
unique symptoms of grief. Eg: Toddlers are unable to understand loss or death, but they feel
great anxiety over loss of objects and separation from parents.
2. Psychological perspectives of loss and grief:-
Age, gender, status, race, spirituality, religious beliefs, intellect, achievement, self
expression, and cultural opportunity are the basis for an individual to define and qualify the
definition of life or death.
3. Socio-economic status:-
It influences a person's ability to obtain options and use support mechanisms
when coping with loss. Generally an individual feels greater burden from a loss when there is a
lack of financial, educational or occupational resources. These clients require referral to
community social service agencies that can provide needed resources.
4. 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. When clients do not receive supportive
understanding and compassion from others, they become unable to handle grief and look to the
future.
5. Nature of loss:-
The ability to resolve grief depends on the meaning of the loss and the situation
surrounding the loss. The visibility of the loss influences the support a person receives. Eg: The
total loss of one's home from a tornado will bring support from the community, where as a
private loss of an important possession may bring less support from others.
6. Culture and ethnicity:-
Interpretation of the loss and the expression of the grief arise from cultural back
ground and family practices. Critical components of culture are their basic core belief systems
that they can and often do hold on to.

4
7. Spiritual beliefs:-
Individual's spirituality influences their ability to cope with loss. Clients who have a strong
interconnectedness with a higher power are able to face death with relatively minimal
discomfort.

GRIEF

TYPES OF GRIEF
1. NORMAL GRIEF:-
It consists of normal feelings, behaviours and reaction to a loss. This normal grief
response to a loss can prove positive, helping one to mature anddevelop as a person. It includes
resentment, sorrow, anger, crying, loneliness and temporary withdrawal from activities.
2. ANTICIPATORY GRIEF:-
The process of disengaging or letting go that occurs before an actual loss or death has
occurred is called anticipatory grief. Eg: once a person or family receives a terminal diagnosis,
they begin the process of saying good bye and completing life affairs. When the actual process of
dying is extended for a long time, persons in the client family may have few syndromes of grief
once the death occurs.
3. COMPLICATED GRIEF:-
When the person has difficulty in progressing through the normal phases or stages of
grieving, bereavement become complicated. In these cases bereavement appears to go wrong and
loss never resolves. This can threaten a person's relationship with others.
Complicated Grief Includes
a. chronic grief
b. delayed grief
c. exaggerated grief
d. masked grief
4. DISENFRANCHISED GRIEF:-
Person experiences grief, when a loss is experienced and cannot be openly
acknowledged, socially sanctioned, or publically shared. Eg: The loss of a partner from AIDS,
children experiencing the death of a step-parent, or the mother whose child dies in-utero or at
birth.

5
STAGES OF GRIEF
De MinabethKabler-Ross (1969) has described the stages through which many terminally ill
patients progress. These are demal, anger bargning depression and acceptance. These stages may
occur in progressive fashion or a person can move back and forth through the stages. There is no
specific time period for completion of stages.
Stage I: Denial
the psychological defense mechanism, by which a person refuses to believe certain information,
helps people to cope initially with reality of death. Terminally ill clients may first refuse to
believe that their diagnis is accurate. They may speculate that test sults are wrong or their reports
have been mixed-up with other's reports.
Stage II: Anger
Emotional response to feeling victimized occurs because there is no way anger onto nurses,
physicians, family members, even god. They may express anger in less obvious way, eg
overreacting to even dight annoyanc
Stage III: Bargaining
A psychological mechanism for delaying the inevitable, involves a process of negotiation usually
with god or other high power. Usually, dying clients are willing to accept death but want to
extend their lives temporarily until some significant event takes place (eg child's wedding).
Stage IV: Depression
Sad mood indicates the realization that death will come sooner rather than later. The sad mood is
a result of confronting social loss.
Stage V: Acceptance
Attitude of complacency occurs after the clients have dealt with their losses and completed
unfinished business Kubler described the unfinished business in two-ways. Literally it refers to
completing legal and financial matters to provide best security for survivors. It also refers to
addressing social and spiritual matters such as saying good bye to loved ones and making peace
with god. After tying up all the loose ends, dying clients feel prepare to die.

GRIEF PROCESS (REACTIONS TO GRIEF AND DEATH)

Grief is the emotional pain caused by a loss. Reactions to both grief and dying are similar. The
stages of these reactions overlap and vary among individuals. Engel (1954) proposed that
grieving process has six phases as given below:
1. Shock and disbelief: Here the person usually refuses to accept the fact of loss, followed by a
stunned or numb responses; 'No'not me' etc.

6
2. Developing awareness: It is characterized by physical and emotional responses such as anger,
feeling empty, and crying: 'why me?"
3. Restitution: It involves the rituals surrounding loss and with death includes religious, cultural,
and social expressions of mourning such as funeral service.
4. Resolving the loss: it is dealing with the void left by the loss.
5. Idealization: It is the exaggeration of the good qualities of the person or object lost, followed
by acceptance of loss and lessened need to focus on it.
6. Outcome: It is the final resolution of the grief process, including dealing with loss as a
common life occurrence.
Treatment: Normal grief does not require any treatment while complicated grief requires
medication depending on the prevailing behavior responses.
THEORY OF GRIEVING PROCESS:-
several theoretical models describe grieving. Someone theory is discussed below
Therese Rando -
Researcher and clinical psychologist: Therese Rando also has contributed a stage model of the
grief process that she observed people to experience while adjusting to significant loss. She
called her model the "Six R's".
1. Recognize the loss- First, people must experience their loss and understand that it has
happened.
2. React- People react emotionally to their loss.
3. Recollect and re experience- People may review memories of their lost relationship
(events that places visited occurred, together, or day to day moments that were
experienced together)
4. Relinquish- People begin to put their low behind thema, realizing and accepting that the
world has truly changed and that there is no turning back
5. Readjust- People begin the process of returning to daily life and the loss starts to feel
less acute and sharp.
6. Reinvest- Ultimately, people re enter the world, forming new relationships and
commitments. They accept the changes that have occurred and move past them.

DEATH
A Harvard University committee stated that the following characteristics must be present
for at least 24 hours before death can be declared:
 Lack of receptivity and responsiveness
 Lack of movement or breathing

7
  Lack of reflexes
 Flat encephalogram.

FIVE ASPECTS OF HUMAN FUNCTIONING:-

1. Physical: While interviewing and observing the patient, the nurse should assess such, areas as
sleeping patterns, body image, activities of daily living (ADLs), mobility, general health,
medications and pain. The nurse also should address the basic needs of nutrition, elimination,
oxygenation, activity, rest, sleep and safety.
2. Emotional: Preparing for one's death is a personal endeavor filled with anxiety and fear.
Assessing the patient and family's anxiety level, guilt, anger, level of acceptance and
identification is important. Major fears of the dying patient include fears of abandonment, loss of
control, pain and discomfort and the fear of the unknown. The nurses can intervene appropriately
when they are able to accept the feelings of the individual of patient's family. Offer
encouragement and support, and give the patient's "permission to die"
3. Intellectual: Intellectual assessment includes an evaluation of the patient and family's
educational level, their knowledge and abilities, and expectations they have in regard to how and
when death will occur. Some aspects of the intellectual dimension can be altered during the
dying process because of physiological changes, medications the patient's emotional state, or the
disease process. Being alert, to these changes will avert problems if the patient's memory or
sensations are decreased.
4. Social: Assessing the patient and family's support systems is valuable. Ascertaining if family
members desire to assist in the patient's daily care will not only lessen the family's sense of loss
of control but also will clarify what tasks the family will do and what will be done by nursing
staff.
5. Spiritual: The nurse assesses the spiritual dimension by gaining insight into the patient's
philosophy of life, his religious resources, and how the rituals of his faith group have
significance in dealing with his death. Interventions in this area can come from clergy, friends,
family, healthcare providers, and significant others. Supporting the patient and family belief
system and values is important.

SIGNS OF APPROACHING DEATH

Although death is unique for each individual, common physical and psychological events occur
when death is approaching
Physical Events:-
Death usually occurs gradually over hours or days. Cells deteriorate from underlying lack of
sufficient oxygen, which leads to multisystem failure. The following are signs of impending
death that alert the nurse that client will die shortly.
 Cardiac Dysfunctions -

8
Failing cardiac functions is one of the first signs that a client's condition is worsening. At first,
heart rate increases in a futile attempt to deliver oxygen to cells. The apical pulse rate may reach
100 or more per minute. Cardiac qutput per minute increases. This may diminish heart's own
oxygen supply which causes heart rate to decrease and blood pressure to fall.

 Peripheral Circulation Changes -

Reduced cardiac output compromises peripheral circulation and impairs cellular metabolism and
produces less heat. Skin becomes pale, nail beds and lips may appear blue, client may feel cold.
 Pulmonary Function Impairment -
Failure of heart pumping function causes fluid to collect in pulmonary circulation, Breath sounds
become moist and client cannot exhale carbon dioxide adequately compounding state of hypoxia.
 Central Nervous System Afteration -
With hypoaia, brain is less sensitive to accumulating levels of carbon dioxide, thus client may
experience periods of apnea. Pain perception is decreased, dient may stare blankly through
partially opened eyes. Senses become impaired. Hearing tends to be remain intact.
 Renal Impairment -
Low cardiac output decreases the urine volume and waste products accumulate.
 Gastrointestinal Disturbance -
Peristalsis decreases, causes intestinal contents to accumulate. This stimulates vomiting center
inducing nausea and vomiting.
 Musculoskeletal Changes -
Reflexes become hypoactive. The client loses control over sphincters leading to incontinence,
law and facial muscles relas Tongue may fallback.
 Psychological Events -
they have reached the stage of acceptance, some terminally-ill clients look forward to dying
because it will end their suffering Some seen to forestall dying when they feel their loved ones
are not prepared. This is waiting for permission phenomenon.
 Near Death Experience -
In this, a person almost dies but is resuscitated, have been reported for sometime. People who
experience neat death experience report similar events such as:
 Floating above their bodies
 Moving rapidly toward a bright life
 Seeing familiar people who have already died

9
  Feeling warm and peaceful
 Being told that it is not time yet for them to die
 Regretting having to return to their resuscitated body

 Nearing Death Awareness - It is a phenomenon characterized by dying client's

premonition of approximate time or date of death. In addition, just belone death, clients
may reach out, point or open their arms as if to embrace someone or call them by name.

SIGNS OF CLINICAL DEATH

1. Skin musculoskeletal system: Perspiration is increased; skin becomes cold and clammy, and
it becomes pale or mottled due to congestion of blood in the vein, loss of muscle tone.
2. Facial appearance: Sagging of jaws takes place, checks become flaccid and breathing takes
place through mouth. Generally, checks are sucked in and blowout. With each respiration, facial
muscles are relaxed.
3. Sight, speech and hearing: Eyes have a sunken appearance and the lids may drop, half
closed. A film a film appears over the eyes. They do not react to light. Speech becomes mumbled
and confused. Hearing becomes dulled, but it is not known when it completely disappears.
4. Absence of pulse, heart beat and respiration is noted. Pupil of the eye become fixed and does
not react to light. There is absence of all reflexes.
5. Rigor mortis sets in: It is the stiffening of the body after death due to fixation of muscles
Signs of clinical death:
1. Absence of pulse, hearts beat and respiration.
2. Red blood cells rolling to a drop or forming rouleaux in retinal vessels.
3. Pupils fixed and non-reactive to light.
4. Absence of all reflexes.
5. Rigor mortis.
6. Postmortem hypostasis.
7. Autolysis.

THE DYING PERSON'S BILL OF RIGHTS:-

 I have the right to be treated as a living human being until I die.
 I have the right to maintain a sense of hopefulness however changing its focus may be
 I have the right to express my feelings and emotions about my approaching death in my
own way.
 I have the right to be particular in decision concerning my care. •

10
  I have the right to expect continuing medical and nursing attention even though cure
goals must be changed to comfor goals.
 I have the right not to die alone.
 I have the right to be free from pain.
 I have the right to have my questions answered honestly.
 I have the right to not to be deceived.
 I have the right to have help from and for my family in accepting my death.
 I have the right to die in peace and dignity.
 I have the right to retain my individuality and not to be judged for my decisions which
may be contrary to belief of others.
 I have the right to be cared by caring, sensitive, knowledgeable people who will attempt
to understand my needs and will be able to gain some satisfaction in helping me face my
death.

COPING WITH LOSS, DEATH AND GRIEF:-

Just as people feel grief in many different ways, they handle it differently, too. Coping can be
adaptive or maladaptive

Adaptive Coping-
Adaptive coping helps the person to deal effectively with event and minimizes distress
associated with it Some people reach ou ar support from others and find comfort in good
memories Others become very busy to take their munds off the loss. For some people, it can help
to talk about the loss with others. Some do this naturally and easily with friends and family,
while others talk a professional therapist
Maladaptive Coping-
It can result in unnecessary distress for the person and other associated with person. Some people
become depressed and withdraw from their peers or go out of the way to avoid the places of
situations that remind them of the person who has died For example, some people may not feel
like talking about it much at all because it is hard to find the words to express auch a deep and
personal emotion or they wonder whether talking will make them feel the hurt more. This is fine,
as long as you find other ways to deal with your pain. People, sometimes deal with their sorrow
by engaging in dangerous or self destructive activities Doing things such as drinking, drugs, or
cutting yourself to escape from the reality of a loss may seem to numb the pain, but the feeling is
only temporary. This is not really dealing with the pam, only masking it, which makes all those
feelings build-up inside and only prolong the grief.
Coping Strategies-

11
In coping with the loss and grief. people tend to use one of the three main coping strategies
Appranal-focused, problem focussel and emotional focussed
 Appraisal-focused Coping- occur when the persons modify the way they think for
example, employing denial or distracting themselves from the problem. People may alter
the way they think about the problem by altering their goals and values, such as by seeing
buio in a situation.
 Problem-focused- People using these strategies try to deal with the cause of their
problem. They do this by finding information on the problem and learning new skills to
manage the problem. Men often prefer problem focused coping. Problem focused coping
mechanism may allow an individual greater perceived control over their problem.
 Emotional-focused- These involve releasing pent-up emotions, distracting oneself,
managing hostile feelings, medlitating, using simple relaxation procedures, etc. Women
prefer emotional-focused response Emotional-focused coping may, more often. lead to a
reduction m perceived control.
Coping Skills and Coping Resources:-
Coping resources are options or strategies that help determine what can be done, as well as what
is stake. Coping resources include economic assets, abilities and skills, defensive techniques,
social supports and motivation Relationship between the individual family group and society are
critically important. Other coping resources include health and energy spiritual support, positive
beliefs, problem-solving and social skills social and material resources and physical well-being
 Spiritual Belief-
Spiritual belief and viewing oneself positively can serve as a basis of hope and can sustain a
person's coping efforts under most adverse circumstances Problem solving skills include the
ability to search for information, identify the problem, weigh alternatives and implement plan of
action,
 Social Skills-
Social skills facilitate solving of the problem involving other people, increase the likelihood of
getting cooperation and support from others and give individual greater social control.
 Material Asset-
Material assets refer to money and goods and services that money can buy Obviously monetory
resources greatly increase person's coping options in almost any situation.
 Knowledge and Intelligence
Knowledge and intelligence are other coping resources that allow people to see different ways of
dealing with loss and grief.
COPING RESOURCES:-

12
Coping resources also include a strong ego identity, commitment to social network, cultural
stability, a stable system of valim and thoughts. People who generally cope successfully have a
varied array of personal resources, which include following abilities
The ability to seek pertinent information
The ability to share concerns and find consolation when needed.
The ability to redefine a situation so as to make it more solvable
The ability to consider alternatives and examine consequences.
The ability to use humor to defuse a situation.
CARING FOR THE BEREAVED:-
 Have contact physically (with the patient's permission) and emotionally with the person.
 Assess when the person is in the grieving process.
 Demonstrate genuine compassion and caring.
 Give permission to grieve and normalize the grieving process.
 Mention the loss or the deceased person's name.
 Encourage the person to talk about the relationship he or she had with the deceased
person. .
 Understand that people need to talk about the events and feelings around the death and
will repeat themselves.
 Tell the person to expect mood swings, pain, and various life changes.
 Focus on clarifying and using coping skills.
 Allow the person to take a break from grieving and focus on self-care.
 Encourage sources of comfort such as religion or nature.
 Identify secondary losses and unfinished business.
 Acknowledge that there will be eventual recovery.
 Discuss the anniversary phenomenon. .
 Encourage medical or psychiatric care as needed.

GRIEF COUNSELING AND GRIEF THERAPY:-

The way the individuals and families cope with dying, death, grief, loss, and berezvement is as
unique as a fingerprint. The to the death of a family member, relative, or close friend places one
in the category of "hereaved". Those who are bevored experience grief, a person's response or
reaction to loss, which encompasses physical psychological, social and ential components How
one copes with other life events and adapts to one's present and future is also part of the grieving
In the broadest context losses can be thought of as the loss of one's possessions, one's self, one's
developmental losses, es significant others. Historically, many grief counselors and grief
therapists have chosen to follow the popular "grief unseling theory of the time. However, in the
twenty-fiest century there are constantly changing theories regarding grief and and new
challenges and questions raised by researchers, clinicians, and the bereaved themselves regarding
13
what is or is not heful darting the bereavement process. In addition to counselors and therapists
as defined in the more traditional sense, "prief al bereavement specialists have emerges and also
Grief Therapy.
 In griefunching and grief therapy (1991), the clinician and researcher William J
Worden. PhD, makes a distinction between grief counseling and grief therapy. He
believes counseling involves helping people facilitate uncomplicated, or normal grief to a
healthy completion of the tasks of grieving within a reasonable timeframe. Grief therapy,
on the other hand, utilizes specialized techniques that help people with abnormal or
complicated grief reactions and helps them resolve the conflicts of separation. He
believes grief therapy is most appropriate in situations that fall into three categories (1)
The complicated grief action is manifested as prolonged grief, (2) The grief reaction
manifests itself through some masked somatic or behavioral ymptom (3) The reaction is
manifested by an exaggerated grief response.
 Does a peson need specialized grief counseling or grif therapy when grief, na normal
reaction to fois, nakes place? Are people not able to cope with loss as they have in the
past or are individuals not being provided the same type of support the received in
previous generations Individual and family geographic living arrangements are different
in the twenty-first mary than in the past years. People have moved from rural to urban
centers, technology has altered the lifespan and the bealth care decisions are becoming
not only more prevalent but often more difficult Cost and legal issues become factors in
nes Today, ethics committees in hospitals and long term care facilities are available to
help families and health care providers arrive at common ground. Traumatic and violent
deaths have also changed the bereavement landscape What had helped individuals and
families in the past in many situations has eroded and the grief and bereavement
specialist, or the persons agencies and organizations providing those services, is doing so
in many cases out of default. Griel counseling is and not only by individuals and families,
but in many situations by schools, agencies, and organizations, and in some cases by
entire communities affected by death.

Goals of Grief Counseling:-

 Accepting the lows and talking about it.
 Identifying and expressing feelings related to the loss (anger, guilt, anxiety, helplessness,
sadness)
 Living without the deceased and making decitints alone to the loss (enger. guilt, anxiety,
helplessnewsadness)
 Sepatrating emotionally and forming new relationships
 The provision of support
 Identifying ways of coping that at the bereaved Explaining the grieving process.

Approaches Used:-
There is not vine niethod or approach. Each counselor or therapist has his ne her in techniques
that he or she uses he they are effective, although counselors often defer to other techniques that
14
suit a particular person much better based on the individuals curcumstances Counseling and
therapy techniques include art and matherapy meditation, creation of personifond itale
bitilistherapy, journaling, communication with the deceased through writing, conversations, etc..
bringing p of pens that belonged to the person who has died, vole playing bearing withes to the
story of the loved one, conting intimates and participating in support groups. The empty chair or
Gestalt therapy technique is also an approach widely d by grief counselors and grief therapists.
This technique involves having an individual talk to the deceased in an empty chair as if the
deceased person were actually sitting there afterward, the same individial sits in the deceased
persons chair and speaks from that person's perspective. The dialogue is in fire person, and a
counselor or therapist is always pensent The intermes alas provides a number of sites that
address the tople of grief and provide links to counseling services and organizations

SUMMARY
Loss is the experience of separation from something of personal importance. Loss is anything
that is perceived as such by the individual. Death is the ultimate loss. It separates people from the
physical presence of persons who influence their lives. Coping with loss, death and grieving is a
difficult task for those who experience it. Adequate support and the effective use of ego defence
mechanisms enable the patient to cope with the situation. Nurses help the patients to identify the
coping strategies and use it in an effective and efficient manner.

15
 BIBLIOGRAPHY
 Kaur Brar N & Rawat HC. Textbook of Advanced Nursing Practice. 1 st ed. New Delhi:
Jaypee Brothers; 2015.page no. 886-907.
 Basheer SP and Khan SY. A Concise Text Book of Advanced Nursing Practice. 2 nd ed.
Bangalore: Emmess Medical Publishers; 2020. page no. 603-608.
 Potter PA and Perry AG. Fundamental of Nusing. 6th ed. Elsevier Publishers. page no.
569-589
 Habeeb S Coping with loss death and grieving [Online]2016 May 26 [cited on 2021 Nov.
18]; [50 slideshare] available from: URL: https://www.slideshare.net>mobile.
 Kamal AS. Loss and Grief [Online] 2015 Sept 07 [cited on 2021 Nov 19]; [23 screen]
available from: URL: https://www.slideshare.net>aneez103.

16