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GRIEF AND LOSS

 Lossis a universal
experience that occurs
throughout life span

 Griefis a form of sorrow
involving feelings, thoughts,
and behaviors caused by
bereavement
GRIEF AND LOSS

 Responses to loss are strongly
influenced by one’s cultural
background
 The grief process involves a
sequence of affective, cognitive,
and psychological states as a
person responds to, and finally
accepts a loss.
Loss and grieving
 LOSS= something valuable
is gone
 GRIEF= total response to
emotional experience
related to loss
 BEREAVEMENT=
Subjective response by
GRIEF AND LOSS
Stages of Grieving (Kubbler-Ross)
 Denial- refuses to believe that the
loss has occurred
 Anger- the individual resists the
loss and may “act out” feelings.
 Bargaining- the individual attempts
to make a deal in an attempt to
postpone the reality of loss.
 Depression- overwhelming feeling
of loneliness and withdrawal from
others
 Acceptance- the individual comes
to terms with loss, or impending
loss, psychological reactions to loss
Loss and grieving
Stages of Grieving by Kubbler-
Ross
DABDA
DENIAL= refusal to believe
ANGER= hostility
BARGAINING= feeling of guilt, fear
of punishment
DEPRESSION= withdrawn
behavior
ACCEPTANCE= comes to terms
Loss and grieving
Stages Behaviors

D Refuses to believe
that loss is
A happening
Retaliation
B Feelings of guilt,
punishment for sins
D Laments over what
has happened
A Begins to plan like
wills, prosthesis
Death and Dying
AGE
(Kozier) Beliefs
Infancy to 5 years old NO clear concept of
Death
5 to 9 years It is Reversible,
Understands DEATH is
temporary sleep
FINAL but can be
9-12 years AVOIDED
Death is INEVITABLE
Understands own
12-18 years mortality
Fears a lingering Death

18-45 Attitude is influenced by
religion
45-65 years Experiences peak of death
anxiety
65 and above Death as multiple
meanings
Nursing
responsibilities In
Death and dying
 Nurses need to take time
to analyze their own
feelings about death
before they can
effectively help others
with terminal illness
Nursing
responsibilities In

Death and dying
The major goals for the dying
clients are:
2. To maintain PHYSIOLOGIC
and PSYCHOLOGIC support
3. To Achieve a dignified and
peaceful death
4. To maintain personal control
Loss and Death
RESPONSIBILITIES
 Provide Relief from loneliness,
fear and depression
 Help clients maintain sense of
security
 Help clients accept losses
 Provide physical comfort
LOSS ,GRIEVING AND
DEATH
 DEATH CONCEPTS
– 1-5 – IMMOBILITY AND INACTIVITY
Wishes and unrelated action
responsible for action
– 5-10 – final but can be avoided
– 9-12 – understands own mortality
and fears death
– 12 – 18 – fears and fantasizes
avoidance
– 18-45 – increased attitude
awareness
– 45-65 – accepts mortality
Interventions
 D – SUPPORTIVE

 A- PROVIDE STRUCTURE AND
CONTINUITY

 B – LISTEN AND ENCOURAGE

 D- ALLOW EXPRESSION AND PROVIDE
FOR SAFETY

 A- ENCOURAGE PARTICIPATION