Posted: August 31st, 2023

The Experience of Loss, Death, and Grief

The Experience of Loss, Death, and Grief

As nurses, we encounter patients and families who are facing loss, grief, and death on a regular basis. These are challenging and sensitive situations that require compassion, empathy, and professionalism. In this blog post, we will explore the concepts of loss, grief, and death, and how we can provide effective and holistic care to our patients and their loved ones.

What is Loss?

Loss is the involuntary separation from something that a person values. Loss can be actual or perceived, physical or psychological, temporary or permanent. Loss can occur at any stage of life and can affect various aspects of a person’s well-being.

Some examples of loss are:

– Loss of a body part or function due to injury, illness, or aging
– Loss of a loved one due to death, divorce, or estrangement
– Loss of a role or identity due to retirement, unemployment, or disability
– Loss of a possession or property due to theft, damage, or disaster
– Loss of a belief or value system due to trauma, crisis, or change

What is Grief?

Grief is the normal and natural response to loss. Grief is a complex and multidimensional process that involves physical, emotional, cognitive, behavioral, social, and spiritual aspects. Grief is not a linear or predictable process; rather, it is dynamic and individualized. Grief can vary in intensity, duration, and expression depending on the person and the situation.

Some common manifestations of grief are:

– Physical symptoms such as fatigue, insomnia, appetite changes, headaches, chest pain, etc.
– Emotional reactions such as sadness, anger, guilt, anxiety, depression, etc.
– Cognitive changes such as confusion, memory loss, difficulty concentrating, etc.
– Behavioral responses such as crying, withdrawal, isolation, restlessness, etc.
– Social impacts such as changes in relationships, roles, activities, etc.
– Spiritual questions such as meaning, purpose, faith, hope, etc.

What are Grief Theories?

Grief theories are models that attempt to explain how people cope with loss and grief. There are many different grief theories that have been proposed over the years. Some of the most influential ones are:

– Kubler-Ross’s Five Stages of Grief: This theory suggests that there are five stages that people go through when facing death or loss: denial, anger, bargaining,
depression,
and acceptance. These stages are not sequential or fixed; rather,
they are fluid and overlapping. Not everyone experiences all five stages or in the same order.
– Bowlby’s Attachment Theory: This theory emphasizes the importance of attachment bonds between humans and how they affect the response to loss. According to this theory,
there are four phases of grief: numbness,
yearning,
disorganization,
and reorganization. These phases reflect the process of detaching from the lost object and reestablishing a new equilibrium.
– Worden’s Four Tasks of Mourning: This theory focuses on the tasks that people need to accomplish in order to adapt to loss. The four tasks are: accepting the reality of the loss,
processing the pain of grief,
adjusting to a world without the lost object,
and finding an enduring connection with the lost object while embarking on a new life.
– Dual Process Model: This theory proposes that there are two types of coping processes that people use when dealing with loss: loss-oriented and restoration-oriented. Loss-oriented processes involve confronting and working through the emotions and meanings of the loss. Restoration-oriented processes involve attending to the changes and challenges that result from the loss. These processes are not mutually exclusive; rather,
they alternate and balance each other.

What are Types of Grief?

Grief can be classified into different types based on the characteristics and circumstances of the loss. Some common types of grief are:

– Anticipatory Grief: This is the grief that occurs before an expected loss. It can help prepare the person for the impending loss,
but it can also cause anxiety,
depression,
and guilt.
– Complicated Grief: This is the grief that is prolonged,
intense,
or unresolved. It can interfere with the person’s functioning and well-being. It can be caused by factors such as sudden or traumatic loss,
ambiguous loss,
multiple losses,
lack of support,
etc.
– Disenfranchised Grief: This is the grief that is not acknowledged or validated by society. It can occur when the loss is stigmatized,
hidden,
or minimized. Examples include loss due to abortion,
suicide,
miscarriage,
etc.
– Cumulative Grief: This is the grief that accumulates over time due to multiple losses. It can overwhelm the person’s coping resources and lead to exhaustion,
isolation,
and despair.

How to Care for Patients and Families Experiencing Loss and Grief?

As nurses,
we have a vital role in providing care for patients and families who are experiencing loss and grief. Some of the strategies that we can use are:

– Assess the patient’s and family’s needs,
preferences,
and resources. Use open-ended questions,
active listening,
and empathic responses to elicit their concerns and expectations.
– Provide information and education about loss,
grief,
and death. Use clear,
simple,
and honest language to explain the diagnosis,
prognosis,
treatment options,
etc. Address any myths,
misconceptions,
or fears that they may have.
– Support the patient’s and family’s coping and decision-making. Encourage them to express their feelings and thoughts. Validate their emotions and experiences. Respect their choices and preferences. Help them identify and access their sources of support and strength.
– Collaborate with the interdisciplinary team to provide palliative care. Palliative care is the care that aims to improve the quality of life of patients and families facing life-threatening illnesses. It focuses on relieving pain and other symptoms,
enhancing comfort and dignity,
and addressing physical,
emotional,
social,
and spiritual needs.
– Implement interventions for symptom management in patients at the end of life. Use pharmacological and non-pharmacological methods to control pain,
dyspnea,
nausea,
anxiety,
etc. Monitor and document the patient’s response and adjust the interventions as needed.
– Discuss the criteria for hospice care. Hospice care is the care that provides comfort and support to patients and families in the last phase of life. It is usually offered when the patient has a prognosis of six months or less to live. It can be provided at home or in a facility. It involves a team of professionals who offer medical,
nursing,
psychosocial,
spiritual,
and bereavement services.
– Provide care of the body after death. Follow the institutional policies and procedures for handling the body after death. Respect the patient’s and family’s wishes regarding organ donation,
autopsy,
funeral arrangements, etc. Provide privacy and dignity to the body. Offer emotional support and condolences to the family.
– Reflect on your own grief experience when caring for dying patients. Recognize that caring for dying patients can trigger your own grief reactions. Acknowledge your feelings and seek support from your colleagues, friends, or professional counselors. Engage in self-care activities such as exercise, relaxation, hobbies, etc.

References

– Corr, C.A., Nabe, C.M., & Corr, D.M. (2019). Death & dying, life & living (8th ed.). Cengage Learning.
– Kubler-Ross, E., & Kessler, D. (2014). On grief & grieving: Finding the meaning of grief through the five stages of loss. Scribner.
– Stroebe, M., Schut, H., & Boerner, K. (2017). Cautioning health-care professionals: Bereaved persons are misguided through the stages of grief. OMEGA-Journal of Death and Dying, 74(4), 455-473.
– Worden, J.W. (2018). Grief counseling & grief therapy: A handbook for the mental health practitioner (5th ed.). Springer Publishing Company.