Loss and Grief

1. Presnted By
Rajnee Shresthta
Lecturer of Bheri Nursing College
Nepalgunj; Nepal

2. STAGES OF DYI NG
 When someone is told they are going to die
and have only a short time to live, there are
five basic stages they go through.

3. ST AGES OF DYI NG
 These stages were created by Elisabeth Kubler-Ross.
 Elisabeth Kubler-Ross was a pioneer in the psychological field of
death counseling.
 While working with dying patients she analyzed what goes on in
their minds.
 From her experience-oriented research, she found five specific
emotional and mental stages that are consistent with almost all
patients.
 These five stages don't usually follow any particular order, and
each can be experienced more than one time.

4. STAGES OF DYING
 State 1: Denial and Isolation
 Stage 2: Anger
 Stage 3: Bargaining
 Stage 4: Depression
 Stage 5: Acceptance

6. The fact or process of losing something or someone.
-oxford dictionary
Unrecoverable and usually unanticipated and non- recurring
removal of, or decrease in, an asset or resource.

7. 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.

8. Mourning is the psychological process through which individual
passes on to successful adaptation to the loss of a valued object.
• Bereavement includes grief and mourning-the inner feeling and
outward reactions of survivor
MOURNING

9.  Healing the self
 Recovering from the loss
GOAL OF GRIFING PROCESS

10. The sadness of losing someone you love never goes away
completely, but it shouldn’t remain center stage.
If the pain of the loss is so constant and severe thatit keeps you
from resuming your life, you may be suffering from a condition
known as complicated grief.
COMPLICATED GRIEF

11.  Chronic grief:
Prolonged grief disorder refers to a syndrome consisting of a distinct
set of symptoms following the death of a loved one
 Delayed grief:
Hose who feel a delayed grief reaction often describe it as a
devastating sadness that hits them out of the blue. It might arrive a
few weeks or months

12.  Exaggerated grief
Exaggerated grief may include major psychiatric disorders that develop
following a loss such a phobias as a result of hyper-
grieving thoughts, actions, words
 Masked grief
 Masked grief is grief that the person experiencing the grief does
not say they have or that they mask.
 This can be common among men or in society and cultures.
Cont..

13.  Disenfranchised grief
Also known as hidden grief or
sorrow refers to any grief that goes
unacknowledged or invalidated by
social norms e.g. death of a friend,
the loss of a pet, the loss of a home
or place in the case of children, who
generally have little or no control in
such situations

14. Intrusive thoughts or images of your loved one
Denial of the death or sense of disbelief
Imagining that your loved one is alive
Searching for the person in familiar places
Avoiding things that remind you of your loved one
Extreme anger or bitterness over the loss
Feeling that life is empty or meaningless
SYMPTOMS OF COMPLICATED GRIEF

15. 1. Denial and Isolation
The first reaction to learning of terminal illness or death of a
cherished loved one is to deny the reality of the situation.
It is a normal reaction to rationalize overwhelming emotions.
It is a defense mechanism that buffers (guard) the immediate shock.
We block out the words and hide from the facts.
This is a temporary response that carries us through the first wave of
pain.

16. 2. Anger
As the masking effects of denial and isolation begin to wear, reality
and its pain re-emerge; We are not ready.
The intense emotion is deflected from our vulnerable core,
redirected and expressed instead as anger.
The anger may be aimed at inanimate objects, complete strangers,
friends or family.
Anger may be directed at our dying or deceased loved one..

17. 3. Bargaining
The normal reaction to feelings of helplessness and
vulnerability is often a need to regain control.
If only we had sought medical attention sooner
If only we got a second opinion from another doctor.
If only we had triedto be a better person toward them.
Secretly we may make a deal with God or our higher power in
an attempt to postpone the inevitable.
• This is a weaker line of defense to lprotect us from the painful
reality.

18. 4. Depression
• Two types of depression are associated with mourning.
• The first one is a reaction to practical implications relating to
the loss.
• Sadness and regret predominate this type of depression.
• This phase may be eased by simple clarification and
reassurance.
•We may need a bit of helpful cooperation and few kind words.
• The second type of depression is more subtle and, in a sense,
perhaps more private.
• It is our quiet preparation to separate and to bid our loved one
farewell.

19. 5. Acceptance
• Reaching this stage of mourning is a gift not afforded to
everyone.
• Death may be sudden and unexpected.
• Acceptance is often confused with the notion of being “all right”
or “OK” with what has happened.
• Most people don’t ever feel OK or all right about the loss of a
loved one.
• This stage is about accepting the reality that our loved one is
physically gone and recognizing that this new reality is the
permanent reality.

20. •We will never like this reality or make it OK, but eventually
we accept it.
• We learn to live with it; it is the new norm with which we
must learn to live.
•We must try to live now in a world where our loved one is
missing.
•In resisting this new norm, at first many people want to
maintain life as it was before a loved one died.

21.  Nursing care involves providing comfort, maintaining
safety, addressing physical and emotional needs ,and
teaching coping strategies to terminally ill patients and their
families .
More than ever ,the nurse must explain what is happening to
the patient and the family and be a confident who listens to
them talk about dying.
Hospice care , attention to family and individual psychosocial
issues ,and symptom and pain management are all part of the
nurse's responsibilities.

22. • The nurse must also be concerned with ethical considerations
and quality-of-life issues that affect dying people.
• Of utmost importance to the patient is assistance with the
transition from living to dying, maintaining and sustaining
relationships, finishing well with the family, and accomplishing
what needs to be said and done.
• In the hospital, in long-term care facilities, and in home
settings, the nurse explores choices and end-of-life decisions
with the patient and family.

23. Referrals to home care and hospice services, as well as
specific referrals appropriate for the management of the
situation, are initiated.
The nurse is also an advocate for the dying person and
works to uphold that person's rights.
• The use of living wills and advance directives allows the
patient to exercise the right to have a "good death or to die
with dignity.