1. Loss, Grief, and Bereavement
Chapter 16
Loss, Grief, and Bereavement
Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

2. Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.
Objectives
List the normal losses that occur during the stages of the life cycle.
State how the response to normal losses influences responses to loss of life.
Explain the difference between grief, mourning, and bereavement.
List the stages and tasks of the grieving process.
Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

3. Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.
Objectives (cont.)
Describe an emotional, cognitive, and behavioral response to grief.
State two religious and two cultural practices related to death.
List two components of an abnormal grief response.
State the response to loss and grief at different development stages within the lifespan.
Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

4. Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.
Objectives (cont.)
Discuss the achievement of the letting go phase of the grief process.
State four ways condolences can be expressed.
Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

5. Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.
Key Terms
anticipatory grief
bereavement
condolence
culture
eulogy
funeral
grief
legacy
mourning
Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

6. Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.
The Concept Of Loss
Loss is a natural part of life
Often painful and requires difficult adjustments
Loss occurs at almost every stage of life
Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

7. Normal Losses During The Life Cycle
Newborn’s loss of security of the womb
Toddler’s loss of being exclusive focus when a sibling arrives
Puberty involves the loss of perceived body image of adulthood
Teen’s loss of security when leaves for college
Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

8. Abnormal Or Atypical Losses
Pearl Harbor bombed
World Trade Center and Pentagon attack
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9. Critical Thinking Question 1
Why does it frequently take years for surviving family members to recover from a community or national disaster?
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Responses To Loss
Must learn how to cope with disappointments
Attitude toward loss often determines the quality of life that is maintained
Response to normal losses determines how losses are perceived and managed in old age
Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

11. Tasks Associated With Death
Hospice movement has enabled the terminally ill to experience the task of dying with dignity
Legacy may give the person a felling of immortality
Spiritual connection
Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

12. Critical Thinking Question 2
What verbal or nonverbal cues could the nurse identify to determine how a dying person is coping with the tasks of death?
Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

13. Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.
Grief
Grief Process
Culture, Religion, and Death
Normal Grief Responses
Dysfunctional Grieving
See Tables 16-1,16-2,16-3 and Boxes 16-1 and 16-2.
Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

14. Critical Thinking Question 3
How does death by suicide affect the normal grieving process in survivors?
Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

15. Role of the Health-Care Worker
Focus of care is on the patient and the family unit
Cultural competence is the key to successful communication and support
See Table 16-4.
Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

16. Critical Thinking Question 4
In some cultures, loud vocalizations accompany the death of a loved one. What interventions may be used to accommodate these families in their distress if death occurs in a hospital or other health care institution?
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17. Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.
Tasks of the Family
Preparing for a funeral
Eulogy
Reorganization of roles
Respond to needs of young children
Assess resources
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18. Grief Early In The Life Cycle
Pregnant Women
Infants
Children
Adolescents
Young Adults
See Figure 16-2 and Box 16-3.
Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

19. Critical Thinking Question 5
How can nurses and health care workers intervene if the survivor has no close family or other apparent support system?
Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

20. Critical Thinking Question 6
Feelings of loss and grief due to a miscarriage are often overlooked by health care providers. What assessments should be made by the nurse and what interventions could be done to help the mother and family cope with this loss?
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21. Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.
The Healing Process
Reintegration and Adjustment
Mastering Tasks Leading Toward Grief Healing
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22. Critical Thinking Question 7
What would you say about “letting-go” to a friend who has recently lost a spouse?
Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

23. Helping Grieving Survivors
Condolence
Grief experience is life changing
Goal is to move successfully into a new life that includes many changes
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24. Critical Thinking Question 8
How would you respond to someone who asks you what to say to or do with the newly bereaved?
Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.