1. Chapter 28: Grief: In Loss and Death Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

2. 2 Grief  Natural and normal reaction to loss; part of the human experience  Grief descends on everyone regardless of age, status, or circumstance  Bereavement: the period after the loss, usually an intense emotional response  Mourning: process where people adapt to loss

3. 3 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Types of Losses  Death of loved one  Self-esteem/self-worth  Identity  Dignity  Psychiatric illness  Surgery  Illness  Birth defect  Change of locale  Job loss

4. 4 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Responses to Grief and Bereavement  Physical manifestations  Cognitive manifestations  Behavioral and relating manifestations  Affective manifestations: guilt and anger

5. 5 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Physical Manifestations  Weakness  Numbness  Anorexia  Feelings of choking  Shortness of breath  Tightness in chest  GI disturbances  Sleep disturbances  Increased vulnerability

6. 6 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Cognitive Manifestations  Preoccupation with thoughts and memories of the departed  Difficulty concentrating  Longing for the deceased  Rumination, isolation, excessive guilt

7. 7 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Behavioral and Relating Manifestations  Disruptions in patterns of conduct  Inability to perform ADLs  Restless disorganization  Excessive rumination  Isolation  Lack of meaning in old life patterns

8. 8 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Affective Manifestations  Emotional: sadness, guilt, anxiety  Cognitive: preoccupied, ruminating  Physical: somatic complaints, lowered immune function  Existential: disruption in life’s certainties, questioning beliefs

9. 9 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Stages of and Process of Grief 1. Avoidance  Numbing  Blunting  Denial 2. Confrontation  Period of active mourning  Disorganization  Despair 3. Reestablishment  Gradual  Reorganization  Recovery

10. 10 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Process of Grief May include some or all:  Shock and disbelief  Protest and despair  Emotionless cognitive activity  Waves of despair  Yearning, despair, and disorganization  Rebuilding process

11. 11 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Tasks of Grief  Telling the death story  Expressing/accepting the sadness, guilt, anger, and negative feelings  Reviewing the relationship  Exploring possibilities for life after loss  Understanding common processes and problems in grief  Being understood or accepted by others

12. 12 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Complicating Factors  Pain of great intensity  Attempts to avoid the pain  Work is contradictory  Pain demands expression  Fear of loss of control if expressed  Cultural values support avoiding expression of grief

13. 13 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Types of Grief  Anticipatory  Catastrophic diagnosis  Acute grief  Painful experience after loss  Dysfunctional grief  Traumatic  Absent/inhibited  Conflicted  Chronic  Chronic sorrow

14. 14 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Bereavement Care  Before loss  Primary prevention (e.g., family involvement in community, improved parenting)  When loss is impending  Assist toward reconciliation  Promote participation in care  Support groups/hospice  Preventive grief therapy  After loss