1.  Grief 9/18/2015 1

2.  Grief is the subjective feeling precipitated by the death of a loved one.  Grief is a subjective state of emotional,physical,and social responses to the loss of a valued entity.  It is a form of sorrow that follows positive perception or anticipation of true loss of one or more value or significant object. 9/18/2015 2

3.  IT IS A STATE OF THOUGHT,FEELING AND ACTIVITY THAT FOLLOWS LOSS.IT INCLUDES GRIEF AND MOURNING. 9/18/2015 3

4.  A PROCESS THAT FOLLOWS A LOSS.  MOURNING IS THE PROCESS BY WHICH GRIEF IS RESOLVED.  IT IS THE SOCIETAL EXPRESSION OF POST BEREAVEMENTBEHAVIOR AND PRACTICES. 9/18/2015 4

5.  KUBLER ROSS(1969) 1. Denial 2. Anger 3. Bargaining 4. Depression 6. Acceptance 9/18/2015 5

6.  STAGE OF SHOCK AND DISBELIEF. THE RESPONSE MAY BE ONE OF no, it cant be true. It is just not poosible.this stage giving the individual some protection against the psychological pain of reality. 9/18/2015 6

7.  THIS IS THE STAGE DURING WHICH REALITY SETS IN. Anger;" why me? And it is not fair.” Anger may be directed at self or displaced on loved ones, caregivers or even GOD. Their may be a preoccupation with an idealized image of the loss of entity. 9/18/2015 7

8.  At this stage in the dying process the individual attempts to strike a bargain with GOD for a second chance or more time. if GOD will help me through this,I promise I will go to church every Sunday. during this stage,which is generally not visible or evident to others, a bargain is made with GOD in an attempt to reverse or postpone the loss. 9/18/2015 8

9.  Depression occurs when the awareness of loss become acute. during this stage full impact of the loss is experienced. this is the time of quiet desperation and engagement from all associations. 9/18/2015 9

10.  The final stage brings feelings of peace regarding the loss that has occurred. focus is on the reality of the loss and its meaning for the individuals affected it. 9/18/2015 10

11. Lindamann says grief is manifested by predictable psychological and somatic symptoms a. Acute mourning – is the feeling or expression of grief or sorrow which is characterized by somatic distress, preoccupation with loss, guilt, hostile reaction, and loss of pattern or conduct b. Disfunctional grief- is defined as distortions of some aspect of normal grief. 9/18/2015 11

12.  1. shock and numbness  2. yearning and searching  3. disorganization and despair  4. reorganization 9/18/2015 12

13. 1. To accept reality of loss 2. To experience pain of grief 3. To adjust to the new environment where the diseased person is missing 4. To reinvest energy in life, loosen ties to the deceased and forge a new type of relationship with them based on memory, spirit and love 9/18/2015 13

14.  1. Anticipatory grief  Anticipating a predicted death or loss  It is an adaptive process  It includes depression, preoccupation and anticipation of modes of adjustment 9/18/2015 14

15.  2. Acute grief  Initial intense reaction to a loss  It is a stress reaction  It is an individualized response to a real, perceived or anticipated loss 9/18/2015 15

16.  3. Dysfunctional grief  It is also known as complicated or pathological grief  Grief always does not progress as expected  Symptoms of depression and anxiety will be present  It does not subside by its own 9/18/2015 16

17.  Intense longing and yearning for the deceased  Intrusive thoughts or images of the loved one  Denial of death or sense of disbelief  Imagining that loved one is alive  Searching for the persons in the familiar places  Avoiding things that remind you of your loved ones  Extreme anger or bitterness over the loss  Feeling that life is meaningless 9/18/2015 17

18.  Absent or inhibited grief  Distorted grief  Converted grief  Chronic grief  4. chronic sorrow 9/18/2015 18

19.  You can not fix or cure grief, but you can listen to it and support grievers  There is no one right way to grieve  There is no universal timetable for grief journey  Every loss is multiple loss  Change creates loss which creates grief  We grieve for old loss while grieving for new loss  We grieve whenever a loss has occurred 9/18/2015 r19

20.  1. Problem solving  Problem identification  Gathering information  Hypothesizing the course of action  Decision making  Implementation  Follow up 9/18/2015 20

21.  2. discussion techniques  3. role playing  4. lectures  5. case conferences  6. operant conditioning  7. assertive conditioning  8. reciprocal inhibition  10. desensitization  11. relaxation 9/18/2015 21

22.  Bereaved persons relationship with deceased  Strength of attachments  Degree of ambivalence  Circumstance of death  Reaction to previous loss  Personality and coping behavior of person  Ability to express emotion  Strength and family system  Presence of support systems  General health and life style practices 9/18/2015 22

23.  Grieving related to actual loss - Assess for causative or contributing factors that may delay grief process - establish trusting relationship - Explain grief reactions - Encourage ventilation of feelings - Demonstrate empathy - Maintain safe environment - Assess for suicidal ideation 9/18/2015 23

24.  Ineffective individual coping related to depression - Assess for causative and contributing factors such as loss, negative self concept, and lack of support systems - assess present coping strategies, and determine risk of self harm - Offer support and reassurance - Maintain a sense of humor when depression subsides 9/18/2015 24

25.  Social isolation related to depression and loss - Assess for causative or contributing factors - Encourage ventilation of feelings - Promote social interaction by mobilizing patient’s support systems - Identify activities that the patient likes, to keep him busy during period of loneliness 9/18/2015 25

26.  WHEN AN INDIVIDUAL CAN LOOK BACK ON THE RELATIONSHIP WITH THE LOST ENTITY AND ACCEPT BOTH THE PLEASURE AND THE DISAPPOINTMENTS.  PRE OCCUPATION WITH THE LOST ENTITY IS REPLACED WITH ENERGY AND DESIRE TO PURSUE NEW SITUATIONS AND RELATIONSHIPS. 9/18/2015 26

27.  IT PROLONGED BY NUMBER OF FACTORS:-  RELATIONSHIP WITH THE LOST ENTITY.  REACTION TO THE LOSS MAY BE BURDENED WITH GUILT. 9/18/2015 27

28.  PROLONGED:-Intense preoccupation with memories of the lost.  DELAYED OR INHIBITED:-individual becomes in the denial stage of the grieving process.  DISTORTED:-fixed in the anger stage of grieving. 9/18/2015 28

29.  PROVIDE AN OPEN ACCEPTING ENVIORNMENT  ENCOURAGE VENTILATION OF FEELINGS  LISTEN ACTIVELY  PROVIDE DIVERSIONAL ACTIVITIES  TEACHING ABOUT COMMON SYSTEMS OF GRIEF  REINFORCE GOAL DIRECTED ACTIVITIES  BRING TOGETHER SIMILAR AGGREVIED PERSONS.  ENCOURAGE COMMUNICATION  SHARE EXPERIENCES OF THE LOSS  OFFERCOMPANIONSHIP  SOCIAL AND EMOTIONAL SUPPORT 9/18/2015 29