1. Grief and Loss Chapter 22

2. Loss is part of human experience Grief and bereavement are normal responses to loss Grieve on reoccurring basis as we face commonplace losses in our lives (loss of persons, relationships, body parts, etc) Course of life depends on how we adapt to loss and how we change to grow Loss through death is major life crisis Well known the sequelae of grief can lead to morbidity and mortality Grief and loss

3. Grief  Reaction to loss  Include depression, anxiety, loss of interest, sadness Bereavement  Social experience of dealing with death of loved one Mourning  Refers to culturally patterned expressions of bereavement and grief  Sensitivity to ethnic, cultural spiritual and religious beliefs of diverse cultural population can help nurses identify needs Disenfranchised Grief Grief engendered by public tragedy Grief and loss

4. Grieving is psychological process that involves disengaging strong emotional ties from significant relationship and reinvesting the energy once given to deceased in a new and productive direction over time Studies of grief and loss by Kubler-Ross, Parkes, Caplan, and Engel and postulate various phases of bereavement in sequences and timeframes  Shock and Disbelief: denial is 1 st response  Development of Awareness: anger, guilt & crying  Restitution: formal ritualistic phase of mourning during acute phase Loss oriented & restoration oriented Theory

5. Assessment  Most come to terms of loss with family/friends  30% require professional help  Unresolved grief result in physical complaints  Assessment guidelines review Diagnosis  Grieving; normal process  Complicated grieving & risk for complicated grieving; Persons that have difficulty coming to terms with the loss Outcomes Identification Planning Application of nursing process

6. Implementation  Nurses focus is helping the bereaved deal with important issues emerging at that time  Communication: active listening  Psychotherapy Short term therapies  Educational Component  Encouragement of expression emotions and affect  Help bereaved come to peace  Evaluation: acceptance, work through pain of grief, adjust to environment, restructure family relationship Application of nursing process