The Experience of Loss,

Death and Grief

 Loss

Types of Loss
Loss of possessions or objects
Loss of known environment
Loss of significant other
Loss of an aspect of self
Loss of life
Necessary losses – change always involved which are a
part of life.
Maturational losses – associated with normal life transitions
help people develop coping skills to use when experiencing
unplanned, unwanted or unexpected loss.
Situational loss – unpredictable external events bring about.
Actual loss – occurs when a person can no longer feel, hear
or know a person or object.
Perceived losses – defined by the person experiencing the
loss and are less obvious to other people.
 Grief
Is the emotional response to a loss.

 Normal Grief – when people are grieving it means that they are
in the process of coping with death of loved one.
 Complicated Grief – has a prolonged or significantly difficult
time moving forward after a loss.
 Anticipatory Grief – the unconscious process of disengaging or
“letting go” before the predicted loss.
 Disenfranchised Grief – also known as marginal or unsupported
grief, when their relationship to the deceased person is not
socially sanctioned.
 Theory of Loss, Grief and Mourning
FIVE STAGES OF DYING ATTACHMENT THEORY TASK OF MOURNING THE PROCESS MODEL
(Kubler- Ross) (Bowlby)

Denial Numbing Accepting the reality of Recognize and accept

loss the reality of the loss

Anger Yearning and Working through the React to, experience,

searching pain of grief and express the pain of
separation

Bargaining Disorganization and Adjusting to the Reminisce

despair environment without
the deceased

Depression Relinquish old

attachments

Acceptance Reorganization Emotionally relocating Readjust and reinvest

the deceased and
moving on with life
 Grief Tasks Model

Task 1 : Accept the reality of the loss.

Task 2 : Work through the pain of grief .
Task 3 : Adjust to the environment in which the deceased is
missing.
Task 4 : Emotionally relocate the deceased and move on with
life.
Nursing Knowledge Base
Nurses develop plans of care to help clients and family members
undergoing, loss, grief, or death experiences.
Factors Influencing Loss and Grief
Multiple variables influence the way a person perceives and responds to
loss.
Human Development
Client age, and stage of development affect the grief response.
Personal Relationship
When loss involves another person, the quality and meaning of the lost
relationship influences the grief response.
Nature of the Loss
Exploring and understand the impact of the loss on the client’s behavior.
Coping Strategies
Life experiences shape the coping strategies a person uses to
deal with the stress of loss.

Socioeconomics Status
influence a person’s ability to access support and resources
for coping with loss and physical responses to stress.

Culture and Ethnicity

A person’s culture and other social structures influence the
interpretations of loss, establish acceptable expressions of grief
and provide stability and structure in the midst of chaos and loss.
Spiritual and Religious Beliefs
Associated with healing, spiritual or religious communities
and beliefs, it include in a higher power communities of support,
a sense of hope and meaning in life.
Hope
Gives a person the ability to see life as enduring or as having
meaning or purpose.
Nursing Diagnosis
Some nursing diagnoses relevant for clients
experiencing grief, loss, or death include the
following :
 Death Anxiety
 Hopelessness
 Caregiver role strain
 Risk for loneliness
 Compromised family coping
 Spiritual distress
 Readiness for enhanced comfort
 Readiness for enhanced spiritual well-being
 Disturbed personal identity
 Ineffective denial
 Fear
 Grieving
 Complicated grieving
 Risk for complicated grieving
 ASSESSMENT
• Assess meaning of loss for this
client
• Observe behaviors and other
symptoms indicative of grief
response
• Note quality and extend of
client’s family support

• Demonstrate the • Take risks if

• Family ethical principles of necessary to
dynamics in health care
develop a close
• Apply intellectual
offering social standards of relationship with
support significance; know the client to
• Concepts of what is important to
understand loss.
the client
caring
 PLANNING
Goals and Outcomes
Consider the client’s own resources, such as physical energy
and activity tolerance.
Setting Priorities Priorities
Encourage clients and family members to share their priorities
for care at the end of life.
Collaborative Care
Team members communicate with each other on a regular
basis to ensure coordination and effectiveness of care.
 Health
promotion
(Palliative
Care)
Care After Use
Death Therapeutic
(postmortem Communicat
care) ion

IMPLEMEN
TATION
Promotion
Hospice Dignity and
Care Self –
Esteem
Maintain a
Comfortable
and Peaceful
Environment
 EVALUATION
• Evaluate signs and symptoms of the client’s grief
• Evaluate family member’s ability to provide supportive care
• Evaluate terminal client’s level of comfort and symptom relief
• Ask if the client’s/family’s expectations are being met

Effective evaluation strategies enable the nurse to determine if

outcomes were met to support the goals of care.

The success of the evaluation process depends partially on the

bond you have formed with the client.

The client responses will determine if the existing plan of care is

effective.