MAR BASELIOS COLLEGE OF NURSING

BHOPAL

SUBJECT: ADVANCED NURSING PRACTICE

TOPIC PRESENTATION ON

COPING WITH LOSS, DEATH AND

GRIEVING

SUBMITTED TO,

SUBMITTED BY,

Mrs. Reena Anil

Ms. Robsy Abraham

Asst. Professor

M.Sc. Nursing, I Year

Date: 16/12/2015

COPING WITH LOSS, DEATH AND GRIEVING

INTRODUCTION
Death is inevitable, yet the loss of a close friend or family member always showers us with a range of
emotions. One day we might desperately try to avoid the pain, anxiety and feelings of helplessness we
feel when a loved one dies. Other days, we feel like life has returned to normalat least until we realize
that our life has changed irrevocably.
Despite the gamut of emotions we feel, grieving for a loved one helps us cope and heal. The intense,
heart-breaking anguish indicates that a deep connection has been severed. Without a doubt, grieving is
painful. But it is also necessary.
Going forward doesnt mean forgetting about the loved one who died. Enjoying life again doesnt imply
that the person is no longer missed. It simply means that your grief has run its course.

DEFINITIONS
Loss: A person experiences loss in the absence of an object, persons body part or function, or
emotion that was formerly present.
Death: Death occurs when an individual has sustained either irreversible cessation of circulatory
and respiratory functions or irreversible cessation of all functions of the entire brain, including
the brain stem.
Grief: Grief is a reaction of an individual to a significant loss.
Coping: The term coping is used to refer to the process by which a person attempts to manage
stressful demands.

CLASSIFICATION OF LOSS
Actual loss: It is easily identified and can be recognized by others as well as person sustaining
the loss, loss of a limb, of a spouse, of an object and of a job.
Perceived loss: it is felt by the person but is intangible or less intangible to others. For e.g.

Maturational loss: loss resulting from normal life transitions (loss of youth, of financial
independence).
Situational loss: loss occurring suddenly in reference to a specific external event (sudden
death of loved one).

Anticipatory loss: in this a person displays loss and grief behavior for a loss that has yet to take
place, e.g. sickness or death.

COMMON SYMPTOMS OF GRIEF

While loss affects people in different ways, many experience the following symptoms when theyre
grieving. It must be remembered that almost anything that you experience in the early stages of grief is
normalincluding feeling like were going crazy, feeling like were in a bad dream, or questioning our
religious beliefs.
Shock and disbelief Right after a loss, it can be hard to accept what happened. We may feel numb, have
trouble believing that the loss really happened, or even deny the truth. If someone we love has died, we
may keep expecting him or her to show up, even though we know he or she is gone.
Sadness Profound sadness is probably the most universally experienced symptom of grief. We may
have feelings of emptiness, despair, yearning, or deep loneliness. We may also cry a lot or feel
emotionally unstable.
Guilt we may regret or feel guilty about things we did or didnt say or do. we may also feel guilty about
certain feelings (e.g. feeling relieved when the person died after a long, difficult illness). After a death, we
may even feel guilty for not doing something to prevent the death, even if there was nothing more we
could have done.
Anger Even if the loss was nobodys fault, we may feel angry and resentful. If we lost a loved one, we
may be angry with ourselves, God, the doctors, or even the person who died for abandoning us. we may
feel the need to blame someone for the injustice that was done to us.
Fear A significant loss can trigger a host of worries and fears. We may feel anxious, helpless, or
insecure. We may even have panic attacks. The death of a loved one can trigger fears about our own
mortality, of facing life without that person, or the responsibilities we now face alone.
Physical symptoms We often think of grief as a strictly emotional process, but grief often involves
physical problems, including fatigue, nausea, lowered immunity, weight loss or weight gain, aches and
pains, and insomnia.

PHYSIOLOGICAL AND PSYCHOLOGICAL RESPONSE TO GRIEF

Physiological
Psychological
Crying
Intense loneliness and sadness
Sighing respirations
Anxiety or panic episodes
Shortness of breath, palpitations
Difficulty focusing and concentrating
Fatigue, weakness, exhaustion
Disorientation
Insomnia
Anger
Loss of appetite
Low self-esteem
Choking sensation
Tightness in chest

Gastrointestinal disturbances

STAGES OF GRIEF
In 1969, psychiatrist Elisabeth Kubler-Ross introduced what became known as the five stages of grief,
which represent feelings of those who have faced death and tragedy. These stages of grief were based on
her studies of the feelings of patients facing terminal illness, but many people have generalized them to
other types of negative life changes and losses, such as the death of a loved one or a break-up.
1. Denial: This is a stage of shock and disbelief. The response may be This cant be happening to
me. Denial is a protective mechanism that allows the individual to cope within an immediate
time-frame while organizing more effective defense strategies.
2. Anger: Why is this happening? Who is to blame? are comments often expressed during the
anger stage. Anger may be directed at self or displaced on loved ones, caregivers and even God.
There may be a preoccupation with an idealized image of the lost entity.
3. Bargaining: Make this not happen, and in return I will ____.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.
4. Depression: Im too sad to do anything. During this stage, the full impact of the loss is
experienced. This is a time of quiet desperation and disengagement from all associations with the
lost entity.
5. Acceptance: Im at peace with what has happened. The final stage brings a feeling of peace
regarding the loss that has occurred. Focus is on the reality of the loss and its meaning for the
individuals affected by it.

GRIEF PROCESS
The grieving process describes a series of occurrences in the resolution of loss. This process
provides support as an individual works through the feelings of anger, hopelessness and futility
that accompany loss. It provides time to put things into perspective, to place into memory that
which is gone, and to embrace life. Growth occurs as the bereaved person comes to the point of
letting off the past. This does not reduce the importance of the loss but allows the person to
continue living with a new perspective. This acceptance indicates that the grief process is coming
to a close.

COPING WITH LOSS, DEATH AND GRIEF

Coping with death is vital to your mental health. It is only natural to experience grief when a loved one
dies. The best thing you can do is allow yourself to grieve. There are many ways to cope effectively with
your pain.
Seek out caring people. Find relatives and friends who can understand your feelings of loss. Join support
groups with others who are experiencing similar losses.
Express your feelings. Tell others how you are feeling; it will help you to work through the grieving
process.

Take care of your health. Maintain regular contact with your family physician and be sure to eat well
and get plenty of rest. Be aware of the danger of developing a dependence on medication or alcohol to
deal with your grief.
Accept that life is for the living. It takes effort to begin to live again in the present and not dwell on the
past.
Postpone major life changes. Try to hold off on making any major changes, such as moving, remarrying,
changing jobs or having another child. You should give yourself time to adjust to your loss.
Be patient. It can take months or even years to absorb a major loss and accept your changed life.
Draw comfort from your faith: If you follow a religious tradition, embrace the comfort its mourning
rituals can provide. Spiritual activities that are meaningful to yousuch as praying, meditating, or going
to churchcan offer solace. If youre questioning your faith in the wake of the loss, talk to a clergy
member or others in your religious community.
Seek outside help when necessary. If your grief seems like it is too much to bear, seek professional
assistance to help work through your grief. It's a sign of strength, not weakness, to seek help.

HELPING OTHERS GRIEVE

If someone we care about has lost a loved one, we can help them through the grieving process.
Share the sorrow. Allow them even encourage them to talk about their feelings of loss and share
memories of the deceased.
Don't offer false comfort. It doesn't help the grieving person when you say "it was for the best" or "you'll
get over it in time." Instead, offer a simple expression of sorrow and take time to listen.
Offer practical help. Baby-sitting, cooking and running errands are all ways to help someone who is in
the midst of grieving.
Be patient. Remember that it can take a long time to recover from a major loss. Make yourself available
to talk.
Encourage professional help when necessary. Don't hesitate to recommend professional help when you
feel someone is experiencing too much pain to cope alone.

COMMON ADAPTIVE COPING TECHNIQUES

Problem-solving
Assertiveness
Positive self talk and self acceptance
Stress and anger management
Learning skills needed for communication and relationships
Conflict resolution
Time management
Community living skills

CONCLUSION
Life is a series of losses and gains. Everyone experiences losses at various points in the life
continuum. Birth, loss and death are universal and individually unique events of the human
experience. At any stage of ones life, there is the potential for loss, grief and death. All losses
have the possibility of triggering the grief process. Understanding loss, the grief process and the
task of dying can assist the nurse in delivering quality care to those patients and families
experiencing death. Nurses need to understand loss and grief because death is a frequent reality
in many nursing care settings. Most nurses interact daily with clients and families experiencing
loss and grief.

BIBLIOGRAPHY

BOOKS

Carol Taylor et.al, fundamentals of nursing: the art and science of nursing care, 3 rd
Edition, Lippincott-Raven Publishers (1997); 781-800.
Mary Kowalski, Textbook of Basic Nursing, 8th Edition, Lippincott William & Wilkins
(2003); 792-799.
Mary Sulakshini Immanuel, Nursing Foundations: Principles & Practices, Universities
press (India) Private Limited (2014); 350-354.
Potter & Perry, Basic Nursing- Essentials for Practice, 6 th edition, Mosby Elsevier
Publishers (2007); 610-629.

JOURNALS

Christopher Hall, Bereavement theory: recent developments in our understanding of

grief and bereavement, 33(1), February, 2014: 25-27.
K. Kellie Goldsworthy, Grief and loss theory in social work practice: All changes
involve loss, just as all losses require change, 58(2), November, 2005:36-40.
Robert A. Niemeyer, et al., A Social Constructionist Account of Grief: Loss and the
Narration of Meaning 38(8), September, 2014: 44-48.
Theresa A. Gordon , Good Grief: Exploring the Dimensionality of Grief Experiences
and Social Work Support, 9(1), January,2013: 52-56.

INTERNET

www.helpguide.org/articles/grief-loss/coping-with-grief-and-loss.htm
www.webmd.com/mental-health/mental-health-coping-with-grief
cmhc.utexas.edu/griefloss.html
www.mentalhealthamerica.net/.../coping-loss-bereavement-and-grief
www.cancer.org/coping-with-the-loss-of-a-loved-one-pdf