Identify the differences between grieving, mourning and bereavement.

Identify the familys spiritual needs related to bereavement experience. Identify possible nursing diagnosis Able to Plan for possible interventions

Sander, in her book Grief, mourning after (1989) conceptualized Bereavement as the overall experience one faces after a loss the state of loss resulting from death; the time period following a loss.

Generally believed to occur when the usual tasks of the grieving process are thwarted or blocked. Most recently identified dysfunctional type of response to loss defined as the grief that person experience when they incur a loss that is not, or cannot be openly acknowledged, publicly mourned, or socially supported. (Doka, 1989)

Sander, in her book Grief, mourning after (1989), viewed as representing the physical and psychosocial reactions an individual experiences while in the state of bereavement. Rando (1988), defined grief as the process of experiencing the psychological, social and physical reactions to *ones+ perception of loss. the strong, complex emotion that accompanies a loss.

Derived from the Greek to care is described as an emotion that results from the universal experience of loss. Sander, in her book Grief, mourning after (1989), describes the culturally prescribed behaviors carried out after a death. the process of adaptation; public rituals associated with bereavement.

Eric Lindemann in 1944 began the study of bereavement experiences in his classic study of 101 bereaved survivors of Bostons coconut Grove. Grief reaction phases by Bowlby and Parkes
Acute grief Conflicted grief/

complicated grief Prolonged/delayed grief

Dysfunctional grief is generally believed to occur when the usual tasks of the grieving process are thwarted or blocked. Some factors associated with Dysfunctional grief are:
Unhealthy relationship between the deceased

and the bereaved Poor coping skills on the part of the mourner A lack of material and social support in the bereavement experience Inadequate mental or physical health of the bereaved.

Disenfranchised grief Most recently identified dysfunctional type of response to loss defined as the grief that person experience when they incur a loss that is not, or cannot be openly acknowledged, publicly mourned, or socially supported. (Doka, 1989) Three reasons for disenfranchised grief:
The relationship is not recognized The loss is not recognized The griever is not recognized

Impaired adjustment r/t newly diagnosed terminal illness Caregiver role strain r/t hospital discharged dying pt because of inadequate insurance. Decisional conflict Ineffective coping Ineffective denial Anticipatory grieving Dysfunctional grieving Hopelessness Ineffective management of therapeutic regimen Spiritual distress

Actions/Interventions: Determine circumstances of current situation (e.g., sudden death, prolonged fatal illness, loved one kept alive by extreme medical interventions). Rationale:Grief can be anticipatory (mourning the loss of loved ones former self before actual death), or actual. Both types of grief can provoke a wide range of intense and often conflicting feelings. Grief also follows losses other than death (e.g., traumatic loss of a limb, or loss of home by a tornado, loss of known self due to brain injury). Evaluate clients perception of anticipated or actual loss and meaning to him or her: What are your concerns? What are your fears? Your greatest fear? How do you see this affecting you or your lifestyle? Identify cultural or religious beliefs that may impact sense of loss. Note emotional responses, such as withdrawal, angry behavior, crying.

Observe clients body language and check out meaning with the client. Note congruency with verbalizations Identify problems with eating, activity level, sexual desire, role performance (e.g., work, parenting). Rationale: Indicators of severity of feelings client is experiencing and need for specific Interventions to address these issues. Provide open environment and trusting relationship. Rationale: Promotes a free discussion of feelings and concerns. Use therapeutic communication skills of active-listening, silence, acknowledgment. Respect client desire/request not to talk.

Incorporate family/SO(s) in problem solving. Rationale: Encourages family to support and assist client to deal with situation while meeting needs of family members. Encourage individuals to participate in activities to deal with loss, rebuild community. Give information that feelings are okay and are to be expressed appropriately. Rationale: Expression of feelings can facilitate the grieving process, but destructive behavior can be damaging. Refer to additional resources, such as pastoral care, counseling, psychotherapy, community or organized support groups (including hospice), as indicated, for both client and family/ SO(s), Rationale: to meet ongoing needs and facilitate grief work.

According to Elizabeth Kubler-Ross, when we are dying or have suffered a catastrophic loss, we all move through five distinct stages of grief. We go into denial, because the loss is so unthinkable, we can't imagine it's true. We become angry with everyone angry with survivors, angry with ourselves. Then we bargain. We offer everything we have. We offer up our souls in exchange for just one more day. When the bargaining has failed and the anger is too hard to maintain, we fall into depression, despair, until finally we have to accept that we have done everything we can. We let go. We let go and move into acceptance. --Dr. Meredith Grey from Greys anatomy