Loss and Grief
Loss is a part of the life cycle. All people experience loss in the form of change, growth, and transition. The experience of loss is painful, frightening, and lonely, and it triggers an array of emotional re-sponses (Chart 7-13). People may vacillate between denial, shock, disbelief, anger, inertia, intense yearning, loneliness, sadness, loss of control, depression, and spiritual despair (Brewster, 1999).
In addition to normal losses associated with life cycle stages there are the potential losses of health, a body part, self-image, self-esteem, and even one’s life. When loss is not acknowledged or there are multiple losses, anxiety, depression, and health prob-lems may occur. Likewise, people with physical health problems, such as diabetes mellitus, acquired immunodeficiency syndrome
(AIDS), cardiac conditions, gastrointestinal disorders, disabili-ties, and neurologic impairments, tend to respond to these ill-nesses with feelings of grief.
People grieve in different ways, and there is no time line for completing the grief process. The time of grieving often depends on the significance of the loss, the length of time the person was known and loved, the anticipation of or preparation for the loss, the person’s emotional stability and maturity, and the person’s coping ability (Arnold & Boggs, 1999).
Regardless of the duration of the grieving process, there are two basic goals: (1) healing the self, and (2) recovering from the loss. Other factors that influence grieving are the type of loss, life expe-riences with various changes and transitions, religious beliefs, cul-tural background, and personality type (Kemp, 2000). Some patients may resort to abuse of prescription medications, illegal drugs, or alcohol if they find it difficult to cope with the loss; the grief process is then complicated by the use of addictive substances.
Nurses identify patients and family members who are grieving and work with them to accomplish the four major tasks of the grief process: (1) acceptance of the loss, (2) acknowledgment of the intensity of the pain, (3) adaptation to life after the loss, and 4) cultivation of new relationships and activities (Worden, 1982). Chart 7-14 outlines nursing care activities useful for those who are bereaved.
Another responsibility of the nurse is to assess and differenti-ate between grief and depression by knowing the common thoughts, feelings, physical or bodily reactions, and behaviors as-sociated with grief compared with depression (see Chart 7-14). The physical response to grief includes the sensation of somatic distress, a tightness in the throat followed by a choking sensation or shortness of breath, the need to sigh, an empty feeling inside the abdomen, lack of muscle power, and intense disabling dis-tress. Grief can further debilitate an already compromised patient and can have a strong impact on family functioning.
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