06.06 Grief and Loss

Overview

  1. Grief & Loss
    1. Perception
    2. Theories
    3. Grief continuum
    4. Human response
    5. Nurse’s role

Nursing Points

General

  1. Perception
    1. Grief
      1. Emotional response to loss
    2. Loss
      1. Deprivation of an object or person
    3. Grief and loss are perceived to be about people or death
      1. Situational loss
      2. Perceived loss
      3. Loss of limb
  2. Theories
    1. Multiple theories on grief and death exist
      1. Kubler-Ross
      2. Bowlby
      3. Worden
    2. Falls on grief continuum
      1. Changes over time
      2. Can go back and forth
    3. Grief may change between theories
    4. Duration of stages may vary
  3. Human response
    1. Age
      1. Acceptance of grief and loss becomes more accepting with age
    2. Coping
      1. People use different coping tools to deal with grief
    3. Socioeconomic status
      1. Lack of resources may increase grief
    4. Culture & ethnicity
      1. Different cultures express grief differently
    5. Spirituality
      1. Belief systems impact how patients deal with grief
        1. Some beliefs allow for easier acceptance of loss
  4. Nurse’s role
    1. Offer support
    2. Use therapeutic communication
    3. Promote resources
      1. Ex: Palliative care for anticipatory grief
    4. Manage symptoms
    5. Maintain comfort
    6. Give a damn

Nursing Concepts

  1. Communication
  2. Coping
  3. Grief
  4. Interpersonal relationships

Patient Education

  1. Educate patient or family on resources available for grief counseling.
  2. Provide information and educate patients or families on misinformation regarding death, grief and loss.

Reference Links

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Video Transcript

In this lesson, we’re going to hit the high points of grief and loss.

Ok guys, for this lesson, we’re really just going to hit on the high points about grief. There’s another lesson on grief and loss in the Mental Health course and I encourage you to go check it out. Today, we’re really just hitting some overall concepts.

Remember that grief is an emotional response to loss, with loss being deprived of something or someone. There’s this idea that grief and loss only exist with death, which is just not true. Loss can be removing someone from their life, so like a breakup, or if someone moves, or if someone is incarcerated, which is situational. Also, grief and loss can be perceived or anticipated. For your patients that you withdraw care on, the family may anticipate that loss, so they already start processing grief. Another situation is an amputee, when they lose their limb.

The important takeaway is that grief doesn’t solely focus on death.

I’m sure you’re looking at this going what the heck, right? Well, hang tight and I’ll explain.

Grief follows a continuum, and there are lots of theories like Kubler-Ross and Bowlby and Worden and they all are about how people process grief. For nurses, what you need to realize is that in spite of all of these theories, there is one main idea, and it’s that people most commonly follow a continuum. They’ll go from one stage to another, and sometimes will fluctuate between theories as well.

For instance, several years ago, I lost a childhood friend, who was relatively young. It was this impossible thing to think about. And looking back on it, I realize that I didn’t follow Kubler-Ross or Bowlby; I circumnavigated this whole thing, jumping from theory to theory. And I never stayed in one stage long, with the exception of maybe Worden’s emotionally relocating. It was difficult for me to figure out how to take his legacy and move forward. Eventually I did, and I learned to appreciate what he did for me.

What you need to understand as the nurse is that regardless of the theory, people can go through stages at various speeds and jump between this principles.

As the nurse, you need to understand that there are several influences on how patients respond to, adapt and overcome grief.

Age is a big one. Most people, as they age, handle grief differently. Older patients tend to understand and accept death better than younger patients, so they may process it faster.

Some people have better coping mechanisms than others.

Socioeconomics play a huge factor in grief processing. If they lose someone or something, and they have all of these other financial or socioeconomic burdens, they may take longer to grieve their loss or losses.

Also, culture and ethnicity play a difference in how people process loss and grief. Some cultures celebrate life instead of grieving or they have their own way of processing loss that doesn’t fit the theories surrounding grief.

Spirituality is a huge player of grief and acceptance. Religious or spiritual beliefs influence grief heavily, with concepts of faith and hope being key players in providing comfort for those patients and families.

So how can we help our patients when they grieve?

First off, give support and find out what the family or the patient needs in that particular time. Sometimes, it’s a soda or maybe a snack or tissues. Just ask them how you can help. Be sure to use your therapeutic communication that you learned about in your other lesson. Also, promote and provide resources to your patient. Do they need chaplain or a grief counselor or some other healthcare provider? Ask them.

If it’s your patient who’s experiencing grief, be sure to also manage their symptoms. Don’t forget to still be their nurse and manage their illness, injury or disease. And be sure to maintain comfort for them. So blankets, pain medications if necessary. Stuff like that.

Most importantly – and I want to drive this home. Give a damn about your patient and family. There’s absolutely nothing worse than a nurse who is apathetic to a patient or family member when they grieve. Ask them how you can help. Sometimes they just want to hold your hand, or they want a hug or they want to be left alone. But ask them, and find out how you can help them.

Today, we’ve really focused on coping and grief for your patients and their family and also how you communicate with them.

Let’s recap:

Remember that grief varies and looks different for lots of people. It’s also influenced by lots of factors like age, culture and spirituality.

Grief is the emotional response to loss, and it doesn’t have to be about death.

People can change between stages and theories. People don’t always follow the same path or stages that others do, and they can bounce back between them.

Don’t be apathetic. Give a damn, and focus on supporting your patient in whatever stage of grief they are in.

And lastly, sometimes grief can be unhealthy, and some patients will need some additional help and resources. Be sure to check out the mental health lesson on grief for more information on unhealthy grieving.

That’s it for this lesson. Make sure you check out all the resources attached to this lesson. Now, go out and be your best selves today. And, as always, happy nursing!!

Read more

  • Question 1 of 7

A 58-year-old client is feeling sadness and loss after his mother died. Which best describes the difference between grief and depression?

  • Question 2 of 7

A nurse is caring for a woman whose mother died six months ago and who is grieving over the loss. The nurse assesses the woman for any signs of complicated grief patterns. Based on the nurse’s understanding of this condition, the nurse knows to look for what signs that indicate complicated grief? Select all that apply.

  • Question 3 of 7

A client is suffering from feelings of loss after experiencing a miscarriage. Which action of the nurse would best support this client in working through her grief?

  • Question 4 of 7

A nurse is caring for a client who lost her father to cancer last year. The client is demonstrating dysfunctional grief in that she has intense feelings of guilt over the situation. Which of the following factors would increase a person’s risk of developing dysfunctional grief?

  • Question 5 of 7

A 35-year-old client is undergoing a lower limb amputation after a crushing injury. Which best describes how the nurse can support the client’s anticipated grief during this time?

  • Question 6 of 7

The parents of a 2-year-old child who died of leukemia are experiencing intense grief in the months following the death. Which of the following is a factor that would affect how these parents experience grief?

  • Question 7 of 7

A hospice nurse is helping a family whose loved one died thirty minutes ago. What kind of grief is the family experiencing?

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