Mental Health Nursing II
NURS 2310
Unit 5
The Bereaved Individual
Key Terms
 Loss = the experience of separation from
something of personal importance
 Grief = deep mental and emotional anguish
that is a response to the subjective
experience of loss of something significant
 Mourning = psychological process through
which the individual passes on the way to
successful adaptation to the loss of a
valued object
 Denial = refusal to acknowledge a loss;
serves to protect individual from the reality
of the loss
Key Terms (cont’d)
 Hospice = provides palliative and
supportive care to meet the special needs
of people who are dying and their families
Objective 1
Exploring the types of loss

Significant others
– Related to death, divorce, or separation

Illness or debilitating condition
– Loss of physical and/or emotional wellness
– Loss of personal independence
Developmental or maturational changes
 Decrease in self-esteem

– Related to inability to meet own expectations or
those of others (whether real or perceived)

Personal possessions
– Symbolizes familiarity and security
– Represents loss of material extension of self
Objective 2
Recalling the stages of grief as
outlined by Kubler/Ross

Stage 1: Denial
– Shock and disbelief

Stage 2: Anger
– Envy and resentment

Stage 3: Bargaining
– Not usually visible or evident to others

Stage 4: Depression
– Full impact of loss is experienced

Stage 5: Acceptance
– Feelings of peace regarding loss
5 Stages Video
Objective 3
Identifying behaviors noted in each
of the Kubler/Ross stages of grief
Denial  The reality of the loss is not
acknowledged; individual can not believe loss
has occurred
Anger  Anger may be directed toward self or
displaced on loved ones, caregivers, or God
Bargaining  Individual makes a “bargain” with
higher power in attempt to reverse or
postpone the loss
Depression  Feelings of sadness prevail;
desperation; disengagement from lost entity
Acceptance  Resignation; the focus is on the
reality of the loss
Objectives
4 and 5
Reviewing specified
types of grief
and
Identifying the behaviors
representative of anticipatory,
resolved, and maladaptive grief
Anticipatory grief = the occurrence of grief
work before an expected loss
 Facilitates process of mourning
 Decreases length and intensity of response
 Emotional disengagement from the entity
Resolved grief = completion of the process of
mourning
 Individual can look back on relationship with
lost entity and accept both pleasures and
disappointments
 Increased energy and desire to pursue new
situations and relationships
Maladaptive grief = inability to progress
satisfactorily through the stages of grieving
to achieve resolution
 Individual usually fixed in the denial or anger
stage of the grief process
 May involve pathological grief responses
– chronic or prolonged response = intense
preoccupation with memories of lost entity for
many years after loss has occurred
– delayed/inhibited response = continued denial of
loss; may manifest through anxiety disorders
– distorted response = continued anger related to
loss; behaviors exaggerated out of proportion
Objective 6
Applying the nursing process to the
client experiencing bereavement
Assessment  Abbreviated (limit to essential
data); specific to culture, age
Diagnosis  Grieving R/T actual or perceived
loss; anticipatory grieving R/T terminal illness
Planning  Clarify own feelings; watch for
overburdening/transference of feelings;
referral to outside resources
Implementation  Open discussion of feelings;
nonjudgmental listening; demonstrate respect
for need to talk or not to talk; encourage
realistic hope
Evaluation  Review of completed grief work