Competency 6: Loss, Grief, & Death
Developed by:
Dede Carr, BS, LDA
Karen Neu, MSN, CNE, CNP
1
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2
Competency 6: Death & Dying
 Define the stages & processes of death & dying &
influences those stages have on clients & families
 List the emotional stages of grief that occur in death &
dying
 List the needs of the dying client & their family
 List the different types of death & how they may affect
the client & the family’s ability to move through the
stages of death
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Lifetime Losses & Grieving
Everyone experiences loss, grieving, & death at some time during
his/her life.
People may suffer loss of:
 Valued relationships through moving from one city or state to
another, separation, divorce, or the death of a family member
(parent, grandparent, sibling, spouse) or friend
 Changing life roles as they watch grown children leave home or
retire from lifelong work,
 Employment or ability to drive a vehicle safely
 Valued material objects through theft, natural disasters
 Pets
(Berman et al., p. 1081)
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Loss in Health Care Settings
 Healthcare workers interact with dying clients & their
families or caregivers in a variety of settings from a
death of an unborn child, to the adolescent victim of
an automobile collision, to the elderly client who dies
from a chronic illness
 There are many influences on the dying process: legal,
ethical, religious, spiritual, biological, personal
 It is important that the healthcare worker provides
sensitive, skilled, & supportive care to all those
affected
(Berman et al., p. 1081)
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Loss in Health Care Settings
 Healthcare workers encounter clients who may be
experiencing grief to declining health, loss of a body part,
terminal illness, or impending death of self or significant
other, loss of function, loss of independence,
 In home healthcare or community, healthcare worker
may work with clients grieving losses related to personal
crisis (divorce, separation) or disaster (tornadoes, floods,
fire)
 It is important to understand the significance of loss &
develop an ability to assist clients as they work through
the grieving process (Berman et al., p. 1081)
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Loss
Loss: The actual or potential situation in which something
that is valued is changed & no longer available
 People can experience the loss of body image, a
significant other, a sense of well-being, a job, personal
possessions, or beliefs
 Illness & hospitalization often produce losses
(Berman et al., p. 1081)
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Death
Death is a fundamental loss for the dying person & for
those who survive
 Death can be viewed as the dying person’s final
opportunity to experience life in ways that bring
significance & fulfillment
 People experiencing loss search for the meaning of the
event, & it is generally accepted that finding the
meaning is needed in order for healing to occur
 However, persons can be well adjusted without
searching for meaning, & even those who find meaning
may not see it as an end point but rather an ongoing
process (Berman et al., p. 1081)
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Types of Losses
1. Actual Loss: Loss that can be recognized by others
2. Perceived Loss: Loss experience by one person but
cannot be verified by another
 Example: A woman who leaves her employment to care for
her children at home may perceive a loss of independence
& freedom
Both actual & perceived losses can be anticipatory loss
Anticipatory Loss: Loss that is experienced before the loss
actually occurs
 Example: A woman whose husband is dying may
experience the actual loss in anticipation of his death (Berman
et al., p. 1082)
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Types of Losses
Loss can be viewed as situational or developmental
Developmental Losses: Losses that occur during the
process of normal development, such as grown children
leaving home, retirement from a career, death of aged
parents (these generally can be anticipated & prepared
for)
 Many sources of loss: Loss of an aspect of self: a body part,
a physiologic function (no longer able to bear a child) or a
psychological attribute; loss of an object external to
oneself; separation from an accustomed environment;
loss of a loved or valued person
(Berman et
al., p. 1081)
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Loss & Death
 Situational Losses: loss of one’s job, death of a child, or
loss of functional ability because of acute illness or injury
Types of Death
 Unexpected death that leaves families feeling shocked &
bereaved; Examples might be death due to a heart attack
 Traumatic death which can lead to complicated grief:
Examples: suicide or homicide
 Anticipated death from a chronic or prolonged illness;
families may be physically & emotionally exhausted from
caring for the family member prior to death (Berman et al.)
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Grief, Bereavement, Mourning
Grief: “The total response to the emotional experience to
loss” “Grief is manifested in thoughts, feelings, &
behaviors associated with overwhelming distress or
sorrow”
(Berman et al., p. 1082)
Bereavement: “The subjective response experienced by the
surviving loved ones after the death of a person with
whom they have shared a significant relationship”
(Berman et al., 1082)
Bereavement: “A common depressed reaction to the death
of a loved one”
(Kochrow & Christensen, p. 190)
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Grief, Bereavement, Mourning
Mourning: “The behavioral process through which grief
is eventually resolved or altered; it is often influenced
by culture, spiritual beliefs, & custom” (Berman et al., p. 1082)
Mourning: “(reaction activated by a person to assist in
overcoming a personal loss) refers to culturally defined
patterns for expressions of grief; mourning patterns
include funerals, wakes, memorials, black dress, &
defined time of social withdrawal”
(Kochrow & Christensen, p. 190)
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Grief, Bereavement, Mourning
 Grief & mourning are experienced by the person who
faces the death of a loved one AND by the person who
suffers other kinds of losses (includes healthcare workers)
 Grieving is important for one’s physical & mental health
 Grieving permits individuals to cope with the loss
gradually & accept it as part of reality
 Grief is a social process & is best shared & carried out with
the assistance of others (Berman et al., p. 1082)
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Grief, Bereavement, Mourning
 Healthcare workers who work with the terminally ill &
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bereaved often develop a heightened empathy & identification
with their patients
This occurs because the loss experience is so universal that
everyone has experienced its impact
Previous losses can prepare people for the ultimate loss of
death
Grief is a normal & universal response to loss
There are many examples of increased illness or an abnormal
condition (both physical & mental) after significant losses in
the survivors, especially caregivers
Research indicates that there are increases in breakups in
marriages & other significant relationships after the loss of a
child or when one partner suffers a loss of a body part or
function
(Kochrow & Christensen, p. 190)
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Grief, Bereavement, Mourning
 Grief involves thought, feelings, & behaviors & has a
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useful function when allowed to operate normally
The goal of the grieving process is to resolve the hurt & to
reestablish one’s life
Grief comes & goes with a person’s life experiences &
many years later an event reminds the person of the loss &
the feelings return
Such events might include encounters with smells, places,
foods, dates, holidays, clothing, music, & other people
Grief is not an episode; it is a process, sometimes one that
goes on forever (e.g. parents grieving for a child)
(Kochrow & Christensen, p. 190)
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Grief, Bereavement, Mourning
Grieving persons try a variety of strategies to cope
Tasks of grief that facilitate healthy adjustment to loss
 Accepting the reality of the loss
 Experiencing the pain of grief
 Adjusting to an environment that no longer includes the lost
person, lost object, or the lost aspect of self
 Reinvesting emotional energy into new relationships
The successful completion of these tasks leads to the passage
from grief to closure
These tasks do not necessarily occur in a specific order or
sequence; people may work all tasks of grief at the same time
or only one or two may be priorities
Healthcare workers can assist patients & their families in
working through these tasks
(Kochrow & Christensen, p. 190)
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Grief, Bereavement, Mourning
Working through one’s grief is important because
bereavement may have devastating effects on health
Symptoms that may accompany grief are:
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Anxiety,
Depression
Swallowing difficulties
Vomiting
Fatigue
Headaches
Dizziness
Fainting
Blurred vision
Skin rashes
Shortness of breath
* Excessive sweating
* Menstrual disturbances
* Palpitations
* Chest pain
* Changes in libido
* Alterations in communication
* Difficulty in concentration
* Disturbances in eating patterns
* Alterations in sleeping patterns
* Changes in activity
(Berman et al., p. 1082)
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Types of Grief
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Grief, Bereavement, Mourning
 It’s important to differentiate the expression of grief as
a normal healthy response to loss (needs support &
public acknowledgement) from grief as a response of
greater distress & personal disruption (requires
intensive intervention/assistance)
There are different types of grief
1. Normal grief
2. Complicated grief
3. Anticipatory grief
4. Disenfranchised grief
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Grief, Bereavement, Mourning
Although bereavement can threaten health, a positive
resolution of the grieving process can enrich the
individual with new insights, values, challenges,
openness, & sensitivity
(Berman et al., p. 1082)
 There is no right or wrong way to grieve; theories of grief
are only tools that can be used to anticipate the
emotional needs of patients/families & plan ways to help
them understand their grief & deal with it
 Healthcare workers’ roles are to observe & assess grieving
behaviors, recognize the influence of grief on behaviors,
& provide empathetic support
(Kochrow & Christensen, pp. 190-191)
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Normal Grief
Normal grief (uncomplicated grief )-most common type of grief ) is
when grieving people are in the process of coping with the death of a
loved one (Potter & Perry, p. 463)
 Coping styles, such as hardiness & resilience & a personal sense of
control, the ability to make sense of the loss, & to find benefit in the
loss are factors found to be helpful (Holland & others, as cited in (Potter & Perry, p.
463)
Normal grief is a complex response with emotional, cognitive, social,
physical, behavioral, & spiritual concepts
 Feelings of acceptance, disbelief, yearning, anger, & depression were
displayed as normal bereavement (Maciejewski & others, 2007 as cited in Potter &
Perry, p. 463)
 Yearning (longing & searching for the deceased person) was the
most common negative feeling, peaking at 2 months after the loss;
 Acceptance was the strongest initial response & grew increasingly
over time
 Negative emotions (anger & depression) peaked around 4 months
& were in decline by 6 months (Potter & Perry, p. 463)
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Complicated Grief
For a minority of people, normal grief adjustment does not occur
In complicated (dysfunctional) grief, the grieving person has a
prolonged or significantly difficult time moving forward from the
loss
 Those with a complicated grief after the loss of a loved one
experience a chronic & disruptive yearning for the deceased & are
likely to have trouble accepting the death & trusting others, feel
excessively bitter, or are uneasy about the future; they may feel
emotionally numb
 This type of grief usually occurs in situations of conflicted
relationships with the deceased, prior or multiple losses or stressors,
mental health issues, or lack of social support
 Loss associated with homicide, suicide, sudden accidents, or loss of a
child may become complicated
 Symptoms & disturbances of complicated grief last at least 6 months
after a loss & interrupt every dimension of the person’s life
(Potter & Perry, p. 463)
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Anticipatory Grief
Anticipatory grief: The unconscious process of disengaging or
“letting go” before the actual loss or death occurs, especially in
long or predicted loss (Corless, as cited in Potter & Perry, p. 463)
 When grief extends of a long period of time, people absorb the
loss gradually & begin to prepare for the inevitability; they
experience more intense responses to grief (shock, denial,
tearfulness) before the actual death occurs & often relief when
it happens
 Anticipatory grief may be a forewarning to give families time
to prepare for death & to complete related tasks to the
impending death (may not apply in every situation though)
 For some others, the stress & strain of a terminal illness
(ruptures in spousal intimacy, separation anxiety, security
threats, & traumatic helplessness of watching a loved one die)
may outweigh the benefits of anticipatory grieving (Potter &
Perry, p. 463)
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Disenfranchised Grief
 People experience disenfranchised grief (known as
marginal or unsupported grief) when their relationship to
the deceased person is not socially sanctioned, cannot be
openly acknowledged or publicly shared, or seems of
lesser significance (Hooyman & Kramer, as cited in Potter & Perry, p. 463)
 Examples include death of a very old person, an exspouse, a gay partner, or even a loved pet (Potter & Perry, p. 463)
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Stages of Grieving/Dying
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Stages of Grieving/Dying
Kübler-Ross (1969) describes five stages of dying
Although these stages are listed in order, grieving
people do not experience them in any particular order
for any length of time & often move back & forth
between stages
Five Stages of Dying
 Denial Stage
 Anger Stage
 Bargaining Stage
 Depression Stage
 Acceptance Stage
(Potter & Perry, p. 464)
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Stages of Grieving/Dying
Denial & Isolation Stage: a person acts as though nothing has
happened & refuses to accept the fact of the loss; person shows
no understanding of what has occurred
(Potter & Perry, p. 464)
This stage serves as a buffer to the patient to shield self until the
individual is able to mobilize alternate defenses
Reaction: “No-not me.”
“There must be a mistake.”
(Kockrow & Christensen, p. 193)
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Stages of Grieving/Dying
Anger Stage of adjustment to loss, a person expresses
resistance & sometimes intense anger at God, other
people, or the situation (Potter & Perry, p. 464)
Hostility may be directed toward caregivers or loved
ones
Reactions: “Why me?”
(Kockrow & Christensen, p. 193)
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Stages of Grieving/Dying
Bargaining Stage cushions & postpones awareness of the
loss by trying to prevent it from happening
Bargaining Stage : Grieving or dying people make promises
to self, God, or loved ones that they will live or believe
differently if they are spared the dreaded outcome
(Potter & Perry, p. 193)
Bargaining is often made with God. It is an attempt to post
pone death & is a positive way to maintain hope
Reactions: “Yes, but…….”
(Kockrow & Christensen, p. 193)
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Stages of Grieving/Dying
Depression Stage occurs when a person realizes the full
impact of the loss
Depression Stage: Some feel an overwhelming sense of
sadness, hopelessness, & loneliness; resigned to the bad
outcome, they sometimes withdraw from relationships & life
(Potter & Perry, p. 464)
Sadness & grief; time of introspection; usually request only
significant others to be with them
The patient struggles with painful realities of life &
prepares for death
Reactions: “Yes, me.”
(Kockrow & Christensen, p. 193)
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Stages of Grieving/Dying
Acceptance Stage: the person incorporates the loss
into life & finds ways to move forward (Potter & Perry, p.
464)
 Resolved to the fact that death is imminent
 Peaceful acceptance & positive feelings are often
present
 Reactions: “I am ready.”
(Kockrow & Christensen, p. 193)
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Factors Influencing Loss
& Grief Responses
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Factors Influencing Loss & Grief
Multiple variables influence the way a person perceives
& responds to loss
Variables are
 Human developmental factors
 Personal relationships
 Nature of the loss
 Coping strategies
 Socioeconomic status
 Cultural influences
 Spiritual influences
(Potter & Perry, pp. 465-467)
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Human Developmental Factors
Client’s age & stage of development affect the grieve
response
Toddlers do not understand loss or death, but feel anxiety
& sometimes express the sense of absence with changes
in eating & sleeping patterns, fussiness, or bowel &
bladder disturbances
School-age children understand permanence &
irreversibility, but do not understand the causes of a
loss; some have intensive emotional expressions
(Potter & Perry, pp. 465-467)
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Human Developmental Factors
Young adults have developmental losses as they leave home and
or form significant relationships; illness or death disrupts
one’s future & the necessary tasks of establishing an
autonomous sense of self
Midlife adults experience major life transitions: caring for aging
parents or dealing with their death, dealing with changes in
marital status, losses resulting from impaired health or body
functions, & adapting to new family roles
 Response influenced by previous loss experiences, person’ s self-
esteem, & strength & availability of support
Older adults deal with losses related to the aging process & may
have more skills dealing with death learned from multiple
previous experiences with loss (Berman et al., p. 1084-1085)
36
Personal Relationships
 The quality & meaning of the lost relationship (if very
close, well-connected) influences the grief
 Grief resolution may be hampered by regret or a sense
of unfinished business when people are closely related
but did not have a good relationship at the time of
death
 Social support & the ability to accept help from others
are critical variables in recovery from loss & grief
 If clients do not receive supportive understanding &
compassion the grief becomes complicated or
prolonged
(Potter & Perry, pp. 465-466)
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Nature of the Loss
 Exploring the meaning of the loss for a client helps the healthcare
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worker understand the impact of loss on client’s behavior, health, &
well-being
(Corless, as cited in Potter & Perry, p. 466)
Highly visible losses generally stimulate a helping response from
others, the community, & government, such as homes lost by
tornados, but more private losses, such as a miscarriage brings much
less support
Stressors from a sudden & unexpected death pose different
challenges than those anticipated by a debilitating chronic illness
In cases of sudden & unexpected death, survivors do not have time
to let go
In cases of chronic disease & death, survivors have memories of
prolonged suffering, pain, & loss of function
Death by violence or suicide or multiple losses by their very nature
complicate the grieving process in unique ways
(Stroebe & Schut, as cited in Potter & Perry, p. 466)
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Cause of Loss or Death
 Individual & societal views on the cause of a loss or death
may influence the grief response or process
 Some diseases are considered “clean” & endear compassion
while others may be viewed as repulsive & unfortunate
 A loss or death beyond the control of those involved may
be more acceptable than one that is preventable, such as a
drunk driver collision
 Injuries & death occurring during respected activities, such
as “in the line of duty” are considered honorable, whereas
those occurring during illicit activities may be considered
the individual’s just reward (Berman et al., p. 1086)
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Coping Strategies
 Life experiences shape coping strategies one uses to deal with
the stress of loss
 One always relies first on familiar coping strategies after a loss;
when the usual strategies do not work, one needs new ones
 Emotional disclosure (venting or talking about one’s feelings)
is viewed as an important way to cope with loss
 Recent research suggests that the focus should be on positive
emotions & optimistic feelings rather than negative feelings or
the expression of anger associated with the loss for a more
successful bereavement coping strategy (Ong & Others, 2004, as cited in
Potter & Perry, p. 466)
 Emotional disclosure is often accompanied by having people write
about their feelings
(Potter & Perry, p. 466)
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Socioeconomic Status
 Socioeconomic status influences a person’s ability to
access support & resources for coping with loss &
physical responses to stress
(Cohen, Doyle, & Baum, as cited in Potter & Perry, p. 466)
 When people lack financial, educational, or occupational
resources, the burdens of loss multiply
 Example: a client with limited finances is not able to
replace a car demolished in a collision & pay for the
associated medical expenses (Potter & Perry, p. 466)
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Culture & Ethnicity
 One’s culture & other social structures (family or
religious affiliation) influence the interpretations of
loss, establish expressions of grief, & provide stability
& structure amid the chaos & loss)
 Expressions of grief in one person’s culture may not
make sense to persons from another culture
 Healthcare workers should try to understand &
appreciate each client’s cultural values related to loss,
death, & grieving
 American cultural values of individualism & selfdetermination are in contrast with communal, family,
or tribal ways of life
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Hope
 Hope: a multidimensional component of spirituality,
energizes & provides comfort to individuals experiencing
personal challenges
 Hopefulness gives one the ability to see life as enduring or
as having meaning or purpose
 As a future-shaping, motivating force, hope helps clients
maintain anticipation of a continued good, an
improvement in their circumstances, or a lessening of
something unpleasant; with hope, a client moves from
feelings of weakness & vulnerability to living as fully as
possible
(Arnaert, Filteau, & Sourial, as cited in Potter & Perry, p. 467)
43
Hope
 Maintaining a sense of hope depends on a person
having a strong relationships & emotional
connectedness to others
 Healthcare workers help provide the sense of
belonging, which is so essential to hope
 The experience of spiritual distress often arises from a
client’s inability to feel hopeful or foresee any favorable
outcomes.
 Spirituality & hope play a vital role in a client’s
adjustment to loss (Potter & Perry, p. 467)
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Gender
 Gender roles into which people are socialized in US &
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Canada affect their reactions at times of loss
Men are frequently expected to “be strong” & show very
little emotion during grief, whereas it is acceptable for
women to show grief by crying
Often the when the wife dies, the husband (chief mourner)
is expected to repress his own emotions & comfort sons &
daughters in their grieving
Gender roles also affect the significance of body image
changes to clients
A man may consider a facial scar to be “macho,” but a
woman might consider hers ugly; thus the woman, not the
man, would see the change as a loss (Berman et al., p. 1086)
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Support System
 People closest to the grieving individual are often the first
to recognize & provide the needed emotional, physical, &
functional assistance
 There are many people who are uncomfortable or
inexperienced in dealing with losses so the usual people
withdraw from the grieving individual
 Support may be available when the loss is first recognized
but as the support people return to their usual activities,
the need for ongoing support is unmet
 Sometimes the grieving individual is unable or unready to
accept support when it is offered (Berman et al., p. 1086)
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Survivor’s Manifestations
of Grief & Bereavement
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Normal Manifestations of Grief
 Manifestations of grief that are considered normal
include the verbalization of loss, crying, sleep
disturbances, loss of appetite, & difficulty
concentrating (Berman et al., p. 1084)
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Survivors’ Manifestations of
Grief & Bereavement
According to Martocchio there are five stages of the
survivor’s reaction to grief & bereavement:
Five Stages of Survivors’ Manifestations of Grief &
Bereavement
1. Shock & disbelief
2. Yearning & protest
3. Anguish, disorganization, & despair
4. Identification of bereavement
5. Reorganization & restitution
(Kockrow & Christensen, p. 193)
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Survivors’ Manifestations of
Grief & Bereavement
Shock & Disbelief
 Survivors feel a sense of unreality
 Often reject offers of comfort & support
 Disbelief may remain even though death is
comprehended intellectually
 Reactions: “Maybe this is not happening.”
“This is just a dream/nightmare.”
(Kockrow & Christensen, p. 193)
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Survivors’ Manifestations of
Grief & Bereavement
Yearning & Protest
 Survivors may express anger toward the deceased for
leaving them
 Reactions: “Why do I feel this way?”
Anguish, Disorganization, & Despair
 Reality & permanency of the loss are recognized
 Reactions: “Living is a chore.”
“All the joy is gone out of life.”
(Kockrow & Christensen, p. 193)
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Survivors’ Manifestations of
Grief & Bereavement
Identification in bereavement
 Bereaved may adopt behavior, ideals, mannerisms, or goals
of the deceased: “I will carry on her (dying person’s) goals.”
 Reactions: “I am just like him (dying or deceased person).”
Reorganization & Restitution
 Life stabilizes but some of the pain of loss may remain for a
lifetime
 Reactions: “Life goes on.”
“The sun has risen on a new day.”
(Kockrow & Christensen, p. 193)
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Dimensions of
Clients’ Needs
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Dimensions of Clients’ of Needs
To give compassionate care & support to the family &
dying patient during the grieving & dying process, the
healthcare worker should consider the five aspects of
human functioning:
 Physical
 Emotional
 Intellectual
 Social
 Spiritual
(Kockrow & Christensen, p. 195)
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Physical Dimension
 Review the physical needs, such as sleeping patterns,
body image, activities of daily living (ADLs), mobility,
general health, & pain
 What are the basic needs of nutrition, elimination,
oxygenation, activity, rest, sleep, & safety (Maslow’s
Hierarchy of Needs)
 Some goals are to provide comfort measures, energy
conservation, pain reduction techniques, promotion of
sleep & rest, & increasing self-esteem through body
image acceptance (Kockrow & Christensen, p. 195)
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Emotional Dimension
 Preparing for death is a personal endeavor filled with anxiety &
fear
 Check the patient’s & family’s anxiety level, anger, level of
acceptance, & identification
 Major fears of dying include fears of abandonment (dying
alone), loss of control, pain & discomfort, & fears of the
unknown
Healthcare workers should
 Accept the patient’s/family’s individual feelings
 Offer encouragement & support
 Give the patient “permission to die” by assisting the patient in
saying good-bye
(Kockrow & Christensen, p. 195)
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Emotional Dimension
 Use silence & personal presence along with techniques of
therapeutic communication (enhances the exploration of
feelings & lets the client know that you acknowledge their
feelings)
 Acknowledge the grief of the client’s family & significant
others (family support persons are part of the grieving client’s
world)
 Offer choices that promote client autonomy (client’s have a
need of a sense of control over their own lives at a time when
much control is not possible) for example: allow the client to
choose when she/he wants his bath
 Provide appropriate information regarding access to
resources, such as clergy, support groups, & counseling
services (Berman et al., p. 1089)
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Intellectual Dimension
 Consider the patient’s/family’s level of education, their
knowledge & abilities, & expectations they have in
regard to how & when death will occur
 There can be changes in the intellectual dimensions
during the dying process because of physiological
changes, medications, the patient’s emotional state, or
the disease process; Be alert to changes if the patient’s
memory or if sensations are decreased
 Provide patient/family education (what they can expect)
& support;
 Keep patient/family informed of procedures, changes in
the patient’s condition (check hospital policies for tasks
appropriate to your position)
(Kockrow & Christensen, p. 195)
58
Social Dimension
 Check to see what involvement the family wishes to do in




providing care of their dying loved one
Assisting with the patient’s cares, such as a bath may give the
family a sense of control– it is important to check what tasks
might be done by the family and what will be done by the
healthcare worker
Important to make needs & wants clear to improve in trust &
reduce hostility between family & healthcare workers
Each family & each individual member are unique in what they
wish to do so don’t assume, but ask
Family is important, but it’s important to learn from the
patient whom he/she considers significant others—who does
the patient consider the most supportive person in his/her
life? (It may be a friend, coworker, or church member
(Kockrow & Christensen, p. 195)
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Spiritual Dimension
 Healthcare worker should assess the patient’s philosophy of




life, religious resources, & how the rituals of the particular
faith group have significance in dealing with the patient’s
death
What are the client’s feelings related to death & dying
experiences
Do not judge or use tendencies to interpret & analyze;
instead create an atmosphere of openness to discuss the
patient’s spiritual concerns
Resources can come from clergy, friends, family, healthcare
providers, & significant others
It is important to support the patient’s/family’s belief system
& values
(Kockrow & Christensen, p. 195)
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Spiritual Dimension
 One aspect of the belief system is hope & can take many




forms
Hope is multidimensional
Hope is a common thread in all stages of grief
It is characterized by a confident yet uncertain
expectation of achieving a goal; it not a single act, but a
complex series of thoughts, feelings, & actions that
change often
The strength of religious connections & performance of
family role responsibilities are significantly related to
hope & coping
(Kockrow & Christensen, p. 195)
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Spiritual Dimension
 It is difficult to maintain hope during the dying
process
 As the person’s condition deteriorates, the health care
worker assists the family in translating hope of a cure
into realistic hopes that are focused on short-term,
achievable goals, such as a comfortable & a pain-free
life or the decision to live long enough to participate in
an important family event, such as a wedding of a child
 A total loss of hope leads to distress of the human
spirit & the relinquishment of hope is rapidly followed
by death
(Kockrow & Christensen, p. 198)
62
References
Berman, A., Snyder, S.J., Kozier, B., & Erb, G. (2008). Loss, grieving,
& death. In A. Berman, S.J. Snyder, B. Kozier, & G. Erb (Eds.).
Kozier & Erb’s Fundamentals of nursing: Concepts, process, and
practice (8th ed.) (pp. 1080-1101). Upper Saddle River, NJ: Prentice
Hall
Kockrow, O.E. & Christensen, B.L. (2006).Loss, grieving, dying, &
death. In B.L. Christensen & E. O. Kockrow (Eds.). Foundations
and adult health nursing (5th ed.) (pp. 188-216). St. Louis, MO:
Elsevier, Mosby
Juliar, K. (2003) Minnesota Healthcare Core Curriculum (2nd ed.).
Clifton Park, NY: Delmar Publishers
Potter, P.A. & Perry, A.G. (2009). The experience of loss, death, &
grief. In P.A. Potter & A.G. Perry (Eds.). Fundamentals of nursing
(7th ed.) (pp. 461-484). St. Louis, MO: Elsevier, Mosby
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