Grief and Loss

When a person loses a loved one, there is a wide range of normal, adaptive feelings and behaviors.
Grief is the personal feelings that go with the loss.
Mourning is the expression of grief.
Bereavement is the period of time of mourning.
"Although the pain of the loss may be tempered by the passage of time, recent conceptualizations of loss as an ongoing developmental process maintain that time does not heal the bereaved individual completely(Silverman, 2001); that is, the bereaved do not get over a loss entirely, nor do they return to who they were before the loss. Rather, they develop a new sense of who they are and where they fit in a world that has changed dramatically and permanently." (Bare, Smeltzer)

Grief vs. Depression--Normal vs. Maladaptive Grieving
Grief--feelings of loss but self esteem intact.
Depression--feelings of guilt, worthlessness precipitates depression.

Delayed or Inhibited Grief
Can be pathological. The person does not deal with the reality. Fixed in the denial stage. Failure of the mourning process.

Care Plan for the Grieving Person
Nursing Diagnosis:Risk For Dysfunctional Grieving;
Related to: loss of loved one;
Evidenced by: Feelings of sadness, anger, guilt, self-reproach, anxiety, lonliness, fatigue, helplessness, shock, yearning, and numbness.
Outcome Criteria: Patient will progress through the grief process in a healthful manner toward resolution.

Nursing Interventions w/ rationales
1.Assess the patient's stage in the grief process.
2. Devolop trust. Show empathy, concern and positive regard. Provides the basis for a therapeutic relationship.
3.Help patient actualize the loss by talking about it. Reviewing the events can help full awareness of the loss.
4.Help the patient identify and express feelings. Such as anger, guilt, anxiety and helplessness. until these feelings are recognized and accepted the grief work can not progress
5.Provide adequate time to grieve and help patient to understand the grief process to help prevent the feelings of guilt.
6.Provide continuing support, if the nurse can not then offer referals to support groups. This facilitates the grief process.
7.Identify pathological defense that the patient may be using such as drug/alcohol, somatic complaints, and social isolation. Help the patient understand that these are not healthy defenses and delay the process of grieving. The bereavement process is impaired by behaviors that mask the pain of loss.
8. Encourage the patient to make an honest review of the relationship that has been lost. Keeping a journal is a good way. To see the positive and negative aspects related to the loss.
(Townshend)
GRIEF Greif Recovery Institute Education Foundation, Inc.= www.grief.net