GRIEF AND LOSS

This module aligns with key elements of APNA’s “Clinical Decision Making”, “Patient Care Roles”, and “Cultural, Ethnic, and Spiritual Concepts” (American Psychiatric Nurses Association Education Council, Undergraduate Branch, 2022).

Module Outline

• Assessment of Grief and Loss
• Problems Associated with Grief and Loss
• Treatment of Grief and Loss

Module Learning Outcomes

• Summarize the types of Grief and Loss
• Describe the signs and symptoms of Grief and Loss
• Review Kubler-Ross five stages of grief
• Identify the common nursing problems associated with Grief and Loss
• Summarize the treatment of Grief and Loss

Concepts

• End of Life
• Spiritual
• Grief and Loss

Overview

Grief and loss are universal concepts. Meaning, all of humanity experiences grief and loss at some point across the lifespan. This module will summarize key factors related to grief and loss; namely, these are the types of grief, signs and symptoms of grief, Kubler-Ross’ Five Stages of Grief, common nursing problems, and treatment considerations.

Types of Loss

Generally, a loss precipitates the experience of grief. The experience of grief is normal response to losing something. The types of loss can be understood within Maslow’s Hierarchy of Needs theoretical framework (Videbeck, 2020). See the MODULE 2: THEORETICAL MODELS USED IN MENTAL HEALTH NURSING for a review of this theory. Let’s look at this application.

• Physiological Loss (e.g., loss of a limb)
• Safety Loss (e.g., loss of a home)
• Loss of Security and Sense of Belonging (e.g., death of a loved one)
• Loss of Self-Esteem (e.g., job loss)
• Self-Actualization Loss (e.g., loss of hope for future goals)

Types of Grief

The experience of grief is a normal to loss. However, two types of grief may be troublesome. These two types are:

• Anticipatory Grief-experienced before the actual loss
• Complicated Grief-grief suppression, prolonged experience of grief, or disproportionate grief experience
• Disenfranchised Grief-inability to openly acknowledge the loss or grief (e.g., related to social stigma) (Oates and Maani-Fogelman; 2022; Videbeck, 2020).

Individuals may be at increased risk or vulnerable for experiencing complicated grieving for several reasons. Some of these reasons are:

• The loss is the death of a spouse, child, or parent (especially as a child/adolescent)
• Low self-esteem
• Perception of the loss (Oates and Maani-Fogelman; 2022; Videbeck, 2020).

Kubler-Ross Stages of Grief

Elisabeth Kubler-Ross defined five stages of grieving. However, keep in mind that while these are typical stages of grief. The experience of grief and loss is individualistic. A person does not necessarily progress through these stages in sequence. A person may also regress to a previous stage or experience stages together. The five grief stages are:

1. Denial-shock and disbelief related to the loss
2. Anger-may feel anger towards God or others
3. Bargaining-asking God or fate to delay the loss
4. Depression-acute awareness of the loss
5. Acceptance-comes to terms with the loss (Oates and Maani-Fogelman; 2022; Videbeck, 2020).

Level Up RN. (2022). Crises, loss, and grief-psychiatric mental health nursing principles [Video]. YouTube. https://youtube.com/watch?v=HqzuxJl6BNc&si=EnSIkaIECMiOmarE

Assessment

It is not uncommon for individuals to express a variation of signs and symptoms to grief. Reviewing Kubler-Ross’ Five Stages of Grief will allow you to anticipate the clinical presentation of grief.

Videbeck (2020) indicates typical universal signs and symptoms of grief are:

• Shock and social disorientation
• Attempts to continue the relationship
• Anger with those believed to be responsible
• Mourning

The signs and symptoms of complicated grief include:

• Intense sorrow and rumination of the loss
• Inability to concentrate on other things besides the loss
• Intense and persistent longing for the deceased

• Ineffective Coping
• Grieving
• Risk for Complicated Grieving

Treatment

The main treatment goal for nurses is to provide comfort and support for the patient and family. Let’s summarize some specific strategies for nurses to help grieving patients and families.

• May use silence and listen; may encourage sharing of memories or feelings
• Don’t assume an understanding of the individual’s/family’s spiritual or cultural grieving process, but can encourage the individual/family to express what is meaningful to them
  • Caveat: may not be able to accommodate practices that may compromise organizations policy or pose health risk to other patients (e.g., burning incense). Check the institutional policy.
• Allow adaptive denial
• Offer food, but do not pressure to eat
• Encourage the bereaved to care for themselves
• Respect the individual’s/family’s beliefs and grieving process
• Encourage the acceptance of support (Oates and Maani-Fogelman; 2022; Videbeck, 2020).

Additional Resources

Check out the resources listed on:

• CDC’s Grief and Loss webpage
• The Center for Prolonged Grief at Columbia University webpage.