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, that 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 a normal response to losing something. The types of loss can be understood within Maslow’s Hierarchy of Needs theoretical framework (Videbeck, 2020). See 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 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 to 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:
- Denial-shock and disbelief related to the loss
- Anger-may feel anger towards God or others
- Bargaining-asking God or fate to delay the loss
- Depression-acute awareness of the loss
- 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
Below is an overview of a nurse’s consideration for the assessment, problems, and treatment of grief and loss.
See Oates and Maani-Fogelman (2022) for further reading.
Assessment
It is not uncommon for individuals to express a variation of signs and symptoms of 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
Problems
The problems that may be associated with childhood disorders include:
- 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 the organization’s policy or pose a 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:
Key Takeaways and Learning Activities
You should have learned the following in this section:
- The experience of grief and loss is universal to all humanity
- Types of loss can be summarized using Maslow’s Hierarchy of Needs
- Types of grief that may be associated with a maladaptive response to a loss include: Anticipatory, Disenfranchised, and Complicated Grief
- Nurses should provide comfort and support to grieving individuals and families
Concept Map Activity
- Create a concept map that depicts the assessment and treatment of Grief and Loss.
- If needed, see the INTRODUCTION for a concept map tutorial.
Case Study: Grief and Loss
Case Scenario
Kai, a 45-year-old widower, presents to his primary care nurse practitioner. He recently lost his spouse to cancer. He is struggling with intense grief, feelings of loneliness, and difficulty adapting to life. He states that some days he is overwhelmed with intense sadness, and other days he is angry. He communicates that he made this appointment for “sleeping pills,” reporting difficulty sleeping for the last two weeks.
Reflective Case Study Questions:
- Name and describe Kubler-Ross’ stages of grief.
- Assess and describe the stages of grief Kai may be experiencing.
- Develop a nursing care plan to support Kai through the grieving process.
- How can the nurse facilitate healthy coping mechanisms for Kai?
- Discuss the importance of cultural competence in providing grief support.
Adaptive loss can be defined as gradually adjusting to the loss; taking on an entire loss may feel overwhelming; example verbal expressions may include "There's been a mistake" or "I can't believe this happened" (Videbeck, 2020).
