Grief involves coping with loss. Death, divorce and the loss of a home are all major events that people grieve. Share with the others. this slide includes nursing interventions, types and process.

1. GRIEF

2. What is grief?
 Grief is a natural response to loss. It's the emotional
suffering feel when something or someone you love is
taken away.
 Grief is a reaction of an individual to a significant loss.
 Shock, disbelief, anger, resentment and depression are
common features in affected individuals.

4.  Grief is defined as the emotional process of
coping with a loss. The reality of loss can be
applied to the absence of anything that is
significant or meaningful to our existence.
 This can include death of a loved one, a separation
or divorce, loss of a body part, loss of a job and
losses that result from a natural or imposed
disaster.

5. There are multiple ways to experience grief. Different
types of grief describe how varied and complex grief can
be.
TYPES
Anticipatory
grief
Abbreviated
grief
OF
Delayed
grief
Inhibited
grief
GRIEF
Cumulative
grief
Collective
grief

6.  Anticipatory grief involves grieving before the
actual loss.
 For example, you may begin grieving when you
learn that you or a loved one has a terminal
illness.
 Processing grief beforehand can prepare you to
face the loss when the time comes.
 Still, it’s important not to allow grieving to
distract you from enjoying the precious time you
do have.
Anticipatory
grief

7.  Sometimes, you’re able to move through the
grieving process quickly. This is the case with
abbreviated grief.
 Abbreviated grief may follow anticipatory grief.
You can grieve a loss quickly because you’ve
already done a lot of emotional labor while
anticipating that loss.
 Grieving for a short time doesn’t mean you never
truly cared about what you lost. When it comes to
grief, we’re all on different timelines.
Abbreviated
grief

8.  Instead of experiencing the emotions that
accompany grief immediately after a loss, you feel
them days, weeks or even months later.
 In some instances, the shock of the loss pauses
your body’s ability to work through these
emotions.
 Or you may be so busy handling the practical
matters that accompany loss (like funerals and
wills) that your body can’t grieve until you’ve
handled these responsibilities.
Delayed grief

9.  Inhibited grief involves repressing emotions.
 Most of us haven’t been taught how to process — or
even how to recognize — the confusing emotions that
can arise when we’re grieving. As a result, many people
who repress their emotions don’t realize they’re doing
so.
 Unfortunately, when you don’t allow yourself to pause
and feel these emotions, grief often shows up as
physical symptoms like an upset stomach, insomnia,
anxiety or even panic attacks.
Inhibited
grief

11. With cumulative grief, you’re
working through multiple
losses at once.
For example, you’re not only
grieving the loss of a child.
You’re grieving the ending of
a marriage that followed that
loss.
Grieving multiple losses

12.  Most of us think of grief as personal, but
collectives (groups) grieve, too.
 Major events like wars, natural disasters, school
shootings and pandemics create far-reaching
losses. They change what counts as “normal” life.
As a group, we grieve the shared experiences
we’ve lost as we struggle to imagine a changed
future
Collective
grief

13. symptoms of grief
Emotional symptoms
 Sadness that a loved one’s gone but relief that they’re at
peace.
 Yearning for a spouse after a divorce but also excitement
that you get another shot at love.
 Guilt for feeling grateful that you no longer have to provide
exhausting around-the-clock care for a dying relative.
 Competing feelings of apathy, anger, sadness and regret as
you grieve the loss of a friend or family member with whom
you had a strained or hostile relationship.

14. Physical symptoms
 Fatigue.
 Headaches.
 Nausea.
 Restlessness.
 Upset stomach.
 Heart palpitations.
 Weak muscles or joint pain.
 Tightness in your chest or
throat.
 Having reduced or increased
appetite.
 Trouble sleeping (insomnia)
or sleeping too much.

15. Behavioral changes
 Confusion.
 Trouble thinking or making decisions.
 Feeling as if you’ve lost a sense of hope or direction.
 Difficulty focusing on anything other than your loss.
 Difficulty remembering or keeping track of your
responsibilities.

17. THEORIES OF GRIEF
Kubler-Ross (1969) having done extensive research
with terminally ill patients identified five stages of
feelings and behaviour that individuals experience
in response to a real, perceived or anticipated loss

18. Kubbler-
Ross

19.  Stage I-Denial: This is a stage of
shock and disbelief. The response may
be one of "No, it can't be true!"
 Denial is a protective mechanism that
allows the individual to cope within
an immediate time-frame while
organizing more effective defence
strategies.

20. Stage II-Anger: "Why
me?" and "It is not fair!"
are comments often
expressed during the
anger stage. Anger may
be directed at self or
displaced on loved ones,
caregivers, and even
God. There may be a
preoccupation with an

21.  Stage III-Bargaining: "If God will
help me through this, I promise I will
go to Temple every and volunteer my
time to help others". During this stage,
which is generally not visible or evident
to others, a bargain is made with God in
an attempt to reverse or postpone the
loss.

23. Stage V-Acceptance:
The final stage
brings a feeling of
peace regarding the
loss that has
occurred. Focus is
on the reality of the
loss and its meaning
for the individuals

24.  All individuals do not experience each of these
stages in response to a loss, nor do they
necessarily experience them in this order.
 Some individuals grieving behaviour may
fluctuate, and even overlap between stages.

25. GRIEF PROCESS
 The grieving process describes a series of
occurrences in the resolution of loss.
 This process provides support as an individual
works through the feelings of anger, hopelessness
and futility that accompany loss.
 It provides time to put things into perspective, to
place into memory that which is gone, and to
embrace life.

26.  Growth occurs as the bereaved person comes to
the point of letting off the past.
 This does not reduce the importance of the loss
but allows the person to continue living with a
new perspective.
 This acceptance indicates that the grief process is
coming to a close.

27. Resolution of Grief
 Resolution of the process of mourning is thought to have
occurred when an individual can look back on the
relationship with the lost entity and accept both the pleasure
and the disappointments (both the positive and negative
aspects) of the association.
 Pre-occupation with the lost entity is replaced with energy
and desire to pursue new situations and relationships.

28. The length of the grief process may be
prolonged by a number of factors:
 If the relationship with the lost entity had been marked by
ambivalence, reaction to the loss may be burdened with
guilt, which lengthens the grief reaction.
 In anticipatory grief where a loss is anticipated, individuals
often begin the work of grieving before the actual loss
occurs.

29.  Most people experience the grieving behaviour once the
actual loss occurs, but having this time to prepare for the
loss can facilitate the process of mourning, actually
decreasing the length and intensity of the response.
 The number of recent losses experienced by an individual
also affects the length of the grieving process and whether
he is able to complete one grieving process before another
loss occurs.

30. Maladaptive Grief
Responses
 Maladaptive grief responses to loss occur when an
individual is not able to satisfactorily progress
through the stages of grieving to achieve
resolution.
 Several types to grief responses have been
identified as pathological [Lindemann (1944),
Parkes (1972)].
 These are prolonged, delayed/inhibited, and
distorted responses.

31. Prolonged Response
It is characterized by
an intense
preoccupation with
memories of the lost
entity for many years
after the loss has

32. Delayed or Inhibited
Response
 The individual becomes fixed in the denial stage
of the grieving process.
 The emotional pain associated with loss is not
experienced, but there may be evidence of anxiety
disorders or sleeping disorders.
 The individual may remain in denial for many
years until the grief response is triggered by a
reminder of the loss or even by another unrelated
loss.

33. Distorted Response
The individual who experiences a distorted response is fixed
in the anger stage of grieving.
 The normal behaviours associated with grieving, such as
helplessness, hopelessness, sadness, anger and guilt are
exaggerated out of proportion to the situation.
 The individual turns the anger inward on the self and is
unable to function in normal activities of daily living.
Pathological depression is a distorted grief response.

34. Management and
Treatment
 Evaluation to find out any primary psychiatric
disorder
 Patient is encouraged to talk about his feelings
concerning the deceased in a private room
 Reassurance is given that this is a normal process
and will subside on its own
 If necessary, refer to psychiatric services

35.  Treatment
Normal grief does not require any treatment while
complicated grief requires medication depending
on the prevailing behaviour responses.

36. Nursing Intervention
 Provide an open accepting environment. Encourage
ventilation of feelings and listen actively.
 Provide various diversional activities.
 Provide teaching about common symptoms of grief.
 Reinforce goal-directed activities.
 Bring together similar aggrieved persons, to encourage
communication, share experiences of the loss and to offer
companionship, social and emotional support.

37.  Assist patient to identify ambivalent feelings
of guilt or anger towards loss of object.
 Assist in developing positive methods of coping
with the loss.
 Provide positive feedback for use of effective
coping strategies.
 Encourage patient to utilize family, religious or
cultural supports that provide a meaning for the
patient.
 Encourage participation in group activities.