hey! its sheral.,,am very interested in making creative, impressive and catchy power point presentations and also very very interested in making mental health ppts.

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Loss and Grief
SHERAL SAMSON
BScN

2. LOSS AND GRIEF 2
OBJECTIVES:
By the end of the presentation, the learners will be able to:
• Discuss loss and grief.
• Identify a clinical scenario and can relate loss and grief theory
to it.
• Enlists the positive coping mechanisms applied to grief.
• Review literature in support of loss and grief.
• Develop a nursing care plan for a griever.

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SCENARIO
A 55-year-old female patient who is admitted to the general ward at the
Karachi Psychiatric Hospital, presents with the chief complaint of intense
grief, hallucinations, and aggression. Her life has been filled with stressful
events that contributed to her schizoaffective disorder diagnosis,
including her parents' divorce, her stepmother's violent behavior, and her
father's death, her lack of an intimate relationship with her husband, his
extramarital affairs, and domestic violence. However, the two tragedies
that affected her the most were the murder of her son and the passing of
her brother. She was so miserable that she made three suicide attempts. Her
current complaints are that she is having hallucinations, is depressed, and
is irritable. The treatment regimen includes only medications that are Anti-
psychotics (Flucate), Glucophage and Atarax.

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Predisposing factors:
• Parent’s divorce
• Father’s death
• Violence by step mother
Precipitating factors:
• Psychological; Grief related to loss of son and brother
• Husband’s extra marital affairs and violence
stressor:
Situational stressor
Appraisal of stressor:
• COGNITIVE: life is so miserable
• AFFECTIVE: depressed
• PHYSIOLOGICAL: drowsy, dizziness, fatigue
• BEHAVIORAL: suicidal attempts
Coping strategies:
NEGATIVE COPING ; SOCIAL AVOIDANCE AND
SUICIDAL ATTEMPTS

5. LOSS AND GRIEF 5
• This theory was introduced by Swiss-American psychiatrist Elisabeth
Kübler-Ross in her 1969 book On Death and Dying.
• It describes a series of emotions experienced by people who are
grieving.
• Kübler-Ross makes it clear that the stages are non-linear – people can
experience these aspects of grief at different times and they do not
happen in one particular order.
KUBLER ROSS THEORY OF LOSS ANDGRIEF
Grief is a natural emotional response to loss.
“The more significant the loss, the more intense the grief is likely to be”.
It might be the loss of a loved one, relationship, pregnancy, job or way of
life.
LOSS ANDGRIEF
(Kristen Rogers, 2022)

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The stages, popularly known by the acronym DABDA, include

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DENIAL
• Feeling numb is common in
the early days after a
bereavement.
• Some people at first carry on as
if nothing has happened. Even
if we know with our heads that
someone has died it can be
hard to believe that someone
important is not coming back.
• “Don’t be ridiculous, it’s not
true.”
ANGER
• Anger is a completely natural
emotion, and very natural after
someone dies.
• Death can seem cruel and unfair,
especially when you feel someone has
died before their time or you had
plans for the future together.
• It’s also common to feel angry
towards the person who has died, or
angry at ourselves for things we did
or didn’t do before their death.
• “Why did it happen to me? God,
isn’t it fair?”
(Kristen Rogers, 2022)

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BARGAINING
• Bargaining is when we start to make
deals with ourselves, or perhaps with
God.
• We want to believe that if we act in
particular ways we will feel better
• “I would do anything if he would
just wake up.”
DEPRESSION
• In this stage, we begin to realize
and feel the true extent of the
death or loss.
• Common signs of depression in
this stage include trouble
sleeping, poor appetite, fatigue,
lack of energy, crying spells,
feel lonely, isolated, empty, lost,
and anxious
• “He really left me, and I don’t
want to live without him ……”
(Kristen Rogers, 2022)

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ACCEPTANCE
• Gradually most people find that the pain eases,
and it is possible to accept what has happened.
• We may never ‘get over’ the death of someone
precious, but we can learn to live again, while
keeping the memories of those we have lost
close to us.
• “Now that it has happened this way, life must
go on!”
(Kristen Rogers, 2022)

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POSITIVE COPINGSTRATEGIES IN LOSSANDGRIEF:
• Positive reframing; “looking at bright side” (focus on good
memories)
• Setting goals; specific tasks (moving to a new place)
• Meditation
• Expressing feelings out loud or in a journal
• Keep up a normal routine.
• Getting plenty of rest
• Starting psychotherapy
• Reconnecting with family & friends.
(Jacquelyn Johnson, 2021)

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• “Severe grief in response to the death of a close friend or
family member is associated with a variety of physical and
mental disorders as well as with persistent depressive
symptoms.” (Cathaleene Macias, et al, 2010).
• Factors expected to influence grief duration
The four situational factors hypothesized to complicate grief:
1. Sharing a residence
2. The suddenness of death
3. The lack of social support
4. The co-occurrence of other stressors
BEREAVEMENT IN THE CONTEXT OF SERIOUS MENTAL ILLNESS
Cathaleene Macias, et al.(2010). “Bereavement in the Context of Serious Mental
Illness”. Psychiatr Serv; 55(4): 421-425. DOI: 10.1176/appi.ps.55.4.421

13. LOSS AND GRIEF 13
Melinda Smith, M.A., Lawrence Robinson, and Jeanne Segal, Ph.D. (2022). “Coping with
Grief and Loss”. HelpGuide.
COPINGWITH GRIEF AND LOSS
Myth: It’s important to “be strong” in the face of loss.
Fact: Feeling sad, frightened, or lonely is a normal reaction to loss. Crying doesn’t mean
you are weak. You don’t need to “protect” your family or friends by putting on a brave
front. Showing your true feelings can help them and you.
Myth: If you don’t cry, it means you aren’t sorry about
the loss.
Fact: Crying is a normal response to sadness, but it’s not the
only one. Those who don’t cry may feel the pain just as
deeply as others. They may simply have other ways of
showing it.
Myth: Grieving should last about a year.
Fact: There is no specific time frame for grieving. How long it
takes differs from person to person.

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The psychology of grief – applying cognitive and behavior therapy principles. (2011).
InPsych; Vol 33, Issue 6.
COGNITIVE BEHAVIORAL THERAPY FOR GRIEVER:
A CBT approach focuses on griever's thoughts and behavior, not only about the death itself,
but also about building a new life without the deceased.
The goal of CBT is to help the bereaved reconcile the death of their loved one.
THE PSYCHOLOGY OF GRIEF-APPLYINGCOGNITIVE ANDBEHAVIORTHERAPY
PRINICIPLES
CBT STRATEGIES:
• Provide information about grief and what to expect
• Encourage identification of thoughts leading to feelings of
guilt and anger
• Prepare to face new or difficult situations
• Promote self-care activities
• Increase pleasant events

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NURSING
CARE
PLAN

16. ASSESSMENT NURSING
DIAGNOSIS
PLANNING IMPLEMENTATION EVALUATION
OBJECTIVE
DATA:
• Crying
• Despair
• Loneliness
• Unable to
perform ADLs.
Loss and grief
related to loss
of love ones as
evidenced by
patient’s
behavior and
expression of
emotions.
SHORT TERM
GOAL:
the patient will be
able to identify and
express feelings in
an appropriate
manner within 5-7
days.
LONG TERM
GOAL:
The patient will be
able to identify and
express feelings in
an appropriate
manner and
continue ADLs as
normal by the time
of discharge..
• Encourage the
expression of feelings to
support client.
• Provide continue
support in the form of
therapeutic
communication.
The patient is able
to identify and
express feelings in
an appropriate
manner.
LOSS AND GRIEF 16

17. ASSESSMENT NURSING
DIAGNOSIS
PLANNING IMPLEMENTATION EVALUATION
SUBJECTIVE
DATA:
“kisi se baat karne
ko dil nahi chahta,
bs chup rehna
chahti”
OBJECTIVE
DATA:
• Staying alone
• Not interested
in group talks
• No friend
Social isolation
related to
anhedonia as
evidenced by
staying alone in
room.
SHORT TERM
GOAL:
Client will involve
in
gatherings/group
talks within 1
week.
LONG TERM
GOAL:
Client will
voluntarily spent
time with other
clients and staff
within 2-3 weeks,
and also with
family by the time
of discharge.
• Show unconditioned
positive regard.
• Convey an accepting
attitude by talking to
client and listening to
the client.
Client involve in
group talks within
3-4 days.
LOSS AND GRIEF 17

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REFERENCES
• Cathaleene Macias, et al.(2010). “Bereavement in the Context of Serious Mental Illness”. Psychiatr
Serv; 55(4): 421-425. DOI: 10.1176/appi.ps.55.4.421
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2759894/
• Melinda Smith, M.A., Lawrence Robinson, and Jeanne Segal, Ph.D. (2022). “Coping with Grief and
Loss”. HelpGuide.
https://www.helpguide.org/articles/grief/coping-with-grief-and-loss.htm
• The psychology of grief – applying cognitive and behavior therapy principles. (2011). InPsych; Vol 33,
Issue 6
https://psychology.org.au/for-members/publications/inpsych/2011/dec/the-psychology-of-grief-applying-
cognitive-and-
b#:~:text=Grief%20can%20be%20described%20as,be%20with%20that%20person%20again.
• Kristen Rogers. (2022). “5 stages of grief, and how to get through them”. Mindfulness CNN.
https://edition.cnn.com/2021/09/12/health/five-stages-of-grief-kubler-ross-meaning-
wellness/index.html#:~:text=A%20Swiss%20American%20psychiatrist%20and,%2C%20bargaining%2C
%20depression%20and%20acceptance.
• Jacquelyn Johnson. (2021). “6 coping skills to work through grief”. PsychCentral.
https://psychcentral.com/health/coping-skills-for-grief#coping-skills-vs-defense-mechanisms

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