Grief
Definition
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It
is a normal response of an individual to the loss of a loved object.
Theories of grief
I.
According to Kubler Ross
Stage I: Denial:
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In this stage the individual does not
acknowledge that the loss has occurred.
•
He or she may say, “No, it can’t be true!”
or “It’s just not possible.”
•
May protect the individual against the
psychological pain of reality.
Stage II: Anger
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Sadness, guilt, shame, helplessness, and
hopelessness.
•
Self-blame or blaming of others leading to
anger.
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The anxiety level may be elevated,
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Confusion and a decreased ability to
function independently.
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Preoccupied with an idealized image of
what has been lost.
Stage III: Bargaining
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The individual attempts to strike a
bargain with God for a second chance, or for more time.
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The person acknowledges the loss, or
impending loss, but holds out hope for additional alternatives
Stage IV: Depression
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Mourns for that which has been or will be
lost.
•
Individual must confront feelings
associated with having lost.
Stage V: Acceptance
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Worked through the behaviors associated
with the other stages
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Accepts or has become resigned to the
loss.
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Anxiety decreases, and methods for coping
with the loss have been established.
II.
According to John Bowlby
Stage I: Numbness or Protest
This stage is characterized
•
A
feeling of shock
•
A
disbelief that the loss has occurred.
•
The
reality of the loss is not acknowledged.
Stage II: Disequilibrium
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Desire to recover what has been lost.
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A preoccupation with the loss
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Intense weeping and expressions of anger
toward the self and others
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Feelings of ambivalence and guilt
associated with the loss.
Stage III:
Disorganization and Despair
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Despair occur in response to the
realization that the loss has occurred.
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Activities of daily living become
disorganized
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Restlessness and aimlessness
Stage IV: Reorganization
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The individual accepts the
loss.
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New
goals and patterns of organization are established.
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The individual begins new relationships
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A readiness to move forward by accepting
the loss
Techniques used in grief
counseling
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Cognitive restructuring- By this technique
person’s irrational thought related to grief is being clarified and thoughts
are being restructured.
•
Expressive
writing- This method uses the writing skill of the patient in releasing his
feeling towards the grief process. Person freely writes about the incidences
and feelings associated with it.
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Role
playing- Helps in recreating the situation and makes the person to accept the
reality and to choose adaptive coping to the situation.
•
Memory
book- In this the person writes down all the events in a book and recollects
the events. Later person analyses the situation and finds out the better way to
resolve the emotions associated with it.
Maladaptive responses to grief
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Prolonged
response-Intense pre occupation with the loss for many years after loss.
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Delayed
or inhibited-During delayed response person will become stagnated in the denial
stage of grief response. This will result in not accepting the reality that
loss had occurred.
•
Distorted-
In this person gets fixed up in the anger stage which may be turned towards
self. All the emotions experienced are exaggerated than normal.
Nursing interventions
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Assess client’s stage in the grief
process.
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Develop trust.
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Help the client actualize the loss by
talking about it.
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Help the client identify and express
feelings
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Provide client with adequate time to
grieve.
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Be accepting and nonjudgmental when client
expresses anger.
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Contact spiritual leader of client’s
choice, if needed.
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