Grief

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Grief
Definition
      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:
      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
      Sadness, guilt, shame, helplessness, and hopelessness.
      Self-blame or blaming of others leading to anger.
      The anxiety level may be elevated,
      Confusion and a decreased ability to function independently.
      Preoccupied with an idealized image of what has been lost.
Stage III: Bargaining
      The individual attempts to strike a bargain with God for a second chance, or for more time.
      The person acknowledges the loss, or impending loss, but holds out hope for additional alternatives
Stage IV: Depression
      Mourns for that which has been or will be lost.
      Individual must confront feelings associated with having lost.
Stage V: Acceptance
      Worked through the behaviors associated with the other stages
      Accepts or has become resigned to the loss.
      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
      Desire to recover what has been lost.
      A preoccupation with the loss
      Intense weeping and expressions of anger toward the self and others
      Feelings of ambivalence and guilt associated with the loss.
Stage III: Disorganization and Despair
      Despair occur in response to the realization that the loss has occurred.
      Activities of daily living become disorganized
      Restlessness and aimlessness
Stage IV: Reorganization
       The individual accepts the loss.
       New goals and patterns of organization are established.
      The individual begins new relationships
      A readiness to move forward by accepting the loss
Techniques used in grief counseling
      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.
      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
      Prolonged response-Intense pre occupation with the loss for many years after loss.
      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
      Assess client’s stage in the grief process.
      Develop trust.
      Help the client actualize the loss by talking about it.
      Help the client identify and express feelings
      Provide client with adequate time to grieve.
      Be accepting and nonjudgmental when client expresses anger.
      Contact spiritual leader of client’s choice, if needed.


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Grief
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