Experiences of loss are normal and essential in
human life. Letting go, relinquishing, and moving on
happen continually as a person travels through the
stages of growth and development. People frequently
say “goodbye” to places, people, dreams, and familiar
objects. Examples of necessary losses that accom-
pany growth include abandoning a favorite blanket
or toy, leaving a first-grade teacher, and giving up
the adolescent hope of becoming a famous rock star.
Loss allows a person to change, develop, and fulfill
his or her innate human potential. Loss may be
planned, expected, or sudden. Although it can be dif-
ficult, loss sometimes is beneficial. Other times, it is
devastating and debilitating.
Griefrefers to the subjective emotions and af-
fect that are a normal response to the experience of
loss. Grieving,also known as bereavement,refers
to the process by which a person experiences the
grief. It involves not only the content (whata person
thinks, says, and feels) but also the process (howa
person thinks, says, and feels). All people grieve
when they experience life’s changes and losses. Often,
grieving is one of the most difficult and challenging
processes of human existence; rarely is it comfortable
or pleasant. Anticipatory grievingis when people
facing an imminent loss begin to grapple with the very
real possibility of the loss or death in the near future
(Zilberfein, 1999). Mourningis the outward expres-
sion of grief. Rituals of mourning include having a
wake, sitting shivah, holding religious ceremonies,
and arranging funerals.
This chapter examines the human experience of
loss and the process by which a person moves through
bereavement and integrates loss into his or her life.
To support and care for the grieving client, the nurse
must understand these phases as well as cultural re-
sponses to loss. At times, grief is the focus of treat-
ment. The nursing process section outlines the nurse’s
role in the grieving process and gives guidelines for
offering support and teaching necessary coping skills
to clients. The chapter also outlines the importance
of the nurse’s self-awareness and competency in
helping clients and families during bereavement.
TYPES OF LOSSES
A helpful way to examine different types of losses is
to use Abraham Maslow’s hierarchy of human needs.
According to Maslow (1954), a hierarchy of needs
motivates human actions. These needs begin with
physiologic needs (food, air, water, sleep), then safety
needs (a safe place to live and work), then security and
belonging needs (satisfying relationships). After those
needs comes the need for self-esteem, which leads to
feelings of adequacy and confidence. The last andfinal need is self-actualization, the ability to realize
one’s full innate potential. When these human needs
are taken away or not met for some reason, the person
experiences loss. Examples of losses related to specific
human needs in Maslow’s hierarchy are as follows:- Physiologic loss.Examples include amputa-
tion and loss of adequate air exchange or
pancreatic functioning. - Safety loss.Loss of a safe environment such
as following domestic or public violence. A
person may perceive a breach of confidential-
ity in the professional relationship as a loss
of psychological safety secondary to broken
trust between client and provider. - Loss of security and a sense of belonging.The
loss of a loved one affects the need to love
and be loved. Loss accompanies changes in
relationships such as birth, marriage, divorce,
illness, and death; as the meaning of a rela-
tionship changes, a person may lose roles
within a family or group. - Loss of self-esteem.Any change in how a per-
son is valued at work or in relationships can
threaten his or her need for self-esteem. A
change in self-perception can challenge
240 Unit 3 CURRENTSOCIAL ANDEMOTIONALCONCERNSGrief