- Experiencing cognitive disorganization and
emotional despair with difficulty functioning
in the everyday world
- Reorganizing and reintegrating the sense of
self to pull life back together
Another theorist, John Harvey (1998), described
similar phases of grieving:
- Shock, outcry, and denial
- Intrusion of thoughts, distractions, and ob-
sessive review of the loss
- Confiding in others as a way to emote and to
cognitively restructure an account of the loss
Rodebaugh, Schwindt & Valentine (1999) viewed
the process of grief as a journey through four stages:
1.Reeling.The person feels shock, disbelief,
or denial.
2.Feelings.The person experiences anguish,
guilt, profound sadness, anger, lack of concen-
tration, sleep disturbances, appetite changes,
fatigue, and general physical discomfort.
3.Dealing.The person begins to adapt to the
loss by engaging in support groups, grief
therapy, reading, and spiritual guidance.
4.Healing.The person integrates the loss as
part of life. Acute anguish lessens. Healing
does not imply, however, that the person has
forgotten or accepted the loss.
Table 12-1 compares the theories of grieving.
Nurses should not expect all clients to follow pre-
dictable steps in the grieving process. Indeed, such
an expectation may put added pressure or stress on
a client when he or she most needs acceptance, re-
flection, and support from care providers to ease the
grieving. Interventions that nurses can use to facili-
tate the grieving process are discussed later in this
chapter.
Tasks of the Grieving Process
Rando (1984) describes tasks inherent to grieving:
- Undoing psychosocial bonds to the loved one
and eventually creating new ties
- Adding new roles, skills, and behaviors and
revising old ones into a “new identity and
sense of self”
- Pursuing a healthy lifestyle that includes
people and activities
- Integrating the loss into life, which does not
mean ending the grieving but accommodat-
ing the reality of the loss
The accompanying Clinical Vignette gives an ex-
ample of integrating loss into life. Margaret has come
to view James’s death and the painful period of grief
as a profound and poignant “search for meaning in
life.” The sense of his presence remains with her as
she pursues her life without him, and she often pic-
242 Unit 3 CURRENTSOCIAL ANDEMOTIONALCONCERNS
Kubler-Ross
(1969)
Bowlby (1980)
Harvey (1998)
Rodebaugh et al.
(1999)
Stage I: denial
Numbness;
denial
Shock; outcry;
denial
Reeling:
shock,
disbelief, or
denial
Stage II: anger
Stage III:
depression
Emotional
yearning for the
loved one;
protesting
permanence of
the loss
Intrusion of
thoughts,
distractions;
obsessive
reviewing of
the loss
Feeling: anguish,
guilt, sadness,
anger, lack of
concentration,
sleep distur-
bances, appetite
changes,
fatigue, general
discomfort
Stage IV: bargaining
Cognitive
disorganization;
emotional despair;
difficulty
functioning
Confiding in others
to emote and
to cognitively
restructure
account of loss
Dealing: adapting to
the loss
Stage V: acceptance
Cognitive
reorganization;
reintegrating
sense of self
Healing: integration
of loss; acute
anguish dissi-
pated; loss may
or may not be
forgotten or
accepted
Table 12-1
THEORETICALUNDERSTANDING OF THEGRIEVINGPROCESS
Theorist/Clinician Phase I Phase II Phase IIIPhase IV
