sonal identity, direction, and purpose for living. He
or she gains independence and confidence (Bowlby,
1980). By experimenting with and accomplishing
newly defined roles and functions, the bereaved be-
comes personally empowered. This emotional and
affective experience is associated closely with the
inherent cognitive recognition that life without the
loved one is a reality and, therefore, must be different.
In this phase, the person still misses the deceased but
thinking of him or her no longer evokes painful feel-
ings. In the vignette, hearing Spanish music, which
Margaret associated with James’ love and her sense
of being loved, was unbearable for many months.
Spanish music now inspires warm memories of their
love for each other and comforts Margaret.Spiritual Responses to Grief
Closely associated with the cognitive and emotional
dimensions of grief are the deeply embedded per-
sonal values that give meaning and purpose to life.
These values and the belief systems that sustain
them are central components of spiritualityand the
spiritual response to grief. During loss, it is within
the spiritual dimension of human experience that a
person may be most comforted, challenged, or devas-
tated. The grieving person may become disillusioned
and angry with God or other religious figures such as
the priest who in Margaret’s situation seemed more
concerned about getting a paper than being aware of
her loneliness in the waiting room. The anguish of
abandonment, loss of hope, or loss of meaning can
cause deep spiritual suffering.
Ministering to the spiritual needs of those griev-
ing is an essential aspect of nursing care. The client’s
emotional and spiritual responses become intertwined
as he or she grapples with pain. With an astute aware-
ness of such suffering, nurses can promote a sense of
well-being. Providing opportunities for clients to
share their suffering assists in the psychological and
spiritual transformation that can evolve through
grieving. Finding explanations and meaning through
religious or spiritual beliefs, the client may begin to
identify positive aspects of grieving. The grieving
person also can experience loss as significant to his
or her own growth and development. In the vignette,
although Margaret was “disillusioned” with aspects
of her religious support system, she eventually finds
much comfort, hope, and strength in her spiritual be-
liefs. She begins to see that her husband’s death gave
her life new direction and empowered her to act in
new ways. She states, “If he hadn’t gone, I wouldn’t
be the person I am today. I’m very content and peace-
ful about who I am and what I am doing.” Through
her volunteer work, she comforts others who have
terminal illness.
Behavioral Responses to Grief
Behavioral responses to grief are often the easiest to
observe. By recognizing behaviors common to griev-
ing, the nurse can provide supportive guidance for
the client’s exploration of emotionally and cognitively
rough terrain. To promote the process, the nurse must
provide a context of acceptance in which the client
can explore his or her behavior. For example, ob-
serving the grieving person as functioning “automat-
ically” or routinely without much thought can indi-
cate that the person is in the phase of numbness—
the reality of the loss has not set in. Tearfully sob-
bing, crying uncontrollably, showing great restless-
ness, and searching are evidence of yearning and
seeking. The person actually may call out for the
deceased or visually scan the room for him or her.
Irritability and hostility toward others reveal anger
and frustration in the process. Seeking out as well as
avoiding places or activities once shared with the de-
ceased and keeping or wanting to discard valuables
and belongings of the deceased illustrate fluctuating
emotions and perceptions of hope for a reconnection.
During the phase of disorganization, the cogni-
tiveact of redefining self-identity is essential, although
difficult. Although superficial at first, efforts made in
social or work activities are behavioral means to sup-
port the person’s cognitive and emotional shifts. Drug
or alcohol abuse indicates a maladaptive behavioral
response to the emotional and spiritual despair. Sui-
cide and homicide attempts may be extremeresponses12 GRIEF ANDLOSS 245
Sobbing