if the bereaved person cannot move through the griev-
ing process.
In the phase of reorganization, the bereaved per-
son participates in activities and reflection that are
personally meaningful and satisfying. After finding
creative outlets and building her personal growth,
Margaret states, “I’m happy with who I am and what
I do. My life is more authentic.”Physiologic Responses to Grief
Physiologic symptoms and problems associated with
grief responses are often a source of anxiety and con-
cern for the grieving person as well as friends or care-
givers. Those grieving may complain of insomnia,
headaches, impaired appetite, weight loss, lack of en-
ergy, palpitations, indigestion, and changes in the im-
mune and endocrine systems. Sleep disturbances are
among the most frequent and persistent bereavement-
associated symptoms (Zisook & Downs, 2000).
CULTURAL CONSIDERATIONS
Universal Reactions to Loss
Although all people grieve for lost loved ones, rituals
and habits surrounding death vary among cultures.
Each culture defines the process of grieving and in-
tegrating loss into life in ways consistent with its be-
liefs about life, death, and an afterlife. Each culture
considers certain aspects of the experience more im-
portant than other aspects (Rotter, 2000)Universal reactions include the initial response
of shock and social disorientation, attempts to con-
tinue a relationship with the deceased, anger with
those perceived as responsible for the death, and a
time for mourning. Each culture, however, defines
specific acceptable ways to exhibit shock and sadness,
display anger, and mourn (Bowlby, 1980). Cultural
awareness of rituals for mourning can help nurses
understand an individual’s or family’s behavior.Culture-Specific Rituals
As people immigrate to the United States and Canada,
they may lose rich ethnic and cultural roots during
the adjustment of acculturation(altering cultural
values or behaviors as a way to adapt to another cul-
ture). For example, funeral directors may discourage
specific rites of passage that celebrate or mourn the
loss of loved ones or they may be reluctant to allow
behavioral expressions they perceive as disruptive.
Many such expressions are culturally related, and
health care providers must be aware of such instances.
For example, the Hmong (people of a mountainous
region of Southeast Asia) believe that harm will come
to the loved one in the next life if the body is invaded
just prior to death. Nurses and physicians inhibit
mourning when they hesitate to accommodate rela-
tives who protest the intrusion of needles and tubes
in their dying loved one (Nelson, 2002).
Because cultural bereavement rituals have roots
in several of the world’s major religions (i.e., Bud-
dhism, Christianity, Hinduism, Islam, Judaism), reli-
gious or spiritual beliefs and practices regarding
death frequently guide the client’s mourning. In the
United States, various mourning rituals and practices
exist. A few of the major ones are summarized below.AFRICAN AMERICANS
Most ancestors of today’s African Americans came to
the United States as slaves and lived under the in-
fluence of European American and Christian reli-
gious practices. Therefore, many mourning rituals
are tied to religious traditions. In Catholic and Epis-
copalian services, hymns may be sung, poetry read,
and a eulogy spoken; less formal Baptist and Holiness
traditions involve singing, speaking in tongues, and
liturgical dancing. Typically the deceased is viewed in
church before being buried in a cemetery. Mourning
also may be expressed through public prayers, black
clothing, and decreased social activities. The mourn-
ing period may last a few weeks to several years.MUSLIM AMERICANS
Islam does not permit cremation. It is important to
follow the five steps of the burial procedure, which246 Unit 3 CURRENTSOCIAL ANDEMOTIONALCONCERNSPhysiologic symptoms