strong bonds among them. The emotional effects of
loss are significant for these nurses; however, there
is seldom a socially ordained place or time to grieve.
The solitude in which the grieving occurs usually
provides little or no comfort (Albert, 2001).COMPLICATED GRIEVING
Some believe complicated grievingto be a re-
sponse outside the norm and occurring when a per-
son is void of emotion, grieves for prolonged periods,
or has expressions of grief that seem disproportion-
ate to the event. People may suppress emotional re-
sponses to the loss or become obsessively preoccupied
with the deceased person or lost object. Others actu-
ally may suffer from clinical depression when they
cannot make progress in the grief process (Enright &
Marwit, 2002). Figure 12-1 depicts an overview of
complicated grieving.
Previously existing psychiatric disorders also
may complicate the grief process, so nurses must
be particularly alert to clients with psychiatric dis-
orders who also are grieving. Grief can precipitate
major depression in a person with a history of the dis-
order. These clients also can experience grief and a
sense of loss when they encounter changes in treat-
ment settings, routine, environment, or even staff.
Although nurses must recognize that complica-
tions may arise in the grief process, the process re-
mains unique and dynamic for each person. Immense
variety exists in terms of the cultural determinants
in communicating the experience and the individual
differences in emotional reactions, depth of pain, and
time needed to acknowledge and grasp the personal
meaning or assimilate the loss. Box 12-1 discusses
styles of grieving.12 GRIEF ANDLOSS 249
Figure 12-1.Overview of complicated grief. Adapted from Bonanno & Kaltmann,
1999; Parkes, 1998; Stroebe, 2002; and Zisook & Downes, 2000.Box 12-1
➤ STYLES OFGRIEVING
When determining if a person may be experiencing a
complicated grieving process, the nurse should con-
sider viewing the person’s behavior as a unique style
of grieving. Silver and Wortman (1980) have suggested
three styles of grieving:- The bereaved vacillates from high to low distress
over time. - The bereaved shows no distress either as an
immediate response to loss or subsequently. - The bereaved remains in a high state of distress
for a period beyond what others would consider
appropriate.