- Types of losses can be identified as unfulfilled
or unmet human needs. Maslow’s hierarchy
of human needs is a useful model by which to
understand loss as it relates to unfulfilled
human needs. - Grief work is one of life’s most difficult chal-
lenges. The challenge of integrating a loss
requires all that the person can give of mind,
body, and spirit. - Because the nurse constantly interacts with
clients at various points on the health–illness
continuum, he or she must understand loss
and the process of grieving. - Loss of a significant other activates attach-
ment behaviors that range from quiet
glances toward the significant other to fol-
lowing, clinging to, searching for and calling
out for the other, to wails of protest when the
significant other or object is lost. - The process of grieving has been described
in terms of dynamically interrelated phases:
numbness and denial; yearning and protest-
ing; cognitive disorganization and emotional
despair; and reorganization and reintegration.- Dimensions of human response include
cognitive, emotional, spiritual, behavioral,
and physiologic. People may be experienc-
ing more than one phase of the grieving
process. - Culturally bound reactions to loss are often
lost in the acculturation to dominant societal
norms. Both universal and culture specific
rituals facilitate grieving. - Nurses and other healthcare providers who
are constantly interacting with dying clients
are vulnerable to disenfranchised grief. - Complicated grieving is a response that lies
outside the norm. The person may be void of
emotion, grieve for a prolonged period, or
express feelings that seem out of proportion.
With so many variables in the grieving
process, what may appear to be complicated
grieving may be only the person’s unique
style of grieving. - Low self-esteem, distrust of others, a psy-
chiatric disorder, previous suicide threats
or attempts, and absent or unhelpful family
members increase the risk of complicated
grieving. - Situations considered to be risk factors for
complicated grief in those already vulnerable
include death of a spouse or child; a sudden,
unexpected death; and murder. - During assessment, the nurse observes and
listens for cues in what the person thinks
and feels and how he or she behaves then
uses this relevant data to guide the client in
the grieving process. - Crisis theory can be used to help the nurse
working with a grieving client. Adequate per-
ception, adequate support, and adequate
coping are critical factors. - Effective communication skills are the key to
successful assessment and interventions. - Interventions focused on the perception of
loss include exploration of the meaning of
the loss and allowing adaptive denial, which
is the process of gradually adjusting to the
reality of a loss. - Being there to help the client while assisting
him or her to seek other sources of support is
an essential intervention. - Encouraging the client to care for himself or
herself promotes adequate coping. - To earn the client’s trust, the nurse must ex-
amine his or her own attitudes about loss and
periodically take a self-awareness inventory.
For further learning, visit http://connection.lww.com.
- Dimensions of human response include
12 GRIEF ANDLOSS 257
Critical Thinking Questions
1.Although grieving is explained in terms of a
process of stages, the client experiences a
myriad of emotions and thoughts. What
phenomena of the grieving process give the
nurse concrete information about the client’s
progress? Of these phenomena, which is easiest
to observe? How must the nurse investigate
the meaning of this phenomenon?
2.What issues of loss does the nurse deal with
every day? What are the nurse’s most valu-
able tools for dealing with these losses? How
might the nurse use these tools across health
care settings?
3.A client in the psychiatric setting has recently
lost his mother. How will the nurse differenti-
ate between the client’s psychiatric illness
and a normal response to grief? How will the
nurse determine the risk of complicated grief
for this client?
4.How might the nurse maintain his or her pro-
fessional responsibility toward the therapeutic
relationship with those who are grieving for a
loss? What components of trustworthiness
must the nurse cultivate in relation to the
client who is grieving?