Loss is a painful experience which occurs throughout the lifecycle of an individual. Some of the normal losses in lifecycle include an infants loss of security of the mothers womb, loss of perceived body image as an individual transit from puberty to adulthood, and loss of attachment of a husband to his wife (Leifer & Fleck, 2012).
How responses to normal losses shapes an individuals responses to loss of life
Response to normal losses is important in shaping individuals responses to loss of life as it enables one to learn how to manage various forms of disappointments. Normal losses are also vital in shaping the quality of life that an individual maintains. Moreover, they determine how an individual perceive and manage losses in old age.
Difference between grief, mourning, and bereavement
Mourning and bereavement are related terms that are often used interchangeably. There, however, exist differences between these terms. In literature, grief and bereavement have been inconsistently used to refer to the state of having lost a person as a result of death, or the response accompanying the loss. However, researchers are of the view that bereavement is used to describe the fact of the loss while grief should be used to describe the responses that result from such a loss (Zisook & Shear, 2009). The responses can be emotional, behavioural, cognitive, or functional. On the other hand, mourning refers to the behavioural responses to grief. The manifestations of these responses are shaped by social and cultural rites e.g. funerals and visitations.
Stage of the grieving process
The grieving process occurs in five stages. These stages are denial, anger, bargaining, depression, and acceptance. It is worth noting that these stages are not necessarily linear. A grieving individual can switch back and forth between the mentioned stages. Also, not all individuals undergo through all these stages of grief.
Denial is an individuals first response to news of the loss of a loved one. Some of the physiological responses displayed in this stage include muscle weakness, anorexia, cold and clammy skin, tremors, and discomfort. The stage is marked by an individuals failure to accept to accept the reality of the loss. In denial stage, a grieving individual is locked up in a state of shock and denial. He or she sees life and the world as meaningless. One wonders if life can go on and why it should go on. This stage is important because it helps an individual to survive the loss, protects one from being overwhelmed, and helps begin the healing process. As one accepts the reality of the loss, he or she begins the healing process. Nursing interventions during this stage include the provision of support for emotional needs but not for denial, offering to remain with the affected person without discussing the reasons for his or her behaviour, and provision of regressive care e.g. food and drinks (Basavanthappa, 2003).
In anger stage, a person may express anger towards a family, health staff, and even the God. The affected individual may also get angry at the deceased. He or she becomes accusing. Anger may lead to a feeling of guilt and, consequently, lead to anxiety and lowering of ones self-esteem. During this stage, a nurse should meet the needs behind the angry response and provide counselling to the patient based on the feelings that accompany grief. The nurse should not take the anger displayed by the client personally (Basavanthappa, 2003).
The bargaining stage is also known as the What if stage. It is manifested by an individual making statements such as If only we had sought better treatment methods. A person in this stage tries to make a deal with God or a supreme being in an attempt to postpone the inevitable. Bargaining helps to provide temporary hope and allows one to adjust to reality. Some of the nursing interventions during this period include the provision of information a client needs in decision making.
In the stage of depression, a person displays reality, and permanence of loss is clearly manifested. This stage is characterised by confusion, loneliness, lack of interest, indecisiveness, suicidal thoughts, sadness, excessive drug use, and crying. An individual also withdraws from social relationships and activities. During this stage, nurses should provide support and empathy, assess a clients risk of harm to himself or herself and refer to a mental health practitioner if necessary. Nurses should also support crying by providing a touch that shows caring.
The acceptance stage is characterised by a persons acceptance of death and loss. In this stage, an individual shares his or her feelings about the loss and fondly remember past occurrences. The good times reminisced by an individual outweighs the bad and life begin to be stable. An individual has accepted the fact that death is real and positive feelings are evident. Some of the nursing interventions in this stage include: offering the affected individuals opportunities to share their feelings verbally or in writing, providing necessary assistance in discussing the future plans of the client, and providing individuals a chance to talk about the grieving experience.
Emotional, cognitive, and behavioral responses to grief
The grieving process is characterised by a variety of behavioural, emotional, and cognitive responses. Behavioural responses are the easiest to observe. These responses include loss of appetite, crying, whining, lack of sleep, loss of appetite, and restlessness. It may also be manifested through suicidal and homicidal attempts, alcohol abuse, and irritability towards others. On the other hand, the emotional response includes anxiety, sadness, and display of anger. Lastly, cognitive responses to loss of a loved one are seen through changes in thinking and attitudes of an individual. Examples of cognitive changes include a realistic view of the world, shedding misconceptions about immortality, and re-evaluation of religious beliefs (Anbu, 2014).
Religious and cultural practices associated with death
The grieving process is dictated by religious and cultural processes of a particular group of people. Culture refers to a set of behaviour, language, and practices that are passed down from one generation to the next (Leifer & Fleck, 2012). Within different cultures, the grief-related practices may vary. Examples of cultural practices include visits to the cemetery to say prayers to the deceased and rituals of commemorating the dead family members. On the other hand, religious practices include last rites conducted by priests for Catholics, body washing by a religious individual in the Jewish religion, and baptism of the deceased in Mormon religion (Eliopoulos, 2013).
Components of an abnormal grief
Abnormal grief (or complicated grief) refers to a syndrome of persistent and intense grief that is characterised by an inability to perform normal daily activities, impairment in health, and inefficiency in social functioning (Zisook & Shear, 2009). The symptoms of complicated grief include separation distress (characterised by unending painful emotions and obsession with thoughts of the deceased) and traumatic distress. Individuals with abnormal grief have a great difficulty coming to terms with the death of a loved one and have an intense longing that ends up becoming the central focus of their lives leading to frustration, anxiety, and sadness.
How condolences are expressed
Condolences are words (verbal or written) meant to convey sympathy and comfort to those who have lost a loved one (Brennan, 2014). This can be expressed in person e.g. by attending funeral services or through visitation or may be in the form of epistolary (letters and bereavement cards).
Response to death and grief across lifespan
The concept of death and dying is understood and responded in a variety of ways throughout the developmental stages of a human being. When the death of a loved one occurs, toddlers take on the anxiety and emotions of individuals around them while pre-schoolers question why and how death occurs. Pre-schoolers also feel that their thoughts and actions may have resulted in the loss of a loved one. In school-aged children, response to death is manifested by the need to know the details of the death and fear of family separation following death. Lastly, when an individual attains adolescence, he or she relates death to cultural and religious beliefs. They also feel immortal and are defiant even when undergoing death (Leifer & Fleck, 2012).
Importance of the letting go phase of grieving process
Letting go of stage of grief process helps an individual to recognize that death is a compulsory stage that an individual must go through in the life cycle. When an individual accepts that loss of life is part and parcel of life, they are can easily move on.
Anbu, T. (2014). Psychiatry Made Easy. JP Medical Ltd.
Basavanthappa, B. T. (2003). Fundamentals of Nursing. Jaypee Brothers Publishers.
Brennan, M. J. (2014). The AZ of Death and Dying: Social, Medical, and Cultural Aspects. ABC-CLIO.
Eliopoulos, C. (2013). Gerontological nursing. Lippincott Williams & Wilkins.
Leifer, G., & Fleck, E. (2012). Growth and development across the lifespan: A health promotion focus. Elsevier Health Sciences.
Videbeck, S. (2013). Psychiatric-mental health nursing. Lippincott Williams & Wilkins.
Zisook, S., & Shear, K. (2009). Grief and bereavement: what psychiatrists need to know. World Psychiatry, 8(2), 67-74.
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