Loss and Grief

Loss and grief in nursing is a widely discussed psychosocial theory and in this essay we will look at it further in nursing care. Loss is an inevitable part of life, and grief is a natural part of the healing process, or to be defined individually, “Loss is wider than a response to a death, important as that is. It is any separation from someone or something whose significance is such that it impacts our physical or emotional well-being, role and status” (Weinstien 2008, p.2). “Bereavement is the response to a loss. It is a core human experience, common to, and also varying across all cultures and historical periods. Grief is the interpersonal or psychological expression of the bereavement” (Weinstien 2008, p.3). In this essay we also explain the importance of nurses understanding loss and grief and its significant role in nursing care. We also want to illustrate the different responses too loss and how we as nurses can help and care during the grieving process. This can be helped achieved through the different theories of loss which we also look at and how we can apply these theories in nursing care and practice. Wright (2007), talks extensively about the different forms of loss and how life changes produce feelings of loss which lead too grief. These life changes could vary from the death of a spouse or close friend to the death of a pet or loss of a job to retirement. Each form will have different effects on different individuals.

As Penson (1990) points out that death and loss of a loved one is something in life that we are all likely to experience and more often as professionals in nursing care. This is also highlighted in an article from the Nursing Standard. It conveys that death is a situation that is frequently encountered by nurses and other healthcare professionals in the course of their work. It is important that nurses have a good understanding of the reactions and responses to grief and bereavement so that they are in a better position to support patients, family members and relatives during the grieving process (Buglass 2010). According to Greenstreet (2004) the nurse is usually the healthcare professional present at an expected death and are therefore involved in supporting the significant others, the survivors at the moment of bereavement. People struggle with many intense and frightening emotions, including depression, anger, and guilt. Often, they feel isolated and alone in their grief. Having someone to lean on can help them through the grieving process. The mental health practitioner needs to understand grief and recognize the role it plays in medical and psychiatric problems (Worden 1991).

Loss and the related emotions are everywhere in healthcare and we are in the position to use our own experiences of loss and grief to help understand and communicate to the patient. In helping our understanding, theories can help us stand outside the situation and retain a professional boundary. Kűbler-Ross (1969) theory on death and dying resulted in dying people discussing how they felt after hearing the news of their terminal state. The five stages identified were Denial, Anger, Bargaining, Depression and Acceptance. These famous five stages have been applied in nursing care and although referred to as a stage model, it is not expected or likely that people will work through their losses in the stated order. In nursing care using the Kubler-Ross theory the patient enters the first stage of the grieving process-a state of shock and denial. As they accept the reality of the loss and start to ask questions, they are unknowingly beginning the healing process. This moves to anger which can be directed at different people including the nurse. They then begin to bargain, they will do anything not too feel the pain of the loss.

The next stage in this theory is depression and is looked at as a process of healing and a necessary step along the way. Finally comes acceptance however this is not saying that everything is now alright it is recognising the new reality and readjusting as grief has to be given time (Kubler-Ross, 1969). Another similar theory is that of Worden (2002) used the phase model of bereavement to develop a therapeutic model called ‘the tasks of mourning’. It also is applied in stages, accepting the reality of the loss, experiencing the pain of the loss, adjusting to an environment in which the deceased is missing and looking at investing in other relationships with the object of loss integrated into the new future as the bereaved person chooses. According to White and Ferszt (2009) they identify Wordens (2002) theory as four tasks that must be completed and each task provides a prescriptive guide for counsellors to use in facilitating an individual’s grief. Although they recognise that this theory can be used as a guide they state that caution must also be given not to oversimplify the approach to grief counselling and identify the different individual coping styles.

In contrast to Kubler-Ross (1969) and Worden (2002) theories, Strobe and Schut’s (1999) dual process model takes a different approach and move away from phases. This describes how the bereaved individual has to cope with the experience of loss itself as well as other changes that result from it. For one thing it could be argued that those phased theories are too specific for loss and grief in nursing care. The strength of Strobe and Schut’s (1999) theory according to White and Ferszt (2009) is that it allows for broad application of gender and cultural differences in the grieving process. Neimeyer and Anderson (2002) theory regarding the grieving process is achieved through ‘telling the story’ it is similar to that of the dual process model that it identifies that each person experiences loss in a different and a unique way. With regard to all the above theories Greenstreet (2004) suggests that their value to nurses in practice lie in their attempt to explain and describe responses that are normal and so infer how nurses can best support the bereaved in their care and recognise those who need additional support.

In conclusion we have looked at the importance of nurses understanding the aspects of loss and grief and illustrated that this psychosocial aspect is predominant in nursing care. Grief is something we as nurses will deal with throughout our profession and the more we learn to understand this psychosocial aspect we will be in a better position to support and help the people in our care. In the essay we have discussed a number of theories that can be used as tools in the grieving process to help those affected overcome their loss. Although some theories discussed differ from others they can all be applied to nursing care and all provide us as nurses with additional knowledge in the grieving process. These theories can give nurses confidence going forward in caring and help equip them with some knowledge in understanding the complicated process of loss and grief. We are not expected to have all the answers as nurses but we are expected to better ourselves in our profession to ensure we give the best possible care we can.

References

Buglass , E. (2010) Grief and bereavement theories. Nursing Standard, 24 (41), 44-47 Dent, A. (2005) Supporting the bereaved: linking theory to practice. Healthcare Counselling & Psychotherapy Journal, 5(3), 102-107. Greenstreet, W. (2004). Palliative care nursing. Why nurses need to understand the principles of bereavement theory. British Journal of Nursing
, 13 (10), 590-593. Kubler-Ross, E. (1969). On death and dying. Macmillan: New York. Neimeyer, R., and Anderson, A. (2002) Meaning reconstruction theory in loss and Grief, TN, Memphis. Penson, J. (1992) Bereavement, a guide for nurses. Chapman and Hall, London. Stroebe, M. And Schut,H. (1999). The dual process model of coping with bereavement: Rationale and description. Death Studies, 23(3), 197–224.

Weinstein, J. (2008) Working with loss, death and bereavement: A guide for social workers. Sage, London. White, P., and Ferszt, G. (2009) Exploration of nurse practitioner practice with clients who are grieving. Journal of the American Academy of Nurse Practitioners, 21 (4), 231-40. Worden, W. (1991). Grief counselling and grief therapy. 2nd ed. Springer publishing, New York. Worden, W. (2002). Grief counseling and grief therapy . 3rd ed. Springer publishing: New York. Wright, B. (2007) Loss and grief: Skills for caring. M&K Ltd, Leeds.