Loss, grief, and death are a commonplace experience related to perceived or anticipated losses of life, relationships, valued material objects, physiologic integrity, valued ideals, terminal illness, and other personal crises. The nurse interacts with dying clients and their families or caregivers in a variety of settings, and must recognize its effects on the dying process—legal, ethical, spiritual, biological, psychologic— and be prepared to provide sensitive, skilled, and supportive care to all those affected.
Loss and Grief
Loss is an actual or potential situation in which something that is valued is changed or no longer available. These are physical and abstract concepts such as loss of body image, a significant other, a sense of well-being, a job, personal possessions, or beliefs. Illness and hospitalization often produce losses.
Death is a loss for both the dying individual for those who survive. Although death is inevitable, it can push individuals to understand themselves better. Individuals experiencing loss often search for the meaning of the event, and it is generally accepted that finding meaning is needed in order for healing to occur. However, there are individuals who become well-adjusted without searching for meaning, and individuals who find meaning yet perceive it as an end point rather than an ongoing process.
Types of Loss
- Actual Loss is a type of loss that can be recognized by others.
- Perceived Loss is experienced by an individual but cannot be verified by others. Psychologic losses are often perceived losses because they are not directly verifiable.
- Anticipatory Loss, which can be both actual loss or perceived loss, is experienced before the loss actually occurs.
- Loss may be situational, e.g., losing one’s job, the death of a child, functional loss, or developmental (events occurring in normal development) such as subfertility in old age, the departure of one’s children, or retirement.
Sources of Loss
- Aspect of Self: body image (scarring), physical capabilities, and mental capabilities. Commonly vulnerable in old age.
- External Objects: inanimate objects that have importance to the individual, such as losing money or the burning down of a family’s house, and loss of animate objects such as pets that provide love and companionship
- Familiar Environment: separation from an environment and individuals who provide security can cause a sense of loss. Examples include 6-year-olds first leaving the home environment to attend school, or immigrants leaving their country to settle down in another (culture shock).
- Loved Ones: illness, divorce, separation, or death of loved ones are among the most powerful sources of loss. Changes in personality of the loved one may also make friends and family feel they have lost that individual.
Grief, Bereavement, and Mourning
Grief is the total response to the emotional experience related to loss. This manifests in thoughts, feelings, and behavior associated with overwhelming distress or sorrow. Bereavement is the subjective response experienced by the surviving loved ones. Mourning is the behavioral process through which grief is eventually resolved or altered; it is often influenced by culture, spiritual beliefs, and custom.
Bereavement may have potentially devastating effects on health. Symptoms that accompany grief include anxiety, depression, weight loss, difficulties in swallowing, vomiting, fatigue, headaches, dizziness, fainting, blurred vision, skin rashes, excessive sweating, menstrual disturbances, palpitations, chest pain, and dyspnea. It is important to work through one’s grief as the bereaved may experience alterations in libido, concentration, and patterns of eating, sleeping, activity, and communication.
While potentially threatening, a positive resolution of the grieving process can enrich the individual with new insights, values, challenges, openness, and sensitivity. For some, the pain of loss, though diminished, recurs for the rest of their lives.
Grief Responses
A normal grief reaction may be abbreviated or anticipatory.
- Abbreviated Grief: genuinely felt, but brief reaction.
- Anticipatory Grief: experienced in advance of the event.