Psych Chapter 10: Grief and Loss

The subjective emotion and affect in response to a significant loss is defined as ________.

grief

The process of experiencing and working through grief is known as ________.

grieving (or bereavement)

Outward expressions of grief through social or religious rituals are known as ________.

mourning

Loss of a limb, mastectomy, or paralysis are examples of ________ loss.

physiological

Loss of a safe home environment due to domestic violence or child abuse is an example of ________ loss.

safety

Loss of a loved one, divorce, or changing schools involves loss of security and ________.

belonging

Loss related to a change in how one is valued, such as job termination or retirement, is a loss of ________.

self-esteem

Grieving or processing a loss before it actually occurs is termed ________ grieving.

anticipatory

The five stages of grief identified by Elisabeth Kübler-Ross are denial, anger, bargaining, depression, and ________.

acceptance

According to Bowlby's theory of grieving, the stage involving disbelief and physical shock is ________.

numbness (or shock)

Worden's tasks of grieving state that the final task is to emotionally relocate the deceased and move on with ________.

life

Grief that is experienced when a loss cannot be openly acknowledged, publicly mourned, or socially supported is ________ grief.

disenfranchised

Examples of disenfranchised grief include losses related to extramarital affairs, abortions, or deaths from ________.

suicide (or substance overdose)

Grief that is persistent, severe, and incapacitating, lasting significantly longer than culturally expected, is ________ grief.

complicated (or prolonged)

Cognitive responses to grief often include difficulty concentrating, pre-occupation with the loss, and ________.

disbelief (or confusion)

Emotional responses to grief commonly include sadness, anger, guilt, and ________.

anxiety

Physical/somatic responses to loss frequently involve insomnia, loss of appetite, fatigue, and bodily ________.

aches (or pain)

Universal mourning rituals across cultures help facilitate social support and provide a structured framework for ________.

grieving

When assessing a grieving client, the nurse should assess their personal coping strategies, social support, and risk for ________.

complications (or suicide)

In caring for a grieving client, effective nursing communication involves active listening, presence, and avoiding false ________.

reassurance

Grief

The subjective emotional and affective response to a loss.

Grieving (Bereavement)

The active human process of experiencing and navigating grief.

Mourning

Outward, social, or cultural expressions of grief (e.g., funerals, wakes, wearing black, Shiva).

Hierarchy of Losses (Maslow's Framework):

Physiological Loss, Safety Loss, Security/Belonging Loss, Self-Esteem Loss, Self-Actualization Loss

Physiological Loss

Amputation, loss of mobility, mastectomy, hysterectomy.

Safety Loss

Loss of a safe home environment due to violence, abuse, or disaster.

Security/Belonging Loss

Divorce, death of a spouse, moving away, loss of relationships.

Self-Esteem Loss

Job loss, demotion, retirement, failure to achieve a goal.

Self-Actualization Loss

Inability to fulfill personal dreams or life ambitions.

Kübler-Ross Key Concepts

Non-linear process; individuals move back and forth between stages.

Bowlby Key Concepts

Attachment theory foundation; distress when attachment bond is severed

Worden (Tasks) Key Concepts

Grieving is an active process requiring completion of specific psychological tasks.

Kübler-Ross Progression

1. Denial

2. Anger

3. Bargaining

4. Depression

5. Acceptance

Bowlby Progression

1. Numbness / Shock

2. Yearning / Searching

3. Disorganization / Despair

4. Reorganization

Worden (Tasks) Progression

1. Accept reality of loss

2. Process pain of grief

3. Adjust to environment without deceased

4. Emotionally relocate deceased and move on

Dimensions of Grieving: Cognitive

Disbelief, confusion, difficulty concentrating, hallucinations of the deceased, pre-occupation.

Dimensions of Grieving: Emotional

Sadness, intense anger, guilt, anxiety, numbness, helplessness.

Dimensions of Grieving: Physical (Somatic)

Sleep disturbances, appetite changes, exhaustion, tight chest/throat, headaches, stomach distress.

Dimensions of Grieving: Behavioral

Crying, restless searching, withdrawal, social detachment, visiting places reminiscent of the lost person.

Dimensions of Grieving: Spiritual

Searching for meaning, questioning beliefs, anger at a higher power, or finding renewed faith.

Disenfranchised Grief

Occurs when a loss cannot be publicly acknowledged, socially validated, or openly mourned (e.g., unapproved relationships, abortion, death of an ex-spouse, death by suicide or drug overdose).

Complicated (Prolonged) Grief

Disorder where grieving remains intense, chronic, and debilitating beyond expected cultural timelines. Characterized by severe functional impairment, persistent longing, or feelings of life having no meaning.

Nursing Assessment Priorities

Assess client's perception of loss, support systems, spiritual/cultural practices, coping strategies, and risk factors for complicated grief (e.g., sudden violent death, history of depression, lack of support).

Nursing Communication

Use therapeutic presence and active listening. Validate feelings without offering cliché statements ("They are in a better place") or false reassurance.

Nursing Support

Encourage client to express feelings openly, utilize healthy coping mechanisms, and engage available support systems or grief counseling groups.