Chapter 36 - Experience of Loss, Death, and Grief

Maturational losses

l. Form of necessary loss ,including all normally expected life changes across the life span

Situational losses

n. Sudden, unpredictable external event

Actual loss

m. Can no longer feel, hear, or know a person or object

Perceived losses

o. Are uniquely defined by the person experiencing loss and are less obvious to other people


f. Emotional response to a loss, which is unique to the individual


k. Outward social expression of grief and the behavior associated with loss that can be culturally influenced


b. Captures grief and mourning, emotional responses, and outward behaviors for a person experiencing loss

Normal grief

j. Complex emotional, cognitive, social, physical, behavioral, and spiritual response to loss and death

Complicated grief

i. Dysfunctional; the grieving person has a prolonged or significant time moving forward after a loss

Disenfranchised grief

d. Marginal or unsupported grief; the relationship may not be socially sanctioned

Delayed grief

h. Suppressing or postponing normal grief responses

Ambiguous loss

c. Difficult to process because of the lack of finality and unknown outcomes

Exaggerated grief

g. May exhibit self-destructive or maladaptive behavior, obsessions, or psychiatric disorder

Masked grief

e. Person is unaware of disruptive behavior as a resuIt of loss

Anticipatory grief

a. The unconscious process of disengaging before the actual loss or death occurs

Describe Kubler-Ross' five stages of dying. (5)

a. Denial (a person acts as though nothing has happened and refuses to accept the fact of the loss)
b. Anger (adjustment to loss; person expresses
resistance and feels intense anger toward others)
c. Bargaining (make promises to God or loved ones)
d. Depr

Describe Bowlby's attachment theory, the four phases of mourning. (4)

a. Numbing (stunned or unreal)
b. Yearning and searching (for the lost person or
c. Disorganization and despair (endlessly examines
how and why the loss occurred)
d. Reorganization (accepts change, assumes roles,
acquires new skills )

Describe Worden;s four tasks of mourning. (4)

a. Accept the reality of the loss.
b. Experience the pain of grief.
c. Adjust to the environment in which the deceased
person is missing.
d. Emotionally relocate the deceased person and move on with life.

Describe Rando's process model for mourning. (5)

a. Recognize the loss.
b. React to, experience, and express the pain of
c. Reminisce (telling and retelling stories).
d. Relinquish old attachments.
e. Readjust and reinvest.

Identify the factors that influence loss and grief. (8)

a. Human development
b. Personal relationships
c. Nature of the loss
d. Coping strategies
e. Socioeconomic status
f. Culture and ethnicity
g. Spiritual and religious beliefs
h. Hope

Identify the important areas of assessment.

It is important to assess the patient's coping style, the nature of the family relationship, personal
goals, cultural and spiritual belief, sources of hope, and availability of support systems .

List the nursing diagnoses that pertain to the patient experiencing grief, loss, or death.

a. Anticipatory Grieving
b. Compromised Family Coping
c. Death Anxiety
d. Fear
e. Impaired Comfort
f. Ineffective Denial
g. Grieving
h. Complicated Grieving
i. Risk for Complicated Grieving
j. Hopelessness
k. Pain
I. Risk for Loneliness
m. Spiritual Distr

List two outcomes appropriate for a patient who has the nursing diagnosis Powerlessness related to planned cancer therapy secondary to breast cancer. (2)

a. Will participate in treatment decisions
b. Will communicate treatment side effects or
concerns to the health care team

Define palliative care

Palliative care is the prevention, relief, reduction,
or soothing of symptoms of disease or disorders throughout the entire course of an illness, including care of a dying individual and bereavement follow-up for the family.

Identify the psychosocial care and symptom management that the nurse provides. (9)

a. Use therapeutic communication.
b. Provide psychosocial care.
c. Manage symptoms.
d. Promote dignity and self-esteem.
e. Maintain a comfortable and peaceful environment.
f. Promote spiritual comfort and hope.
g. Protect against abandonment and isolation

Identify the nursing strategies for the family members to facilitate mourning. (7)

a. Help the survivor accept that the loss is real.
b. Support efforts to adjust to the loss using a
problem-solving approach.
c. Encourage establishment of new relationships.
d. Allow time to grieve.
e. Interpret normal behavior.
f. Provide continuing sup

Define the following terms that relate to the care of the patient after death.
Organ and tissue donation

Organ and tissue donation provides information
about who can legally give consent, which organs
or tissues can be donated, associated cost , and how donation will affect burial or cremation.

Define the following terms that relate to the care of the patient after death.

Autopsy is the surgical dissection of a body after death to determine the cause and circumstances of death or discover the pathway of a disease.

Define the following terms that relate to the care of the patient after death.
Postmortem care

Postmortem care is the care of the body after death, maintaining the integrity of rituals and mourning practices.

Identify the short- and long-term outcomes that signal a family's recovery from a loss.
Short term

Short-term goals include talking about the loss without feeling overwhelmed, improved energy level, normalized sleep and dietary patterns, reorganization of life patterns, improved ability to make decisions, and finding it easier to be around people.

Identify the short- and long-term outcomes that signal a family's recovery from a loss.

Long-term goals include the return of a sense
of humor and normal life patterns, renewed or new personal relationships, and decrease of inner pain.

Which statement about loss is accurate?
1. Loss may be maturational, situational, or both.
2. The degree of stress experienced is unrelated to the type of loss.
3. Loss is only experienced when there is an actual absence of something valued.
4. The more a

I. Life changes are natural and often positive, which are learned as change always involves necessary losses .

A hospice program emphasizes:
1. Prolongation of life
2. Hospital-based care
3. Palliative treatment and control of symptoms
4. Curative treatment and alleviation of symptoms

3. Care of the terminally ill patient and his or her family

Trying questionable and experimental forms of therapy is a behavior that is characteristic of which stage of dying?
1. Anger
2. Bargaining
3. Depression
4. Acceptance

2. Cushions and postpones awareness of the loss by trying to prevent it from happening

All of the following are crucial needs of the dying patient except:
I. Control of pain
2. Love and belonging
3. Freedom from decision making
4. Preservation of dignity and self-worth

3. To help patients and families achieve the best
possible quality of life, determine the goals of care, and select the appropriate interventions