Helping Patients Cope with Grief: Creating a Niche for Nurses
In the past, nursing students learnt about anatomy and physiology of a system, dealt with an infected toe, a brain with infarcts, a heart with surgeries etc. but nowadays, students are learning about the wholeness of people, a physically ill child struggling for safety in an abusive family, an adolescent coping with self-esteem and ego, a young adult grieving or feeling stigmatized with the diagnosis of cancer and its complications. This is the world of Oncology.
Grief and the grieving process:
It is complex phenomenon which deals with multiple dimensions of grief but there is a lack of explanation in the context of why and how grief response occurs.
Bowlby’s proposed an attachment theory which deals with reasoning behind grief in response to death and major losses. According to this theory, attachments develop from needs for security and safety which are acquired throughout life. Bowlby proposed that grief responses are biologically general responses to separation and major losses and these behavioral responses make up the grieving processes.
Dimensions of grief : The process of grief is multifaceted, with bereaved individuals experiencing major physical, emotional and cognitive changes.
Physical Response: It includes the physical signs and symptoms such as tight feelings in throat and chest, over sensitivity to notice, breathlessness, and muscular weakness and of energy (Barton and Irwin 1992).These sensation are considered to be a normal component of grief, but intermittently, physical health may be seriously impaired.
Emotional response: Grief is a fundamental emotional response to loss, which includes sadness, fatigue, depression, shock, anger guilt and anxiety. Although grief and depression do share a number of similar aspects including sleep and appetite disturbance, intense sadness but these aspects are evident for a shorter period of time. However, the intense feeling of loneliness and isolation, following the death of loved one can make a bereaved person withdraw from social contact (Worden, 1991) In most of the cases, if anger is not addressed, complications may occur.
Cognitive response: Most of the time new thought pattern occurs in the early stages of mourning but disappear after short period. However, persistent maladaptive behaviors may lead to depression or anxiety. Disbelief is often an initial cognitive reaction, although this response is usually transitory but it can persist and become denial. Other cognitive responses include feelings of confusion and difficulty in organizing thoughts. The bereaved may report to a sense of presence of their deceased loved ones and of auditory and visual hallucinations: these feelings might provide comfort in coping with loss.
Normal grieving: includes a variety of feeling, moods and behavior that follow a significant loss of someone or something that was meaningful to the person e.g. the death of a loved one. Following are the two types of grief.
Anticipatory grief: It is a multidimensional process that includes the intellectual and emotional responses and behaviors which an individual experiences before a perceived potential loss or grieving before the actual loss occurs.
Dysfunctional grief: It is a process that includes maladaptive intellectual and excessive or prolonged emotional responses and behaviors that get intensified to a degree wherein an individual is unable to progress through the process of normal grieving after experiencing a significant loss.
Losing a close family member or any potential losses are an unpleasant reality. Certain life events or illness may cause extreme or abrupt change in people’s life. These disabling conditions increasingly compromise a person’s ability to function independently.
Grief is an aspect of the human situation that touches every individual, but the way an individual or a family system responds to losses and how grief is expressed, varies widely. The more significant the loss, the more intense the grief is. Grieving is a personal and highly individual experience.
How you grieve depends on many factors including your personality and coping style, your life experience, your faith and the nature of the loss. Healing happens gradually; it can’t be forced or hurried. It’s important to be patient with yourself and allow the process to naturally unfold.
Complicated grief: Also referred to as prolonged grief disorder. (Prigerson, vanderwerker and maciejewski, 2008). The inability to accept the fact that a loss has occurred can lead to prolong, excessive denial as well as prolonged depression, inability to trust others, feelings that life is meaningless and suicidal ideation.
In 1969, psychiatrist Elisabeth Kubler Ross introduced “Five stages of Grief”.
Denial: “This can’t be happening to me.”
Anger: “Why is this happening?” “Who is to blame?”
Bargaining: ”May this not happen, and in turn I will…….”
Depression: “I am too sad to do anything.”
Acceptance: “I am peace with whatever happened.”
Expert nursing care is essential for patient care in end of life situations. It is the nurse who spends most of the time with the patients and their families. The oncology nurse provides the type of care that allows patients and families to grow in the experience of dying. Through care, the patients or families may experience the final phase of life as one that heals.
The role of an oncology nurse in the care of a patient who is undergoing the process of dying includes imparting information and education related to the bereavement process, clinical acknowledgment of abnormal bereavement, offering emotional support, extending communication with the bereaved family after death, enabling effective palliative care which focuses on spiritual, psychological, physical, and social aspects of the patient’s life.
They also encourage caregivers to maintain a healthy lifestyle during the periods of caregiver burden, as well as during bereavement; and honour rituals of death and mourning in a culturally sensitive manner. By listening to their concerns, nurses can make a difference in the ability of the bereaved family members to move towards their life goals, such as appreciation of a significant relationship, acceptance of change, and development of new life patterns and relationships.
Dec 1, 2011 – Hirsch M, ed. Coping with Grief and Loss: A Guide to Healing (Harvard Health Publications, 2010). Mojtabai R.
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Murray, c. i. (2000). “coping with death, dying, and grief in families.” in families and change: coping with stressful events and transitions, 2nd edition, ed. p. c. mckenry and s. j. price. thousand oaks, ca: sage.
Harvey, j. h. (2000). give sorrow words: perspectives on loss and trauma. philadelphia: brunner/mazel.