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This type of grief requires the professional intervention of a grief counselor, a psychiatric nurse practitioner, or a psychologist who is skilled in helping grieving elders Corless, The person whose loss cannot be openly acknowledged or publicly mourned experiences what is called disenfranchised or unspeakable grief. The grief is socially disallowed or unsupported Doka, The person does not have a socially recognized right to be perceived or function as a bereaved person. In other words, a relationship is not recognized; the loss is not sanctioned; or the griever is not recognized.

Disenfranchised grief has frequently been associated with domestic partnerships e. In the language of the Loss Response Model, coping with loss is the ability to move from a state of chaos and disequilibrium to one of reorder, equilibrium, and peace. Many factors affect the ability to cope with loss and grief Box Number of concurrent medical conditions. Nutritional state, if inadequate, reduces the ability to cope or meet demands of daily living; Inadequate rest can lead more quickly to mental and physical exhaustion.

Exercise, if inadequate, limits emotional outlet; may increase aggressive feelings, tension, and anxiety. Individual coping behavior, personality, and mental health. Social, cultural, ethnic, religious, or philosophic background. Perceived importance of the loss or relationship to that which is lost. Individual support systems and the acceptance of assistance of its members.

Individual sociocultural, ethnic, religious, or philosophic background. Role that the deceased occupied in family or social system. These are individuals or families who have experience with the successful management of crisis. They are resourceful, and they are able to draw on techniques that have worked in the past. These individuals or families do the following:. In other words, the persons who cope with loss most effectively are those who can acknowledge the loss and try to make sense of it.

They can maintain composure, use generally good judgment, and can remain optimistic without denying the loss. Good copers seek guidance when it is needed. On the contrary, those who cope less effectively have few, if any, of these abilities. They tend to be more rigid, pessimistic, and demanding, and they experience emotional extremes.

They are more likely to be dogmatic and expect perfection from themselves and others. Ineffective copers are also more likely to live alone, socialize little, and have few close friends or have an ineffective support network. They may have a history of mental illness, or they may have guilt, anger, and ambivalence toward the individual who has died or that which has been lost.

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Those at risk for pathological grief will more likely have unresolved past conflicts or be facing the loss at the same time as other secondary stressors. They will have fewer opportunities as a result of the loss. They are the elders who are most in need of the expert interventions of grief counselors and skilled gerontological nurses.

Loss, grief, and death are parts of the lives of all and occur with increasing frequency as one ages. The goal of the gerontological nurse is not to prevent grief but to support those who are grieving and coping with loss. Although the acute emotions associated with loss will go away, the potential long-term detrimental effects can be ameliorated. While promoting healthy aging, the nurse works with grieving elders as part of the normal workday; this is both a privilege and a responsibility. It is one of the few areas in nursing in which small actions can make a large difference in the quality of life for the persons to whom we provide care.

The goal of the grief assessment is to differentiate those who are likely to cope effectively from those who are less likely so that appropriate interventions can be planned Box A grief assessment is based on knowledge of the grieving process. Previous experience with illness, pain, deterioration, loss, grief. The nature of the illness death trajectory, problems particular to the illness, treatment, amount of pain. Comfort in expressing thoughts and feelings and how much is expressed. Relationship with each member of the family and significant other since diagnosis.

Family rules, norms, values, and past experiences that might inhibit grief or interfere with a therapeutic relationship. From Hess PA: Loss, grief, and dying. A thorough grief assessment includes questions about spiritual or existential needs, such as recent significant life events, and the relationship to that which has been or will be lost. Information about concurrent life stresses will help determine the intensity of support needed and the risk for complicated grieving.

The nurse determines what stress management techniques are normally used and if they have been helpful e. Are usual support systems available? If the loss is of a partner, how was the relationship? The loss of an abusive or controlling partner may liberate the survivor, who may feel guilty for not feeling the amount of grief they or others expect. For many older women who depended on their spouses financially, death may leave them impoverished, significantly complicating their grief. A survivor may be suddenly homeless after the loss of a domestic partner in jurisdictions in which such relationships are unrecognized.

Therapeutic communication, a basic nursing skill, is the cornerstone of gerontological nursing, end-of-life care, and palliative care. This includes knowing what to say and when to listen.

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At all times, communication begins with gently establishing rapport. Nurses introduce themselves and explain their roles e. If it is the time of impact e.

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While it is tempting to give advice at this time, it is more therapeutic to provide a grieving person permission to express feelings. Nurses observe for functional disruption and offer support and direction in the immediate postcrisis period. They may have to help the family figure out what needs to be done immediately and find ways to do it—the nurse either offers to complete the task or finds a friend or family member who can step in so the disruption does not have any deleterious effects and movement toward equilibrium is possible.

Understanding Bereavement and Grief - Irish Hospice Foundation

As grievers search for meaning, they may need help finding what they are looking for and spend time talking it out. Sometimes what they are looking for is information about a disease, a situation, or a person, and the nurse can assist in obtaining the information whenever possible. Talking it out requires active listening when grievers are trying to make sense of the loss and find meaning in it, questioning their values, and constructing new ones to account for the change in their reality.


The expressions of grief and emotion, be they moments of panic or hysteria, and sharing them with others help make the grief less frightening. Sometimes nurses offer to inform others for the grievers, thinking that this is something that will help. Because it usually is therapeutic for grievers to talk to others about the losses, nurses should refrain from helping in this way. As the person or family moves toward equilibrium after a loss, be it a death, a move from home to a nursing home, or other change with meaning, the nurse can help the person reorganize this new life. The nurse talks with the elder about what was most valued about living at home and what habits were comforting and finds ways to incorporate these in a new way to the new environment.

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For the cycle of grieving to reach some level of resolution, new memories are needed. Reminiscence is often helpful in creating new memories see Chapter 6. Listening to the story, endlessly repeated, is difficult to do.

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  • The story is likely to change with each retelling as new memories or perspectives develop. Reminiscence is a means by which denial can fall by the wayside and allow reality of the loss to filter slowly into the conscious mind. Reminiscence helps the griever acknowledge that the loss is indeed real and that life can go on, even though the future may be experienced in a different way. By incorporating the loss and putting the deceased into the life story in a new way re-forming the story , energy can be invested in all other relationships that exist or may come to be. Drawing out anecdotes and vignettes of the relationship helps the griever keep control over the story of his or her life and reframe it into a new, updated memory.

    Encourage the griever to talk and tell the story of the relationship as it had been. Weisman suggests four specific types of interventions or countercoping strategies: 1 clarification and control, 2 collaboration, 3 directed relief, and 4 cooling off. The nurse helps elders cope with loss and dying by helping them confront the loss by getting or receiving information, considering alternatives, and finding a way to make the grief manageable.

    The nurse helps persons resume control by encouraging them to avoid acting on impulse. Some temporary directed relief may be necessary, especially during acute grief. Catharsis may be helpful. In many instances, the nurse encourages the griever to cry or otherwise express feelings, such as hurt or anger.

    For some, the experience of grief may be physical: aches and pains, difficulty eating or sleeping, fatigue.

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    Grief can affect our spiritual selves, too; our relationship with our faith beliefs may change or grow stronger. Bereavement care is an essential component of hospice care that includes anticipating grief reactions and providing ongoing support for the bereaved over an extended period.

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    • We welcome the opportunity to share our experiences with you. However, the palliative care team should be aware of the process and common themes that emerge during anticipatory grief because the responses may have an effect on caregiving and the emotional status of the person with AIDS. Redefining terms related to expressions of grief "lose control" or "break down" can be reframed into "emotional releases," which are normal, expected aspects of coping with stress and grief.

      Encouraging people to live fully and enjoy life whenever and wherever they can As people face their death, they want to know that they will be remembered and that their life had meaning. Engaging patients and caregivers in life review and memory work are effective interventions in coping with anticipatory grief. Several factors affect the length and intensity of the grief process. These may help or hinder the bereaved move through the grief process. For those dealing with AIDS-related deaths, many of the factors experienced indicate significant risks and often complicate the grief process, leading to potentially dangerous health outcomes.

      This is a crucial factor during the grief process. Generally the greater the bond between the deceased and the bereaved, the greater the grief experienced. The type of bond parent, child, partner, sibling does not necessarily indicate the intensity of grief; every relationship is unique. However, the death of a child is usually always considered a high risk for the bereaved parent s. For those dealing with AIDS-related deaths, another complicating factor is that often the relationship may be disenfranchised , or not socially recognized as a valid relationship for which to grieve.

      Additionally, young children, the elderly, and the developmentally disabled are often considered unable to comprehend the loss, therefore unable to grieve. Anyone who is able to create a bond is able to grieve when that bond is threatened or broken.