(Based on Elsevier, Chapter 36)
🔶 1. What is Loss?
Loss = anything valued is gone or changed.
Types of Loss
- Actual loss → clearly seen (ex: death, limb amputation).
- Necessary loss → natural part of life (🧓 aging → “maturational loss”).
- Situational loss → sudden, unexpected (ex: accident, illness).
- Perceived loss → internal, not obvious to others (ex: loss of confidence).
➡️ Remember: Not all losses are visible.
🔶 2. Grief, Mourning, Bereavement
- Grief → emotional response to loss.
- Mourning → actions/behaviors expressing grief.
- Bereavement → grief + mourning (the whole experience).
🔶 3. Types of Grief (Easy Breakdown)
Normal (uncomplicated)
Gradual movement toward acceptance; healthy coping.
Anticipatory
Happens before the actual loss (ex: terminal illness).
Disenfranchised / Ambiguous
Grief that you can’t openly share or society doesn’t recognize. (ex: ex-partner, miscarriage, secret relationship).
Disenfranchised = “This grief is not allowed.”
Ambiguous = “This grief has no clear ending.”
Complicated Grief
Long-lasting, intense; interferes with functioning.
Types:
- Chronic – never ends
- Exaggerated – self-destructive behaviors
- Delayed – postponed reaction
- Masked – behaviors hide grief
🧠 4. Major Theories of Grief (Memorization-Friendly)
Kubler-Ross: Stages of Dying
DABDA → Denial, Anger, Bargaining, Depression, Acceptance
Attachment Theory (Bowlby)
- Numbing → emotional shock
- Yearning & Searching → crying, SOB, insomnia, loss of appetite
- Disorganization & Despair → questioning how/why loss happened
- Reorganization → adapting, learning new roles
Worden’s Grief Tasks Model
TEAR Mnemonic:
- T – To accept reality of the loss
- E – Experience the pain
- A – Adjust to a world without the deceased
- R – Relocate the deceased emotionally & move on
Rando’s “6 Rs” Model
Recognize
React
Recollect
Relinquish
Readjust
Reinvest
Dual Process Model
2 Switching Modes:
- Loss-oriented activities → crying, grief work, remembering
- Restoration-oriented activities → new routines, distractions, new roles
🔶 5. Factors Influencing Grief
➡️ Very testable.
- Developmental stage (children vs adults)
- Personal relationships
- Nature of the loss (sudden? expected?)
- Coping strategies
- Socioeconomic factors
- Culture
- Spiritual/religious beliefs
🔶 6. Nursing Process for Loss & Grief
Assessment
Use: presence, silence, listening, touch
Assess:
- Coping style
- Support system
- Beliefs & culture
- Patient’s goals
- Signs of grief
Nursing Diagnoses
- Impaired family coping
- Death anxiety
- Dysfunctional grief
- Anticipatory grief
- Acute or Chronic Pain
Planning
- Prioritize patient needs first
- Reassess frequently
Implementation
Health Promotion
- Palliative care = relief of symptoms, best quality of life
- Hospice = care for terminally ill, comfort, dignity
Therapeutic Communication
- Open-ended questions
- Non-judgmental presence
- Promote dignity
- Maintain peaceful environment
Support Family & Facilitate Mourning
- Prevent isolation
- Provide bereavement care
After Death Care
- Organ/tissue donation
- Autopsy considerations
- Postmortem care
Evaluation
Ask:
- Are goals met?
- Is grief complicated or progressing normally?
- Does the patient or family need more support?
🧩 7. Super-Fast Memory Section
🔥 Top 10 Facts to Memorize for Exams
- Loss = actual, necessary, situational, perceived
- Grief vs mourning vs bereavement
- Kubler-Ross DABDA
- Worden TEAR
- Rando’s 6R model
- Dual Process = loss mode + restoration mode
- Types of grief: normal, anticipatory, disenfranchised, complicated
- Culture & spirituality heavily influence grief
- Hospice = terminal, comfort; Palliative = quality of life (not dependent on prognosis)
- Nursing priority: presence + communication over “fixing”
📝 Quick Quiz
✔ A child leaving for college → Maturational loss
✔ Best preparation for caring for dying patient → Understand your own feelings about death