Death and Dying Handout: Grief

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Death and Dying Handout:

Grief: grief is a natural response to a loss. The emotional suffering that one feels when someone or

something you love is taken away. Examples:

  1. A relationship breakup

  2. Loss of health

  3. Lose of a job

  4. Loss of financial stability

  5. A miscarriage

  6. Death of a pet

  7. Loss of a cherished dream

  8. A loved one’s serious illness

  9. Loss of a friendship

  10. Loss of safety after a trauma

Types Of Grief:

  1. Uncomplicated Grief: “NORMAL GRIEF”

A grief reaction that normally follows a significant loss

Physical reactions:

Loss of appetite, insomnia, fatigue, decreased libido, restlessness

Psychological reactions:

Helplessness, hopelessness, denial, anger

  1. Dysfunctional Grief:

  • These individuals DO NOT progress through the stages of overwhelming emotions and fail to demonstrate any behaviors commonly associated with grief.

  • They remain isolated and DO NOT return to their normal life.

  • They continue to focus on the deceased and they usually need professional counseling.

There are different forms of dysfunctional grief:

Chronic Grief: Inability to conclude grieving

Delayed grief: When grief does not take place at the time of the loss.

Exaggerated grief: When grief is expressed as overwhelming

Masked grief: When grief is covered up by maladaptive behaviors (i.e.

Apathy, irritability, unstable moods etc.

  1. Anticipatory Grief:

Is the occurrence of grief BEFORE an expected loss usually occurs.

  1. Disenfranchised Grief:

Grief that is not openly acknowledged, socially sanctioned or publicly shared.

(ie loss of a pet)

Five stages of Grief: Elizabeth Kubler-Ross Model ( Claimed these steps do not necessarily come

in the following order, nor are all steps experienced by all patients )

Denial: “This can’t be happening to me”, “I feel fine”

Anger: “Why is this happening? Who is to Blame?”, Why me?

Bargaining: “Make this not happen and in return I will ____””, Just let me live to see my

child graduate”

Depression: “I’m too sad to do anything”, “I’m going to die …What’s the point?”

Acceptance: “I’m at peace with what happened.”, “It’s going to be Ok”, “I can’t fight it”

Common Symptoms of grief:

  1. Shock and Disbelief: Right after a loss, it can be hard to accept what happened. You may

feel numb have trouble believing that the loss really happened or even

deny the truth.

  1. Sadness : Profound sadness is probably the most universally experienced symptom of


  1. Guilt: A person may regret or feel guilty about things they did or did not say or do.

  2. Anger: Even if the loss was nobody’s fault, a person may feel angry and resentful.

  3. Fear: A significant loss can trigger a host of worries and fears.

  4. Physical symptoms: Such as fatigue, nausea, lowered immunity, weight loss/gain, aches

and pains, insomnia

How to cope with grief:

  1. Get support:

  1. Turn to friends and family members

  2. Draw comfort from your faith

  3. Join a support group

  4. Talk to a therapist or grief counselor

  1. Take care of yourself:

A. Face your feelings

B Express your feeling in a tangible or creative way (ie write about your loss in a


  1. Look after your physical health

  2. Don’t let anyone tell you how to feel, and don’t tell yourself how to feel either.

  3. Plan ahead for grief “triggers” (ie: Anniversaries, Holidays. Milestones etc.)

How to support a grieving person:

  1. Ask them about their feelings (allow them to express their feelings and fears)

  2. spend time with them,

  3. listen when they want to talk

Contact grief counselor if:

  1. Patient feels like life isn’t worth living

  2. When patient wishes they had died with their loved one.

  3. When a person blames themselves for the loss or for failing to prevent it.

  4. When a person feels numb and disconnected from others for more than a few weeks.

  5. Person is having difficulty trusting others since their loss.

  6. Person is unable to perform their normal daily activities.

Loss: Is any situation either actual, potential, or perceived wherein a valued object or person is

changed or is no longer accessible to the individual.

Types of Loss: A Loss can be 1. Tangible or Intangible

  1. Actual or Anticipated

(ie. If a person is not selected for a job : INCOME

is the Tangible loss/ Intangible loss is: SELF ESTEEM)

“ An Intangible loss is a loss that is NOT evident to others “

  1. Perceived Loss: Sense of loss felt by an individual but not tangible to others. (ie Loss of self -


  1. Actual Loss: Loss of someone or something (ie Death of a loved one Theft of property)

  2. Anticipated Loss: (i.e. Diabetic patient has a foot amputation)

  3. Physical Loss: Loss of a part or aspect of a body (ie. Loss of an extremity)

  4. Psychological loss: Emotional loss (women feeling inadequate after menopause)

6. Maturational Loss: A loss that occurs as a person moves from 1 developmental stage to

another (IE. Toddler who loses a bottle and begins to drink from a cup/

a person who accepts the responsibility of their first full time job)

7. Situational Loss: A Loss that takes place in response to external events that the person has no

control over (i.e. Loss of a job when the company goes bankrupt or the

company downsizing)

Factors that affect Loss and grief:

  1. Development stages :

Childhood: Infant and toddler: Not aware of what death is

Preschool: view death as a temporary separation

School Age: Fantasizes about death and tends to personify death.

Preadolescence and adolescence: Understands death and recognizes that death is final.

Early Adulthood: Grief is usually precipitated by loss of role or statue.

Middle Adulthood: Death of a peer may threaten their own mortality.

Late Adulthood: Individuals realize that death is inevitable.

  1. Religious cultural beliefs

  2. Relationship with the lost object.

  3. Cause of death (expected or unexpected suicide etc.)

How to Talk to children about death:

  1. Avoid the use of euphemisms: (i.e. Substituting death for “sleeping” )

  2. Do Not overexplain: (i.e. using medical terms such as “Congestive Heart Failure”)

  3. Use simple concrete terms: (i.e. “grandma is in a better place now”)

  4. Show them : ((take them to the funeral service and cemetery)

Legal considerations about Death:

  1. Advance directives: Includes “Living Will”/ “Durable Power of Attorney”

  2. Health care Surrogate Law: Legal Means for specific individuals to make decisions for patients

FIRST: Spouse followed by Children

  1. Autopsy: May be mandated when there is an unusual death

  2. Organ Donation

  3. Physician’s pronounce patients death/ Hospice Nurse

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