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:
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A relationship breakup
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Loss of health
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Lose of a job
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Loss of financial stability
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A miscarriage
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Death of a pet
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Loss of a cherished dream
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A loved one’s serious illness
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Loss of a friendship
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Loss of safety after a trauma
Types Of Grief:
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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
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Dysfunctional Grief:
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These individuals DO NOT progress through the stages of overwhelming emotions and fail to demonstrate any behaviors commonly associated with grief.
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They remain isolated and DO NOT return to their normal life.
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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.
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Anticipatory Grief:
Is the occurrence of grief BEFORE an expected loss usually occurs.
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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:
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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.
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Sadness : Profound sadness is probably the most universally experienced symptom of
grief.
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Guilt: A person may regret or feel guilty about things they did or did not say or do.
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Anger: Even if the loss was nobody’s fault, a person may feel angry and resentful.
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Fear: A significant loss can trigger a host of worries and fears.
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Physical symptoms: Such as fatigue, nausea, lowered immunity, weight loss/gain, aches
and pains, insomnia
How to cope with grief:
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Get support:
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Turn to friends and family members
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Draw comfort from your faith
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Join a support group
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Talk to a therapist or grief counselor
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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
Journal)
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Look after your physical health
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Don’t let anyone tell you how to feel, and don’t tell yourself how to feel either.
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Plan ahead for grief “triggers” (ie: Anniversaries, Holidays. Milestones etc.)
How to support a grieving person:
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Ask them about their feelings (allow them to express their feelings and fears)
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spend time with them,
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listen when they want to talk
Contact grief counselor if:
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Patient feels like life isn’t worth living
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When patient wishes they had died with their loved one.
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When a person blames themselves for the loss or for failing to prevent it.
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When a person feels numb and disconnected from others for more than a few weeks.
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Person is having difficulty trusting others since their loss.
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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
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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 “
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Perceived Loss: Sense of loss felt by an individual but not tangible to others. (ie Loss of self -
esteem)
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Actual Loss: Loss of someone or something (ie Death of a loved one Theft of property)
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Anticipated Loss: (i.e. Diabetic patient has a foot amputation)
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Physical Loss: Loss of a part or aspect of a body (ie. Loss of an extremity)
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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:
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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.
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Religious cultural beliefs
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Relationship with the lost object.
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Cause of death (expected or unexpected suicide etc.)
How to Talk to children about death:
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Avoid the use of euphemisms: (i.e. Substituting death for “sleeping” )
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Do Not overexplain: (i.e. using medical terms such as “Congestive Heart Failure”)
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Use simple concrete terms: (i.e. “grandma is in a better place now”)
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Show them : ((take them to the funeral service and cemetery)
Legal considerations about Death:
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Advance directives: Includes “Living Will”/ “Durable Power of Attorney”
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Health care Surrogate Law: Legal Means for specific individuals to make decisions for patients
FIRST: Spouse followed by Children
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Autopsy: May be mandated when there is an unusual death
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Organ Donation
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Physician’s pronounce patients death/ Hospice Nurse
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