LOSS, GRIEF, DEATH AND DYING

• Loss


  Experience of being deprived of something significant or important in one's life. An actual or potential situation in which something that is valued or changed is no longer available.
• Death


  A fundamental loss, both for the dying person and for those who survived. End of a biological life, cessation of all vital functions.
• Types of Loss


  • Actual Loss
  • Perceived Loss
• Actual Loss


  • Can be recognized by others. Examples: death of loved ones, loss of property, loss of job.
• Perceived Loss


  • Is experienced by one person but cannot be verified by others. Examples: loss of self-esteem, loss of control, feeling a loss of independence/purpose.
• Anticipatory Loss


  • Experienced before the loss actually occurs. Grieved before the actual death of loved ones. Anticipating the end of a relationship.
• Loss can be viewed as

  • Situational Losses
  • Developmental Losses
• Situational Losses


  • Losing one's job, the death of a child, and losing functional ability. Losses due to natural disasters, accidents, divorce.
• Developmental Losses


  • Losses that occur in the process of normal development such as: departure of grown children from home, retirement from career and the death of aged parent that to some extent be anticipated and prepared for.
• Sources of Loss


  • Aspect of Self
  • External Objects
  • Familiar Environment
  • Loved Ones
• Aspect of Self


  • Losses related to one's identity, capabilities, or sense of self. Changes a person's body image, loss of physical abilities (illness/injury), loss of self-confidence, loss of employment, of usual activities, of independence, of health and of family.
• External Objects


  • Losses related to tangible objects/possessions that hold personal significance. Loss of inanimate objects that have importance to the person, loss of animate (live) objects such as pets that provide love and companionship.
• Familiar Environment


  • Related to changes in one's physical surroundings or living movement. Separation from an environment and people who provide security can result in a sense of loss. Loss of neighborhood, transfer of job.
• Loved Ones


  • Related to death, absence or separation. The loss of a loved one or valued person through illness, divorce, separation or death. The death of a loved one is permanent and complete loss.
• Grief


  Natural response to loss including sadness, anger, guilt, or despair. The total response to the emotional experience related to loss. Is manifested in thoughts.
• Bereavement


  The subjective response experienced by the surviving loved ones after the death of a person with whom they have shared a significant relationship. State of being deprived of someone through death.
• Mourning


  The behavioral process through which grief is eventually resolved or altered. Process of expressing griefs and adjusting to life after loss. Wearing black clothing, lighting candles, prayers.
• Kubler-Ross's Stages of Grieving

  • Denial
  • Anger
  • Bargaining
  • Depression
  • Acceptance
• Denial


  • Deny the reality of the loss/refuse to accept the situation, feeling shocked or unbelief. Refuses to believe that loss is happening.
• Anger


  • Intense emotions, including anger and frustration/blame others.
• Bargaining


  • To reverse or to mitigate the loss. Seeks bargain to avoid loss. May experience feeling of guilt or fear of punishment for past sins.
• Depression


  • Profound sadness, hopelessness and despair. Grieves over what has happened and what cannot be.
• Acceptance


  • Eventually find come to terms with the reality. Peace, closure, readiness to move forward. May wish to begin making plans.
• Manifestations of Grief Considered to be Normal

  • Verbalization of the loss
  • Crying
  • Sleep disturbance
  • Difficulty concentrating
  • Loss of appetite
• Factors Influencing the Loss and Grief Responses

  • Age
  • Significance of the Loss
  • Culture
  • Spiritual Beliefs
  • Gender
  • Socioeconomic Status
  • Support System
  • Cause of Loss of Death
• Age


  • Affects a person's understanding of and reaction to loss. Childhood: struggle with understanding/that leads to confusion and magical thinking. Early/Middle Adulthood: experience loss as part of normal development. Late Adulthood: losses experienced include loss of health.
• Significance of the Loss

  • Closer the relationship or the greater the impact of the loss on one's life. One may experience a great sense of loss over a divorce; another may find it only mildly disrupting.
• Culture


  • Rituals/cultural norms.
• Spiritual Beliefs


  • Beliefs can provide comfort and hope. Most religious groups have practices related to dying and these are often important to the client and support people.
• Gender


  • Men are expected to be strong and show very little emotion during grief, Women show grief by crying.
• Socioeconomic Status


  • A person who is confronted with both severe loss and economic hardship may not be able to cope with either.
• Support System


  • The people closest to the grieving individual are often the first to recognize and provide needed emotional, physical and functional assistance.
• Cause of Loss of Death

  • A loss of death that is beyond of those involved may be more acceptable than one that is preventable.
• Types of Death


  • Heart-Lung Death
  • Cerebral Death or Higher Brain Death
• Heart-Lung Death


  The traditional clinical signs of death were cessation of the apical pulse, respiration and blood pressure.
• Cerebral Death or Higher Brain Death


  Occurs when the cerebral cortex is irreversibly destroyed. There is presence of cardiac activity.
• Legalities Related to Health

  • Advance Health Care Directives
  • Autopsy or Postmortem Examination
  • Certification of Death/Death Certificate
  • Do Not Resuscitate Orders (DNR)
  • Euthanasia
  • Inquest
  • Organ Donation
• Advance Health Care Directives

  • Legal documents that allow individuals to outline preferences for medical treatment in the event that they become unable to communicate their wishes due to illness.
• Types of Living Will

  • Living Will
  • Health Care Proxy/Durable Power of Attorney for Healthcare
• Living Will


  If being sound of mind, hereby declare that if I am ever in a terminal condition where there is no reasonable hope of recovery, I don't want to be kept alive.