Daily, nurses encounter patients and families who are grieving. Grief is a common response to loss. The patient may be dealing with loss of function, independence, confidence, self-esteem, energy, or life. People process loss in various ways. They may not be relating to the person they once knew; perhaps roles are gradually shifting; or they suddenly have become a caregiver. In the case of death, he/she is single and alone, grieving not only a person, but the loss of a familiar role and status.
Grief is not one size fits all. Grief is an emotional response to a loss, manifested in ways unique to everyone, based on personal experiences, cultural expectations, and spiritual beliefs (Potter & Perry, 2009, p. 463). Potter and Perry propose that grief is on a continuum, and they delineated four tasks of grief. The first task is accepting the reality of the loss. The second is working through the pain of grief. The third is adjusting to the environment in which the deceased is missing. The fourth is emotionally relocating the deceased and moving on with life. Being aware of the tasks of the grieving process will allow nurses to better assess our patient and family situations.
When assessing for grief, we need to recognize that coping and adjusting to the tasks of grief can be different for every person. They may have: 1) normal uncomplicated grief, in which the person copes and progresses; 2) complicated grief, in which adjustment doesn't happen or is prolonged; and 3) anticipatory grief, in which the patient or family begins to disengage as a way of preparing for the actual loss before it occurs. Famous author and theologian C. S. Lewis, in writing about the loss of his wife, says that in grief, nothing stays put. One keeps on emerging from a phase, but it always recurs. Round and round. Everything repeats. He often felt he was going in circles, but he hoped not on a spiral downward (Lewis, 1961, p. 56).
As grief is an emotional response, nurses need be attuned to the feelings of the patient and the family. Lewis compares grief to physical pain. He feels that the body can suffer 20 times more than the mind. Grief comes back like a bomber circling and dropping its bombs. Each time it circles overhead, physical pain is steady and continuous, like a barrage on a trench in WW I (Lewis, p. 40). There is an unpredictability in grief and the feelings. There is an intense sorrow and sadness. Families have expressed that they feel selfish, that they are only looking at themselves when they experience loss. Others have said that when they are grieving, they feel weak and have a total loss of self-confidence.
Knowing more about grief will assist with nursing interventions for spiritual support. Key thoughts to keep in mind regarding grief are:
1. Allow patients and families to share their feelings and encourage them to express their emotions openly. Avoid pat answers like "It's going to be all right," or "I know how you are feeling," which may suppress their feelings and pain.
2. Encourage the patient and family to grieve at the time of loss and not postpone grief. I had a patient who had a stillborn baby and was not allowed to the funeral because she was in the hospital. A few years later, in preparing for minor surgery, she experienced intense anxiety. She realized it was partly because she never fully grieved the loss of her baby. Grieving at the time of loss allows healing to begin and being able to move on.
3. Remind the patient and family that they are not alone in their grief. Compassionately and tenderly remind them there are others to help carry their burden. Galatians 6:2 (NASB) reads, "Bear one another's burdens and thus fulfil the law of Christ." As nurses, we often share others' burdens. In doing so, we generate hope.