Grief and Loss

Summary

The video, presented by Riz G. Francisco, delves into the complexities of grief and loss, highlighting how these emotions are a natural yet profoundly personal experience. It explores various models and stages of grief proposed by theorists like Elizabeth Kubler-Ross, John Bowlby, and others, emphasizing their application in both personal and professional contexts, particularly for nurses. The discussion covers not only the emotional aspects of grief but also its cognitive, physiological, and spiritual impacts, with a focus on comprehensive and compassionate nursing care. It also addresses disenfranchised and complicated grief, underscoring the need for acknowledging non-traditional losses and providing appropriate support.

Highlights

• Grief is more than sadness; it's an emotional reaction that varies widely across individuals. 😢
• Loss can mean losing something non-physical, like a sense of identity or a relationship. 💔
• According to Elizabeth Kubler-Ross, grief involves stages of denial, anger, bargaining, depression, and acceptance. 📅
• J. William Worden's model views grief as involving active tasks, not just emotional stages. 📝
• Disenfranchised grief refers to losses that aren't socially acknowledged, like job loss. 🕵️‍♂️

Key Takeaways

• Grief is a complex process that touches every aspect of life, from emotions to physical health. 🌊
• Loss isn't just about death; it can involve jobs, relationships, or identity shifts. 🔄
• Various grief models, like Kubler-Ross's stages, help us understand grieving dynamics better. 📘
• Nurses play a crucial role in supporting patients through empathetic, thoughtful care. 💉
• Disenfranchised grief involves losses society often overlooks; acknowledging them is key. 🎭

Overview

Grief and loss are universal parts of the human experience, touching various aspects of our lives. Whether it's the end of a relationship, job, or a significant life change, the impact can be profound. In the video by Riz G. Francisco, the multifaceted nature of these feelings is explored, shedding light on how deeply they affect us on personal and collective levels.

Different models of grief, such as those proposed by Elizabeth Kubler-Ross and John Bowlby, provide frameworks for understanding the emotional and cognitive processes that accompany loss. These models are particularly useful for healthcare professionals, especially nurses, who are often on the frontline of providing support. They need to recognize these stages to offer the best care possible, ensuring that their support is empathetic and comprehensive.

Grief can also be complicated by societal attitudes toward certain types of loss, known as disenfranchised grief. This refers to types of loss that aren't publicly acknowledged, such as job loss or nontraditional relationships. The video emphasizes the importance of recognizing these nontraditional forms of grief to ensure that everyone receives the support they need during such challenging times.

Chapters

• 00:00 - 01:00: Introduction to Grief and Loss The chapter 'Introduction to Grief and Loss' explains that experiencing loss and grief is a natural aspect of life. Grief extends beyond mere sadness; it is an emotional reaction that differs greatly among individuals. Furthermore, the concept of loss encompasses more than just death—it can include losing a job, a body part, or undergoing any significant life change or transition.
• 01:00 - 02:00: Reflecting on Personal Experiences and Empathy The chapter discusses the importance of empathy and understanding in nursing, particularly in helping individuals through life transitions that often involve letting go, such as loss, changes in relationships, or shifts in identity. Nurses, due to their close and supportive relationships with patients, are in a unique position to aid in these processes.
• 02:00 - 03:00: Maslow's Hierarchy of Needs and Loss The chapter explores how Maslow's Hierarchy of Needs can be applied to understanding the concept of loss. It emphasizes the importance of reflecting on personal experiences with loss to enhance empathy and clinical judgment, particularly in patient interactions. It's suggested that losses can be categorized according to the different levels of Maslow's model, encouraging a deeper and more structured understanding of personal and patient losses.
• 03:00 - 04:00: Different Types of Loss The chapter titled 'Different Types of Loss' explores the concept of loss as it relates to unmet needs due to life events. It specifically addresses physiological loss, which involves the loss of body function or structure, such as what occurs after an amputation or a stroke.
• 04:00 - 06:00: Elisabeth Kübler-Ross' Five Stages of Grief This chapter discusses the concept of safety loss, which includes experiences like exposure to violence or trauma that affect one’s sense of security, such as domestic abuse. It also covers security and belonging loss, typically experienced through the death of a loved one. The chapter likely ties these aspects to Elisabeth Kübler-Ross' Five Stages of Grief, providing a framework for understanding how individuals process these significant losses and their emotional repercussions.
• 06:00 - 08:00: John Bowlby's Attachment Theory and Grief This chapter discusses John Bowlby's Attachment Theory in the context of grief, particularly focusing on how different forms of separation, such as divorce, relocation, or job loss, can disrupt familial or community bonds. It highlights the emotional impact these events can have, including loss of self-esteem.
• 08:00 - 10:00: George Engel’s Stages of Grief The chapter delves into George Engel's Stages of Grief, emphasizing the impact of rejection and events that affect self-worth. It highlights the notion of loss of self-actualization, which, although less apparent, carries significant emotional weight. This loss pertains to the fading of dreams, goals, or a sense of purpose.
• 10:00 - 12:00: Mardi Horowitz's Framework on Grieving The chapter discusses Mardi Horowitz's framework for understanding grief, highlighting the complexities of personal loss beyond the death of loved ones, such as the inability to become a parent. It emphasizes that each person's grief is uniquely tied to their individual experiences and contexts.
• 12:00 - 15:00: J. William Worden’s Tasks of Mourning This chapter discusses J. William Worden's concept called 'Tasks of Mourning'. It starts by comparing Worden's model with the well-known Kubler-Ross's five stages of grieving. Initially meant to describe the emotional transitions during terminal illness, Kubler-Ross's model found its application in various types of loss experiences. The chapter will delve into how Worden presents a task-based approach, contrasting Kubler-Ross’s stage-based process, to explain the grieving path when dealing with death or significant losses.
• 15:00 - 19:00: Cognitive and Emotional Responses to Grief The chapter explores the various stages of grief which include denial, anger, bargaining, depression, and acceptance. Each stage is characterized by different emotional and cognitive responses. Denial is marked by shock and disbelief about the loss, while anger involves expressions of frustration or rage about the situation.
• 19:00 - 21:00: Spiritual and Cultural Considerations in Grief This chapter discusses the spiritual and cultural aspects that influence individuals' experiences and expressions of grief. It explores how different beliefs and cultural backgrounds can shape the way people perceive and cope with loss. The chapter emphasizes the importance of understanding and respecting these diverse perspectives, especially in providing support to those who are grieving. It also highlights the role of spirituality in finding meaning and comfort during the grieving process.
• 21:00 - 25:00: Disenfranchised and Complicated Grief The chapter titled 'Disenfranchised and Complicated Grief' delves into the emotional journey faced by individuals experiencing loss. It describes depression as an acute awareness and sadness that often accompanies loss. The chapter culminates in the acceptance stage, where individuals begin to come to terms with the death or loss.
• 25:00 - 30:00: Assessing Grieving Clients The chapter discusses various stages of grief, emphasizing that these stages are not linear, and individuals may move back and forth between them. It suggests that understanding this model is crucial for providing better support to grieving individuals. John Bulby's contributions to understanding grief are mentioned.
• 30:00 - 38:30: Nursing Actions and Communication in Grief Support The chapter "Nursing Actions and Communication in Grief Support" explores the theoretical foundation of grief, particularly through attachment theory, which views grief as a response to the disruption of bonds. The intensity of grief is linked to the depth of attachment. This theory proposes four key phases of grieving, starting with an introductory phase.
• 38:30 - 45:00: Self-reflection and Boundaries for Nurses This chapter discusses the emotional process of grief focusing on the initial phase of numbness. It delves into how individuals may deny or find it difficult to accept loss and transition into a yearning phase where emotional longing for the lost loved one occurs.
• 45:00 - 46:30: Summary of Key Concepts The chapter discusses the third phase of dealing with loss, known as 'disorganization'. During this phase, individuals experience cognitive and emotional turmoil as they come to terms with their loss. Following this, the 'reorganization' phase involves individuals reintegrating their sense of self and rebuilding their lives without what was lost.

Grief and Loss Transcription

• 00:00 - 00:30 Loss and grief are a natural part of the human experience as we go through life's changes and transitions. Grief is more than just sadness. It's the emotional reaction to loss and it varies widely from person to person. Loss is not just about death. It can also mean losing a job, a body part,
• 00:30 - 01:00 or a relationship, or even a sense of identity. Every stage of life involves some form of letting go. As nurses, we are in a unique position to support individuals through these transitions. As we go through this
• 01:00 - 01:30 topic, let us think not only about our patients but also reflect on our personal experiences with loss. This reflection will help strengthen our empathy and clinical judgments. Losses can be categorized based on Maslo's hierarchy of needs which many of you are already
• 01:30 - 02:00 familiar with. When any of these needs are unmet due to life events, a person experiences loss. Physiological loss involves the most basic level loss of body function or structure like after an amputation or a stroke.
• 02:00 - 02:30 Safety loss includes exposure to violence or trauma that shakes one's sense of security like domestic abuse. Security and belonging loss is often experienced in the death of a loved one.
• 02:30 - 03:00 Divorce or separation or relocation which severes bonds and disrupts rules in families or communities. Self-esteem loss can result from job loss, retirement, or
• 03:00 - 03:30 rejection. Events that damage how a person values him or herself. And finally, loss of selfactualization. This may be less obvious but equally painful. This could be the loss of dreams, goals, or purpose like someone
• 03:30 - 04:00 realizing they will not be able to become a parent. Each of these losses can trigger grief and must be understood in the context of the individual's lived experience. Elizabeth Cubeller Ross proposed five stages of grief that many
• 04:00 - 04:30 people experience. Cubellar Ross's five stages of grieving are a well-known model for understanding the emotional journey people go through when dealing with loss or death. Originally conceptualized to describe how people cope with terminal illness, it has been widely used since then to apply to many types of losses. The
• 04:30 - 05:00 stages are denial, anger, bargaining, depression, and acceptance. Denial is the initial shock and disbelief about the loss. Anger is when the person expresses
• 05:00 - 05:30 their emotions toward God, relatives, friends or health care providers. Bargaining is the attempt to delay the inevitable loss, often by asking for
• 05:30 - 06:00 more time. Depression is the acute awareness and sadness about the loss. Acceptance is when the person comes to terms with the death or loss.
• 06:00 - 06:30 These stages are not always linear and people may move back and forth between them as they grieve. Understanding this model can help us better support those who are grieving. John Bulby, known for his work in
• 06:30 - 07:00 attachment theory, viewed grief as a response to the disruption of bonds. According to him, the intensity of grief is directly linked to the depth of attachment. He proposed four key phases. The first phase is
• 07:00 - 07:30 numbness where the person may initially deny or have difficulty accepting the loss. This is followed by a phase of yearning where the person emotionally longs for the lost loved one.
• 07:30 - 08:00 The third phase is disorganization where the person feels cognitive and emotional turmoil as they grapple with the loss. Finally, the reorganization phase involves the person reintegrating their sense of self and rebuilding their life without the lost
• 08:00 - 08:30 loved one. These faces are not always linear and again people may move back and forth between them as they work through their grief. The stages of grief as described by Dr. George Engel provide a helpful
• 08:30 - 09:00 framework for understanding the emotional journey people experience when dealing with loss. Engel added a medical lens to the study of grief. He saw grief as a biological response to loss, almost like a physical wound that heals in stages. He described six
• 09:00 - 09:30 stages. The first stage is shock and disbelief. This is the stage where the person initially refuses to acknowledge the reality of the laws. This is followed by developing
• 09:30 - 10:00 awareness as a person begins to cry and feel helpless in the face of the loss. The restitution stage involves participating in rituals like funerals to accept the reality of the laws.
• 10:00 - 10:30 The resolution stage is the point wherein the person begins to come to terms with the loss. While sadness may still be there, they start redirecting their energy toward daily life. They may begin to focus on other relationships, work, or personal goals.
• 10:30 - 11:00 During the idealization stage, the person starts to remember the deceased or the lost situation in a positive light. They may minimize flaws and focus on good memories. This idealization helps maintain a respectful
• 11:00 - 11:30 and loving emotional connection which can be comforting. The sixth stage is the outcome. This is when the person accepts the loss as part of life and is able to move forward. They've integrated the experience of grief and are now functioning at a new
• 11:30 - 12:00 level of normaly. What's valuable about Engle's model is that it helps us recognize the psychological and social dimensions of grief, not just the emotional. It also reminds us that grieving takes time and each stage may look different depending on the person's background,
• 12:00 - 12:30 support system and personality. The stages of loss by Marty Horowitz is a framework that describes the common emotional process people go through when facing a significant
• 12:30 - 13:00 loss. The first stage is outcry. This is the initial realization and reaction to the loss. This can manifest outwardly through crying, screaming or be more internally suppressed. The second stage is denial and intrusion.
• 13:00 - 13:30 This is where people oscillate between not thinking about the loss and being consumed by it. In the working through stage, people start to find new ways to manage the loss with less bouncing between denial and intrusion.
• 13:30 - 14:00 Finally, the completion stage is when life starts to feel normal again, though different and the memories of the loss become less painful. Understanding these stages can help people navigate their own grieving process. and for nurses to support these
• 14:00 - 14:30 grieving persons. The tasks of grieving are a process we all go through when experiencing loss. First, we need to recognize that the loss is real and understand what has happened. Next, we react
• 14:30 - 15:00 emotionally, feeling the feelings that come with grief. We then recollect and relieve the memories of the person or things lost. Next is relinquish. This is accepting that the
• 15:00 - 15:30 world has changed and relinquishing the past is the next step. readjusting to daily life without the lost person or thing is an important part of the process. Finally, the grieving person
• 15:30 - 16:00 reinvest. During this reinvesting, there is the formation of new relationships and moving forward. These six tasks are a framework for working through the grieving process in a healthy way. The approach of J. William Warden who
• 16:00 - 16:30 viewed grief not as a positive experience but as active tasks that a person must go through. This is a very practical framework something that we nurses can really use in planning care and patient support. There are four key tasks in Weren's
• 16:30 - 17:00 model. The first task is to accept reality acknowledging that the loss has occurred despite the pain it causes. The second task is to work through the pain. This is experiencing the physical and emotional pain of the
• 17:00 - 17:30 loss. The third task is to adjust to the environment. This is adapting to the change rules and relationships that come with the loss. The fourth task is to find a place for the deceased. This is remembering the person
• 17:30 - 18:00 while also moving forward with life. The loss of a loved one can lead to a range of cognitive responses as the person tries to make sense of the grief. One common response is
• 18:00 - 18:30 questioning, asking why the loss happened and trying to understand the reasons behind it. Another is searching for meaning, grappling with a profound questions that arise, trying to find purpose and significance in the face of such a profound loss.
• 18:30 - 19:00 Many also find themselves keeping the lost one present through internal dialogues as if continuing a conversation with a person who has passed. Grief can also lead to changes in our
• 19:00 - 19:30 core beliefs and assumptions about life as we re-evaluate what we thought we knew. These cognitive processes are all part of the complex journey of grieving and finding a way to move forward. Grief can evoke a wide range of
• 19:30 - 20:00 emotional responses in people. This include common emotions like anger, sadness, anxiety, guilt, numbness, despair and loneliness. Each person experiences grief differently and these emotions can come and go in waves or
• 20:00 - 20:30 cycles. It's important to acknowledge and validate the full range of emotions that our patient or even ourselves may be feeling when grieving a loss. Grief can present significant spiritual challenges as people may feel
• 20:30 - 21:00 disillusioned with God, angry at religious figures, feel abandoned, or lost a sense of meaning and hope. However, grief can also be a catalyst for spiritual growth. Many find new meaning, a deepened faith, spiritual
• 21:00 - 21:30 transformation, and a renewed sense of purpose in life. It's important to acknowledge both the spiritual struggles and potential for growth that can arise during times of grief. As nurses, let us encourage our patients to be open to exploring their
• 21:30 - 22:00 spiritual responses. Whether that means wrestling with difficult questions or discovering new deep paths of faith. The key is to create space for people to authentically process their grief in a way that is meaningful to
• 22:00 - 22:30 them. Let us now discuss the different behavioral responses our patients can have when grieving the loss of a loved one. These are key behavioral responses and this includes automatic functioning, emotional outcry and avoidance seeking.
• 22:30 - 23:00 Automatic functioning refers to going through the motions of daily life without much conscious thought or engagement. This is a common coping mechanisms in early grief. Emotional outcry includes things like sobbing, crying, and restlessness.
• 23:00 - 23:30 These are the outward expressions of intense emotions of grief. Avoidance and seeking describe the conflicted feelings people often have about places or activities associated with the deceased. They may avoid these triggers or
• 23:30 - 24:00 compulsively seek them out. It's important to recognize that all of these responses are normal and valid ways of processing grief. There is no single right way to grieve. Grief can also have a significant physiological impact leading to a range
• 24:00 - 24:30 of distressing physical symptoms. Sleep disturbance is one of the most common and persistent symptoms affecting around 70% of those experiencing grief. Appetite changes are also very common,
• 24:30 - 25:00 often leading to unintentional weight loss in around 65% of cases. Persistent fatigue and energy loss are experienced by around 60% of grieving individuals. Physical pain such as headaches and
• 25:00 - 25:30 palpitations are reported by around half of those going through the grieving process. Here are some cultural considerations that we need to acknowledge and take note of when dealing with patients who are grieving. When dealing with loss or
• 25:30 - 26:00 tragedy, people from different cultures often have universal reactions like shock. disorientation, anger, and a period of mourning. However, the specific ways that grief is expressed can vary greatly between cultures.
• 26:00 - 26:30 Many cultural expressions of grief are rooted in religious traditions and rituals. It's important to be aware of and respectful of these cultural differences when supporting our patient who is grieving.
• 26:30 - 27:00 What is disenfranchised grief? Disenfranchised grief refers to losses that are not openly acknowledged, socially validated, or publicly mourned. This type of losses often involved unrecognized
• 27:00 - 27:30 relationships such as non-family bonds that are not seen as significant. Disenfranchised losses can include prenatal death, pet loss, job loss, and other types of losses that are not always validated.
• 27:30 - 28:00 Certain people group like children, the elderly and us nurses or health care workers may also have their grief overlooked or minimized. Losses that are stigmatized, such as suicide,
• 28:00 - 28:30 incarceration, or execution, can also lead to disenfranchised grief where the mourning process is not supported. It's important to recognize these types of losses and support those experiencing disinfranchised grief even when the relationship or loss is not widely
• 28:30 - 29:00 acknowledged. What is complicated grieving? Complicated grief is a condition where the grieving process becomes prolonged or disproportionate. There are several risk factors that can contribute to complicated grief. This includes low
• 29:00 - 29:30 self-esteem, low trust, previous psychiatric disorder, suicide attempts, lack of family support, and ambivalent attachment. It's important to be aware of these risk factors. So we nurses can identify individuals
• 29:30 - 30:00 who may be at higher risk of developing complicated grief and provide them with appropriate support and interventions. Now how do we conduct assessment of grieving clients? Let us not forget that laws can mean different things to different
• 30:00 - 30:30 people. It's important to understand their personal perception of the loss they are experiencing. Identifying the client's support systems, both personal and professional, can help determine how their emotional needs are being met during this difficult time.
• 30:30 - 31:00 Observing the client's coping behaviors, both healthy and unhealthy, provides insight into how they are handling the grieving process. Grief is a profoundly personal experience and as nurses we play a vital
• 31:00 - 31:30 role in supporting our clients through this challenging times. Here are nursing actions that we can provide for grieving clients. Our first step is to explore their perceptions of the loss. Help them make sense of what has happened and understand the meaning it holds for
• 31:30 - 32:00 them. Next, we facilitate support by encouraging the client to reach out to their loved ones and community. Having a strong support network can make all the difference during this grieving process.
• 32:00 - 32:30 Promoting healthy coping mechanisms is also important. Nurses can suggest self-care activities and behaviors that can help the client work through their grief in a constructive way. Throughout this process, it is
• 32:30 - 33:00 important that we closely monitor our clients progress, ensuring they are moving through the stages of grief in a healthy manner. Our guidance and compassion can make all the difference for them at this time. How do we provide care during the grieving process? As nurses, effective
• 33:00 - 33:30 communication is essential for providing compassionate and high quality care. Four key communication skills are critical for us to develop. presence. Our presence means we are fully engaged and attentive when
• 33:30 - 34:00 interacting with our clients, listening actively and using silence thoughtfully questioning. This involves asking open-ended questions that encourage our patients to describe their experiences and their concerns in their own
• 34:00 - 34:30 words. Reflection. Reflection means mirroring our patients feelings and validating their perceptions to show them that we understand. Honesty. Honesty is about building trust by giving dependable, consistent, and worthy or
• 34:30 - 35:00 being worthy of their confidence. Mastering these communication skills will help us connect with our patients, help us understand their needs, and provide the best possible care. Nurses often face difficult situations that can lead to personal
• 35:00 - 35:30 losses and grief. It's important to take time to selfreflection to examine this feelings. Seeking support, whether from colleagues, counselors, or other resources, can help us process our emotions in a healthy way. Maintaining clear boundaries, which is crucial to
• 35:30 - 36:00 providing effective therapeutic care. This means keeping the focus on our patient's need, not on our own need. By developing selfawareness in these areas, nurses can better manage the emotional demands of their work and
• 36:00 - 36:30 avoid burnout. In summary, here are what we've covered about grief and loss. First, we established that grief is a holistic response. It's not just about feeling sad. It touches all parts of a person's life. how they think, feel, behave,
• 36:30 - 37:00 relate to others, and even how their body reacts. We also highlighted that loss can occur at many levels, not just through death, but in physical health, relationships, roles, or identity. Understanding the type of loss helps us appreciate how deep the impact
• 37:00 - 37:30 can be. We also explored several key theories of grief. Cubler Ross gave us a framework for emotional stages. Balby focused on attachment and separation. Angel likened grief to a healing process and warden emphasized that grief
• 37:30 - 38:00 involves tasks that the person actively works through. Each of these models help us recognize that our client might be going through this and enable us to think of ways we can support them. We also noted that grief isn't just emotional. It affects the mind, body,
• 38:00 - 38:30 spirit, and behaviors. That's why our nursing care must be comprehensive and compassionate. We also discussed this infranchised grief. This is a grieving process when someone's loss isn't openly acknowledged and complicated grief which
• 38:30 - 39:00 can interfere with functioning and may require mental health support. Finally, as nurses, we use the nursing process to assess, plan, and provide care to grieving clients. But beyond the interventions and outcomes, we offer something powerful. Our presence, our patience,
• 39:00 - 39:30 and our understanding. Remember, grief has no set timeline. What matters most is that we walk alongside our patients, honoring their journey with empathy and skill.