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Introduction
The concept of grief is an emotional and psychological reaction that occurs in people during bereavement. For the bereaved to accept the loss of a loved one, they should undergo the grieving process, which entails denial, anger, bargaining, depression, and acceptance. Thus, grieving is the process of accepting and acknowledging the reality of death and the loss that occurs due to the demise of a loved one. It is the most crucial process that an individual must undergo for effective resolution of psychological and emotional conflicts associated with the loss. Since nurses are advocates of patients, they are part of the patients families; hence, they participate in the grieving process. Attig (2004) argues that, lives of caregivers intertwine with the lives of those who receive care and love, and in case of death, grieving is a process of transformation that enables people to accept the loss (p.242). The process of grieving is a constructive response that enables the bereaved to come into terms with the loss coupled with accepting that, the loss is real and irreversible. Thus, studying grieving is paramount in nursing because it enables nurses to provide bereavement support to the grieving families and relatives as well as enabling them to cope with the grief as a professional challenge in nursing practice.
Grieving and Nursing
Grieving is an integral part of nursing practice because nurses constantly encounter deaths of their patients and they have to grief for the loss. Being advocates of patients, nurses are part of patients families as they dedicate their lives to offering best nursing services to patients with a view of enabling them recover effectively. However, in case a patient fail to recover and succumb to death, nurses face a challenge of delivering sad news to family and relatives of deceased. In such circumstances, nurses need to have support skills of helping families and relatives of deceased to undergo the process of grieving. Wright and Hogan (2008) argue that, understanding of the grieving process is essential in nursing because it enables nurses to provide bereavement support to families and relatives affected by the loss (p.354). Thus, knowledge of grieving will enable nurses to handle families and relatives who are grieving the loss of their loved ones who have been under the care of nurses. Delivery of effective bereavement support is critical in build strong relationships between nursing community and patients together with their relatives, thus enhancing nursing care.
Although nurses offer bereavement support to grieving families and relatives, they also experience grieve because they too experience loss when their patients die. As the objective of nursing is to improve health status of patients as they recover, death of patients is a serious setback for nurses. Usually, many nurses experience frustrations and start to grief when they see their patients die while they watch helplessly. Hence, nurses also undergo the process of grieving just like families and relatives of deceased patients. Keene, Hutton, Hall, and Rushton (2008) assert that, ability of a nurse to cope with grief in response to loss of a patient determines psychological, emotional, and physical capacity of professional practice (p.185). Therefore, it means that grieving process due to death of patients negatively affect professional capacity of nurses. According to Hall (2004), nursing is an occupation that predisposes nurses to stress and burnout because they constantly experience suffering and death of patients, which put them under grieving condition for a longer period (p.6). Thus, grieving is a challenge that nurses encounter in the course of their profession, and thus it is indispensable in nursing.
Attributes of Grief
Grieving is a process of psychological and emotional reactions that people undergo when they experience loss of a loved one or a close person. There are several theories and models that explain different processes of grieving. Attachment theory by Bowlby and grieving model by Kubler-Ross hold that grieving is a process that involves denial, anger, bargaining, depression, and acceptance of the loss. Denial of the fact that death of the loved one has occurred is the first stage of grieving that people experience. At this stage, shocking news of death triggers emotional and psychological responses that push the bereaved family and relatives into a state of disbelief. When the reality of death dawns on the bereaved, they enter the second stage of grieving where they become angry about the cause of death. According to Wright and Hogan (2008), confusion, anxiety, crying, self-reproach, and anger characterize this stage as the bereaved try to attribute the cause of death (p.351). For instance, if death occurred due to accident, the bereaved direct their blame to the driver for careless driving. On the other hand, if death occurred in hospital, they blame the doctors and nurses for medical negligence. Thus, anger is an active response that tries to attribute and justify the cause of death.
The third stage of grieving involves bargaining where the bereaved attribute the occurrence of death to the natural process of life and develop hope of coping with the challenging times ahead. At this stage, the bereaved come to terms with the reality of death, and since they are helpless about the loss of loved one, they only look upon the Supreme Being for comfort and encouragement. After bargaining, the bereaved enter the stage of depression where they experience loss of concentration, weakness, loss of appetite and irregular sleep patterns. Acceptance of the loss and reality of death is the fifth stage of grieving. Grievers at this stage have undergo denial, anger, bargaining and depression stages, and have finally realized that death and the loss of loved one is a reality that happens in life. The bereaved at this stage begin to perceive death as part of humanity and develop positive perspective about life, which make them live normal lives despite the massive loss they have suffered. Concerning acceptance, Attig (2004) contends that, it is about overcoming suffering and becoming strong in readiness to face eventualities, and pursuing meaning of life through unanticipated pathways (p.355). Thus, acceptance is about realizing the meaning of death as an inherent part of life that needs endurance as life goes on in the world.
Literature Review
Review of medical and nursing articles shows that grieving is a process rather than an event that nurses, families, and relatives undergo when they experience loss of a patient. Brunelli (2005) defines grieving as a natural phenomenon characterized by series of operations, or actions that eventually result into reconciliation feelings due to loss (p.124). Hence, grieving is a process that involves resolution of emotional and psychological reactions following shock that emanate from loss of a loved one. According to Attig (2004), grieving is an emotional, and active response to loss (p.343). In essence, grieving is neither a passive nor an automatic response, but it is an active and a constructive response that occurs when the bereaved individuals engage with the loss while accepting reality. Thus, grieving is not more of what happens to the bereaved, but it is more of what the bereaved do in the face of death and suffering. Hence, grieving is an active process that entails emotional and psychological changes, which ultimately leads to acceptance of reality of the loss.
Many theories and models elucidate and define grieving as a process of emotional and psychological recovery from loss of a loved one. Wright and Hogan (2008) define grief as a positive experience that enables the bereaved to detach emotionally from the deceased, but at times can cause serious psychological problems if detachment fails (p.351). Thus, grieving is a process that the bereaved undergo as they struggle to break emotional and psychological bonds that link them with the deceased. Hence, if the bereaved are unable to break the bonds, they will suffer psychological condition of melancholia and psychosis that always remind them of the deceased. According to Ott, Reynolds, Schlidt, and Noonan (2006), grieving is an emotional reaction triggered by the loss of a loved one and has physical, psychological, and cognitive consequences on the bereaved (p.6). Emotional reactions that the bereaved experience involves crying, frustrations, sadness, sorrow, loss of weight, and anger amongst others. According to attachment theory, emotional reactions occur when death severs relationships of loved ones.
Definition of Grieving
According to literature review, the theoretical definition of grieving is emotional and psychological reaction that people experience when they lose a loved one. Theoretically, grieving is a process that entails several stages depending on varied theories and models of grieving. According to attachment theory, and Kubler-Ross model, grieving entails five stages viz. denial, anger, bargaining, depression, and ultimately acceptance. Basing on this theory and model, the bereaved must undergo through the five stages so that they can effectively resolve emotional and psychological disturbances triggered by the loss. According to Wright and Hogan (2008), attachment theory postulate that intensity of grief and its resolution depends on attachment that the bereaved have to the deceased (p.351). Thus, effective resolution of grief as emotional and psychological disturbance requires severing of attachment to the deceased.
Although grieving is a natural phenomenon that entails emotional and psychological recovery following loss of a loved one, operational definition requires that the bereaved should receive bereavement support to enhance them recover and accept reality of death. As the bereaved grief due to loss of their loved one, friends usually give them bereavement support to help them cope with the daunting challenge of grieving. According to Attig (2004), given that grieving is an active process, bereavement support from caregivers is essential to prevent the bereaved from passively going through the process, and enhance active passage of all stages for effective healing process (p.358). Therefore, in spite of theoretical postulation that the bereaved need to undergo through stages of grieving, operationally, the bereaved need bereavement support to undergo through the process effectively.
Application of Grieving in Nursing
Since grieving does not only affect families and relatives of the patients, but also affects nurses, understanding grief and the process of grieving is essential in enabling nurses to provide bereavement support. As an advocate of patients, nurses normally face challenge of delivering sad news to the family and relatives of the deceased patient. Thus, knowledge and skills of grieving will empower nurses to provide bereavement support to the families and relatives of their patients who succumb to death. Kaunonen (2000) argues that, for nurses to give effective and appropriate bereavement support, they must understand grief and healing process due to the loss of a loved one (p.10). Moreover, grief affect nurses for they constantly interact with patients as they try to offer best health care services possible. According to Keene, Hutton, Hall, and Rushton (2008), nurses also experience grief when they care for patients with terminal illness or when their patients die suddenly (p.185). Thus, nurses and other health care professionals require skills and knowledge of managing grief effectively.
Understating of grieving is necessary because nursing involves interaction of nurses with patients, families and relatives who are grieving because of sickness or loss of a loved one. Therefore, it means that nurses need to have knowledge and skills of providing bereavement support to the bereaved, as well as managing grief as a professional challenge. Dunn, Otten, and Stephens (2005) argue that, the more experience of grieving nurses have, the better bereavement support they can provide to the bereaved (p.103). Hence, attaining knowledge and skills of grieving both theoretically and practically is the importance in improving nursing practice.
Conclusion
The concept of grief is paramount in nursing because nurses continually experience grief due to loss of their patients. Moreover, the nursing profession requires nurses to offer bereavement support to families and relatives of the deceased patients. Since grieving involves the process of healing, the bereaved require health care support to enable them manage emotional and psychological disturbances that emanate from loss of a loved one. Thus, nurses must understand grief and the process of grieving for them to provide effective bereavement support as well as manage their own grief.
References
Attig, T. (2004). Meanings of Death Seen Through The Lens of Grieving. Death Studies, 28, 341-360.
Brunelli, T. (2005). A Concept Analysis: The Grieving Process for Nurses. Nursing Forum, 40(4), 123-128.
Dunn, K., Otten, C., & Stephens, E. (2005). Nursing Experience and the Care of Dying Patients. Oncology Nursing Forum, 32(1), 97-104.
Hall, E. (2004). Nurse Burnout in High Stress Health Care Environment: Prognosis Better than Expected? Human Resource Management, University Of Otago, 1-36.
Kaunonen, M. (2000). Support for a Family in Grief. University Of Tampere, 1-97.
Keene, E., Hutton, N., Hall, B., & Rushton, C. (2008). An Intervention to Support Health Care Professionals in Managing Their Grief after the Death of a Patient. Pediatric Nursing, 36(4), 185-189.
Ott, C., Reynolds, S., Schlidt, A., & Noonan, P. (2006). A Guide To Supporting Family Caregivers Through The Alzheimers Disease Trajectory: Grief And Personal Growth. An Educational And Resource Manual, 1-72.
Wright, P., & Hogan, N. (2008). Grief Theories and Models: Applications to Hospice Nursing Practice. Journal of Hospice And Palliative Nursing, 10(6), 350-356.
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