Frequently Asked Questions
Chapter 45: Loss and Grief

What are the reactions to normal grief described by Lindemann?

The reactions to normal grief described by Lindemann are somatic distress, preoccupation with the image of the deceased, guilt, hostile reactions, and loss of patterns of conduct (restlessness and search for something to do).

How do the stages of mourning described by Engle differ?

The first stage of mourning is shock and disbelief, in which the person feels disoriented and helpless. The second stage is developing awareness, characterized by pain, recognition, guilt, anger, sadness, isolation, and loneliness. The third stage is restitution and resolution, when the mourner “comes to grips” with the loss and establishes new patterns and relationships. During this period, the mourner may have bodily symptoms and may idealize the deceased.

What is the usefulness of the various theories of grief?

Theories of grief provide a framework for studying and understanding grief. However, it is important to realize that grievers do not necessarily follow the patterns described in the theories exactly.

How are reactions to grief influenced by developmental level?

Children vary in their ability to comprehend death and need honest explanations. Adolescents understand the concept of death but do not see themselves as mortal. Early adults grieve significantly for the loss of roles and relationships. The loss of a child or partner can be particularly painful for this reason. The potential for grief increases in middle adulthood, from death as well as changes in employment and relationships. Older adults recognize the inevitability of death and experience many losses in addition to death.

What are the clinical manifestations of severe depression, indicating the need for medical intervention?

The clinical manifestations of severe depression are a flat affect, depressed mood most of the day, a markedly diminished interest or pleasure in activities of the day, a significant weight loss, insomnia, psychomotor agitation, and fatigue.

How should the nurse teach parents to deal with children who have experienced the death of a loved one?

When advising parents, the nurse should encourage them to (1) use simple, concrete language; (2) involve the child in mourning rituals, explaining what is going to happen; (3) encourage the child to express feelings; (4) reassure the child that he or she will not be abandoned; and (5) answer all questions truthfully.

What are the risk factors for complicated grief?

The risk factors for complicated grief are the type of loss (sudden loss, multiple losses, violent loss, loss for which the griever feels responsible, loss for which others are seen as responsible, or disenfranchised loss), personal vulnerability (survivor was dependent on the deceased person, survivor feels ambivalence toward the deceased person, survivor lacks self-esteem and trust, survivor is psychologically vulnerable), and lack of social support (survivor lacks family, has a nonsupportive family, or is socially isolated).