How to Cope With Grieve

Psychological Coping With Grieve

Response to grieve or coping with grieve include emotional response to spiritual response to grieve, behavioral response to grieve and cultural values.

Emotional Responses to Grief

    Anger, sadness, and anxiety are the predominant emotional responses to loss. The grieving person may direct anger and resentment toward the dead person and his or her health practices, family members, or health care providers or institutions. Common reactions the nurse might hear are as follows:

"He should have stopped smoking years ago." "If I had taken her to the doctor earlier, this might not have happened." "It took you too long to diagnose his illness."

    Guilt over things not done or said in the lost relationship is another painful emotion. Feelings of hatred and revenge are common when death has resulted from extreme circumstances, such as suicide, murder, or war ( Zisook & Zisook , 2005). In addition to despair and anger, some people may also experience feelings of loss of control in their lives, uncharacteristic feelings of dependency on others, and even anxiety about their own death.

    Emotional responses are evident throughout the grieving process. A common first response to the news of a loss is to be stunned, as though not perceiving reality. Emotions hesitate in frequency and intensity. The person may function automatically in a state of calm and then suddenly become overwhelmed with panic. Theory of emotion may involve crying and screaming or suppressed feelings with a stoic face to the world.

    Eventually reality begins to set in. He or she often reverts to the behaviors of childhood by acting similar to a child who loses his or her mother in a store or park. The grieving person may express irritability, bitterness, and hostility toward clergy, medical providers, relatives, comforters, and even the dead person. The hopeless yet intense desire to restore the bond with the lost person compels the bereaved to search for and recover him or her. 

    The grieving person interprets sounds, sights, and smells associated with the lost one as signs of the deceased's presence, which may intermittently provide comfort and ignite hope for a reunion. For example, the ring of the telephone at a time in the day when the deceased regularly called will trigger the excitement of hearing his or her voice. Or the scent of the deceased per fume will spur her husband to scan the room for her smiling face. As hopes for the lost one's return diminish, sadness and loneliness become constant. Such emotional tumult may last several months and seems necessary for the person to begin to acknowledge the true permanence of the loss.

    As the bereaved person begins to understand the loss's permanence, he or she recognizes that patterns of thinking, feeling, and acting attached to life with the deceased must change. As the person relinquishes all hope of recovering the lost one, he or she inevitably experiences moments of depression, apathy, or despair. The acute sharp pain initially experienced with the loss becomes less intense and less frequent.

    Eventually, the bereaved person begins to reestablish a sense of personal identity, direction, and purpose for living. He or she gains independence and confidence. New ways of managing life emerge, new relationships form. The person's life is reorganized, and seems "normal" again, although different than before the loss. The person still misses the deceased, but thinking of him or her no longer evokes painful feelings.

Spiritual Responses to Grief

    Closely associated with the cognitive and emotional dimensions of grief are the deeply embedded personal values that give meaning and purpose to life. These values and the belief systems that sustain them are central components of spirituality and the spiritual response to grief. During loss, it is within the spiritual dimension of human experience that a person may be most comforted, challenged, or devastated. The grieving person may become disillusioned and angry with God or other religious figures or members of the clergy. The anguish of abandonment, loss of hope, or loss of meaning can cause deep spiritual suffering.

    Ministering to the spiritual needs of those grieving is an essential t of nursing care. The client's emotional and spiritual aspect responses become intertwined as he or she grapples with pain. With an astute awareness of such suffering, nurses can promote a sense of well-being. Providing opportunities for clients to share their suffering assists in the psychological and spiritual transformation that can evolve through grieving. Finding explanations and meaning through religious or spiritual beliefs, the client may begin to identify positive aspects of grieving. The grieving person also can experience loss as significant to his or her own growth and development.

Behavioral Responses to Grief

    Behavioral responses to grief are often the easiest to observe. The grieving person may function "automatically" or routinely without much thought, indicating that the person is numb-the reality of the loss has not set in. Tearfully sobbing, crying uncontrollably, showing great restlessness, and searching are evidence of the outcry of emotions. 

    The person actually may call out for the deceased or visually scan the room for him or her. Irritability and hostility toward others reveal anger and frustration in the process. Seeking out as well as avoiding places or activities once shared with the deceased, and keeping or wanting to discard valuables and belongings of the deceased, illustrate fluctuating emotions and perceptions of hope for a re connection.During disorganization or working through grief, the cognitive act of redefining self-identity is essential but difficult. 

    Although superficial at first, efforts made in social or work activities are behavioral means to support the per son's cognitive and emotional shifts. Drug or alcohol abuse indicates a maladaptive behavioral response to the emotional and spiritual despair. Suicide and homicide attempts may be extreme responses if the bereaved person cannot move through the grieving process.
    In the phase of reorganization, or recovery, the bereaved person participates in activities and reflection that are personally meaningful and satisfying. Redefining the meaning of life, finding new activities and relationships restore the person's feeling that life is good again.

Physiologic Responses to Grief

    Physiologic symptoms and problems associated with grief responses are often a source of anxiety and concern for the grieving person as well as for friends or caregivers. Those grieving may complain of insomnia, headaches, impaired appetite, weight loss, lack of energy, palpitations, indigestion, and changes in the immune and endocrine systems. Sleep disturbances are among the most frequent and persistent symptoms ( Zisook & Zisook , 2005).

Cultural Consideration 

Universal Reactions to Loss

    Although all people grieve for lost loved ones, rituals and habits surrounding death vary among cultures. Each culture defines the context in which grieving, mourning, and integrating loss into life are given meaningful expression. The context for expression is consistent with beliefs about life, death, and an afterlife. Certain aspects of the experience are more important than other aspects for each culture.

    Universal reactions include the initial response of shock and social disorientation, attempts to continue a relationship with the deceased, anger with those perceived as responsible for the death, and a time for mourning. Each culture, however, defines specific acceptable ways to exhibit shock and sadness, display anger, and mourn, Cultural awareness of rituals for mourning can help nurses understand an individual's or a family's behavior.

Culture-Specific Rituals

    As people immigrate to the United States and Canada, they may lose rich ethnic and cultural roots during the adjustment of acculturation (altering cultural values or behaviors as a way to adapt to another culture). For example, funeral directors may discourage specific rites of passage that celebrate or mourn the loss of loved ones, or they may be reluctant to allow behavioral expressions they perceive as disruptive. 

    Many such expressions are culturally related, and health care providers must be aware of such instances. For example, the Hmong (people of a mountainous region of Southeast Asia) believe that the deceased person enters the next world appearing as she or he did at the time of death. This may lead to a request for removal of needles, tubes, or other "foreign objects" before death.

    Because cultural bereavement rituals have roots in several of the world's major religions (ie, Buddhism, Christianity, Hinduism, Islam, Judaism), religious or spiritual beliefs and practices regarding death frequently guide the client's mourning. In the United States, various mourning rituals and practices exist. A few of the major ones are summarized next.