Patient In Grief and Health Care

Health Care Dealing With Grief

What is Grief,Terms Related to Grief,Grief and Nursing Role,Death Grief or Terminal Illness, Standardized Instruments for Grief Assessment ,Manifestations of Grief,Variables in Grief Researches,Descriptive Studies and Meaning of Grief,Consequences of Grief.

What is Grief 

    Grief is a multifaceted response to the loss of a significant person, object, belief, relationship, body part, or body function. Grief includes the entire range of physical, psychological, cognitive, and behavioral responses to loss. 

    Grief is characterized by intense mental anguish and varies in duration from a few weeks to many years. Three types of grief have been identified: conventional grief, anticipatory grief, and pathological grief. Conventional grief occurs after a loss, while anticipatory grief is the response to an impending loss. 

    Although there is little agreement on the exact nature of anticipatory grief, there is general agreement that anticipatory grief facilitates coping with a loss when the loss actually occurs. Grief that falls outside normal parameters is often labeled pathological grief; however, there are no specific signs or symptoms that differentiate conventional grief from pathological grief.

Terms Related to Grief

    Loss, bereavement, and mourning are terms related to grief. Loss is the experience of parting with an object, person, belief, or relationship that is valued, whereby the loss necessitates a reorganization of one or more aspects of the person's life. 

    Losses range from minor ones, such as the loss of a wallet which necessitates only minor adjustments, to major ones, such as the death of a loved one or the loss of one's home in a fire or flood which necessitates major adjustments. 

    Bereavement is the state of having experienced a loss, particularly the death of a significant other. Mourning encompasses the socially pre-scribed behaviors after the death of a significant other. Such behaviors vary from culture to culture. Mourning behaviors are conventional outward signs of grief that are socially constructed and do not necessarily indicate the presence or absence of grief.

Grief and Nursing Role

    Throughout time, nurses have had key roles managing grief. Whether working in the emergency room, a critical care unit, labor and delivery, a psychiatric setting, or any other setting, nurses frequently deal with individuals and families who are experiencing either anticipatory grief or grief following a loss. 

    Despite the importance of nurses in caring for the grieving, little nursing research was conducted on grief until the late 1980s.

Death Grief or Terminal Illness

    In 1983, Jeanne Quint Bonoliel reviewed nursing research on death, dying, and terminal illness at a time when few nurses were conducting research in those areas. Since then, research on grief and bereavement has proliferated. 

    In 1987 Demi and Miles published a review of research on bereavement. Opie, in 1992, published a review on childhood and adolescent bereavement. In 1995 Martinson reviewed research on pediatric hospice care and addressed both anticipatory grief and grief after the death of a pediatric hospice patient. 

    Corless , in 1994, critiqued research on symptom control within hospice care and reviewed research on coping with dying. A number of nurses developed research programs focused on grief, including JQ Benoliel , R Constantino, A Demi, M Diamond, N Hogan, M Miles, S Murphy, J Saunders, and M Vachon. 

    Hogan and Schmidt (2002) recently developed a model of grief to personal growth through structural equation modeling.

Standardized Instruments for Grief Assessment 

    Standardized instruments such as the Texas Inventory of Grief, the Grief Experience Inventory, and the Bereavement Experience Questionnaire have been used to assess grief manifestations. 

    The emotional distress that accompanies grief was often measured with instruments such as the Brief Symptom Inventory, the Profile of Mood States, the Impact of Events Questionnaire, or a depression scale such as the Beck's or Hamilton's. 

    Children's and adolescents' grief was often measured by the Child Behavior Checklist. A recent addition is the Hogan Grief Reaction Checklist (Hogan, Greenfield, & Schmidt, 2001).

Manifestations of Grief

    Much nursing research on bereavement has been directed at describing the manifestations of grief among diverse samples: bereaved parents, children, siblings, and widows; suicide survivors; and people facing a life-threatening or terminal illness. 

    Other re- searchers have described bereaved persons' responses to events such as the loss of a home. by fire (Keane, Brennan, & Pickett, 2000) or a spontaneous abortion (Van & Meleis , 2003). Still other researchers have focused on describing nurses' responses to caring for the dying or the bereaved. 

    These descriptive studies have used diverse analytical approaches, such as grounded theory and phenomenology, and diverse data collection methods including participant observation, semi structured interviews, survey questionnaires, structured instruments, and q-sort techniques.

    Some nursing research on bereavement has focused on comparing different modes of bereavement (suicide vs. accident, expected vs. unexpected) or comparing bereaved persons with a nonbereaved group. For example, Murphy, Johnson, Wu, Fan, and Lohan (2003) compared grief manifestations of parents whose child died by suicide, accident, and homicide.

Variables in Grief Researches

     A number of nursing studies have investigated variables related to bereavement outcomes such as self-blame, coping processes, and social support. A few studies have used quasi-experimental designs to investigate the effects of specific interventions to help the bereaved or to help nurses to better meet the needs of the bereaved. 

    For example, researchers have studied the effect of a support group on bereaved parents whose child died from cancer, the effect of a support group on bereaved children and adolescents, and the effect of a grief workshop for pediatric oncology nurses.

Descriptive Studies and Meaning of Grief

    Descriptive studies have contributed greatly to our understanding of the grief process and the many forms it may take. Comparative and correlational studies have provided insight into variables related to bereavement outcomes. 

    However, very little research has been done to assess the effects of bereavement interventions. More attention needs to be paid to intervention studies that address what helps people deal with conventional grief and anticipatory grief. Further, most of the participants in the studies re-viewed were White Americans. 

    With increasing cultural diversity in the US, it is important that research address bereavement responses among diverse cultural groups. 

    Fortunately, a few researchers have addressed cultural differences in bereavement. Lee and Chu (2001) studied the grief of Chinese men who were diagnosed as infertile, and Van and Meleis (2003) studied African American women's grief after involuntary pregnancy loss; however, much more research is needed on grief of diverse cultural groups. 

    In addition, researchers should work on developing culturally relevant instruments to assess bereavement outcomes.

Consequences of Grief

    Grieving people are vulnerable and need special attention to protect them from studies that could increase their vulnerability. 

    Although many grieving people find that participating in research that focuses on their grief provides them with an opportunity to express their thoughts and feelings to a nonjudgmental researcher, there is the potential of increasing the participant's pain and distress. 

    The researcher must have the skills to provide immediate support if this occurs and also should be prepared to refer participants for counseling if they need further support.