Loss and grief

Question 1

Types of loss

Answer 1

Traumatic
Developmental

Question 2

Traumatic loss

Answer 2

Unwelcome
Implicit pain
May gain something from the loss long term
e.g. illness, unemployment, disability, divorce

Question 3

Developmental loss

Answer 3

Occurs as a natural part of growth and change
Made by choice
Hope to gain something
e.g. changing job, moving house, leaving home

Question 4

Categories of loss

Answer 4

External: objects and possessions, loved ones, environment, support Self losses:

Self losses: Loss of psychological, sociocultural, physical or spiritual self

Question 5

Loss of psychological self

Answer 5

Loss of self-esteem
Loss of personal identity

Question 6

Loss of sociocultural self

Answer 6

Language
Associations and the meanings of one’s cultural heritage
Loss of control/change in your environment

Question 7

Loss of physical self

Answer 7

May be obvious, but the impact may depend on the extent, duration and visibility of the loss, and the effect this has on the person’s life.

Question 8

Loss of spiritual self

Answer 8

May include loss of hopes, values and beliefs

Question 9

Bereavement

Answer 9

Refers to the objective situation of having lost someone significant. It is the cause of both grief and mourning

Question 10

Grief

Answer 10

Emotional and affective reaction to bereavement.

Grief is universal - humans and other animals react to the loss of significant others in their environment, however the expression and duration of grief is culturally determined.

Question 11

Mourning

Answer 11

The acts of expression of grief. This is shaped by the practices of a given society or social group

Question 12

Manifestations of normal grief

Answer 12

Cognitions (thoughts): disbelief, confusion, preoccupation with loss, sense of presence, hallucinations

Feelings:denial, sadness, anger/frustration, guilt (irrational), anxiety, lonliness, fatigue, shock, relief

Behaviour: sleep disturbance, appetite disturbance, absent-mindedness, withdrawal, avoiding/searching for reminders, dreams of deceased.

Physical sensations: lethargy, tightness in chest/throat, breathlessness, dry mouth, lack of energy, pain

Question 13

Kubler ross 5 stage model of grief

Answer 13

Denial

Anger
bargaining
Depression
Acceptance

Question 14

Bowlby attachment theory

Answer 14

The meaning of attachment furthers our ability to comprehend grief. Throughout human development, continual attachments to others are formed.

Attachments develop from needs for security and safety which are acquired through life, and are usually directed towards a few specific individuals. The goal of attachment behaviour is to form and maintain affectionate bonds, throughout childhood and adulthood.

Bowlby proposed that grief responses are biologically general responses to separation and loss. Behavioural responses making up the grieving process are pro-survival mechanisms geared towards restoring the lost bonds

Question 15

Worden’s tasks of mourning

Answer 15

Divides mourning into a series of tasks linked to stages.

1. To accept the reality of the loss (needs to face the reality of what happened, may accept fact but not significance of it)
2. To experience the pain of grief
3. To adjust to an environment where the deceased is missing
4. Emotionally relocate the deceased and move on with life.

Question 16

Stroebe and schut model of grief

Answer 16

Suggests that people oscilalte between restoration focussed coping (dealing with everyday life) and loss focussed coping (expressing their distress)

Restoration orientated: attending to life changes, doing new things, distraction from grief, denial/avoidance of grief, new relationships

Loss orientated: Grief work, breaking bonds/ties, denial or avoidance of restoration changes

Question 17

Continuing bonds model of grief

Answer 17

Believed that grieving is not about breaking bonds but about finding ways of continuing the bonds with the dead person

For many people adapting to loss involves incorporating some aspect of their previous relationship with the deceased person into their current lives but in a way that is tolerable and not distressing

Question 18

Three tier model of bereavement support

Answer 18

Level 1 – all HCP’s should provide information about local services to bereaved people

Level 2 – Those in need of more comprehensive support should be offered support from professionals and/or volunteers

Level 3 – a minority of people at high risk of complicated grief reactions should be referred to specialist services