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Understanding Grief and Bereavement
Hospice nurses work with families and caregivers throughout a patient’s last months, weeks, and days. During those times, the hospice nurse provides guidance and support as each new symptom appears and the patient draws closer to death. The purpose of this chapter is to provide information about the processes of grief and bereavement for nurses working with grieving families.
After reading this chapter, you will be able to:
■ Identify current grief theories
■ Discuss the role of the hospice nurse in providing grief support
■ Describe red flags that necessitate grief intervention
GRIEF THEORIES
Hospice nurses regularly work with grieving families. Yet, most nursing programs do not include content specifically on grief support. In this section, several current grief theories, models, and concepts are reviewed.
■ Theory of chronic sorrow: This theory indicates that after a loss, bereaved individuals experience “periods of happiness . . . interspersed with episodes of re-grief” (Eakes, Burke, & Hainsworth, 1998, p. 180). This theory differs from Parkes’s work in that it applies to many situations, not to bereavement only, and is ongoing and cyclical in nature.
■ Grief to personal growth theory: This theory (Hogan & DeSantis, 1996) states that grief results in various negative emotions but ultimately leads to personal growth, which involves feeling more compassionate, more loving, and more appreciative of one’s life and loved ones.
■ Continuing bonds: This concept denotes the ongoing relationship that bereaved individuals have with their loved ones after the death. Specifically, bereaved individuals may indicate that, although they have moved forward emotionally, their deceased loved one continues to hold a place of value in their lives (Hogan & DeSantis, 1996; Silverman, Nickman, & Worden, 1992).
■ Complicated grief: This term is used to describe very severe grief symptoms that do not abate over time as expected. Signs include excessive longing; yearning; preoccupation with the deceased; hallucinations; ongoing, intrusive thoughts of the deceased or the circumstances of the loss; and failure to adapt to the loss over time (Horowitz et al., 2003; Prigerson et al., 1996; Shear, 2015; Worden, 1991).
Question: Why isn’t Elisabeth Kübler-Ross’s work included in the list of grief theorists?
Answer: The five stages in Kübler-Ross’s model refer to how a person responds when facing his or her own death, not to how a person responds to the loss of a loved one.
PROVIDING GRIEF SUPPORT
Grief occurs repeatedly during the illness of a loved one. With each further decline, the family members or caregivers come closer to facing the reality of loss. Hospice nurses provide emotional support as grief emerges and reemerges. Other members of the interdisciplinary team, especially the social worker and chaplain, also offer invaluable support to families as they grieve. The nurse’s grief assessment should include:
■ Sources of support
■ Sources of strength and comfort
■ How the family has faced difficulties or losses in the past
Fast Facts in a Nutshell
