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Working with the bereaved
Working Bereave JOANN ALEXANDER JOAN KIELY· The whole process of grief or a part of it may be abnormal when it is excessive, inhibited, prolonged, or delayed. In "Much Ado About Nothing," Shakespeare wrote that "everyone can master a grief but he that has it." Grief is a painful emotion and because each individual is unique, each will react differently to the dying and death of a beloved person. In "Support for the Survivor," Elaine Whelan stated that survivors perceive the nurse's role in the death process as being kind and considerate, knowledgeable about what to do to make dying persons comfortable, and sensitive to their needs (I ). Most of the nurse's interventions are related directly to the dying patient and are comforting to the loved one as well. Some survivors, however, do not begin the grief process until the loved one has actually died, especially when death is quick and not anticipated. Whose responsiblity is it to help this group regain a normal, healthy, well-adjusted life? Nurses would seem to be a logical choice, since they usually are the professionals who have developed an empathic, trusting relationship with the survivors while caring for JoAnn Alexander, RN, MSN, and Joan Kiely, RN, MSN, are assistant professors of nursing at the University of Evansville, Evansville, IN.
patients dying at home or in the hospital or nursing home. To continue supporting the survivor the nurse needs to identify the expected "grief work" through a thorough assessment of the survivor's ability, available support systems, physical status, financial means, and present stage in the grieving process. Research identifies several common problems that may follow the loss of a loved one(2-3). These problems are depression; loneliness; social isolation; anxiety; and loss of identity, role, and balance between independence and dependence. Assessment can identify the bereaved person's potential or actual problems, so it is essential to recognize their various manifestations in order to help the survivor through the grief work (see Nursing Care Plan For Survivors). Some or all of these symptoms may appear in the various stages of the grieving process. Most are normal for a given period of time, but if they persist too long the behavior may be considered maladaptive. This is when intervention is crucial. The generalized nursing care plan shown here provides a guide for health care personnel in meeting the needs of survivors. In many localities, counseling programs and support groups are conducted by hospitals, community health agencies, civic organizations, and senior citizen centers. The Widow to Widow Program, which currently numbers more than 100 groups throughout the na-
tion, provides excellent outreach. This program offers assistance to newly widowed persons through volunteers who have been widowed for at least two years and have adjusted satisfactorily. These volunteers are required to meet certain criteria and attend a training program as well as regular monthly meetings. Similar groups include Widows Consultation Center and Niam, a group for Catholic widows and widowers(4). To be of real help to survivors, nurses need, first, to understand their own feelings about death and grieving. This requires internalizing, experiencing, knowing oneself, and empathy Most of all it calls for the acceptance of grief as a healthy emotion that requires expression. Fortunately, most people cope with the sorrow of bereavement without undue turmoil. However, they need an opportunity to work through their grief if subsequent ill health is to be prevented. To those survivors who are unable to work through the grief process nurses can offer support, counsel, referral on occasion, and encouragement about their progress. References I. Whelan, Elaine. Support for the survivor. Geriatr.Nurs, 6:21-23, Jarr-Feb. 1985.
2. Block, Marilyn. Women Over Forty: Visions of Realities. (Focus on Women Series No.4) New York, Springer Publishing Co., 1981, pp_ 96-99. 3. Lopata. H.Z. Women As Widows: Support Systems. Westport, CT, Greenwood Press. 1979, pp. 381-385. 4. Wakin, Edward. Living as a widow--only the name is the same. U.S. Catholic 40:23-28, July 1975.
Geriatric Nursing March/April 198685
patients dying at home or in the hospital or nursing home. To continue supporting the survivor the nurse needs to identify the expected "grief work" through a thorough assessment of the survivor's ability, available support systems, physical status, financial means, and present stage in the grieving process. Research identifies several common problems that may follow the loss of a loved one(2-3). These problems are depression; loneliness; social isolation; anxiety; and loss of identity, role, and balance between independence and dependence. Assessment can identify the bereaved person's potential or actual problems, so it is essential to recognize their various manifestations in order to help the survivor through the grief work (see Nursing Care Plan For Survivors). Some or all of these symptoms may appear in the various stages of the grieving process. Most are normal for a given period of time, but if they persist too long the behavior may be considered maladaptive. This is when intervention is crucial. The generalized nursing care plan shown here provides a guide for health care personnel in meeting the needs of survivors. In many localities, counseling programs and support groups are conducted by hospitals, community health agencies, civic organizations, and senior citizen centers. The Widow to Widow Program, which currently numbers more than 100 groups throughout the na-
tion, provides excellent outreach. This program offers assistance to newly widowed persons through volunteers who have been widowed for at least two years and have adjusted satisfactorily. These volunteers are required to meet certain criteria and attend a training program as well as regular monthly meetings. Similar groups include Widows Consultation Center and Niam, a group for Catholic widows and widowers(4). To be of real help to survivors, nurses need, first, to understand their own feelings about death and grieving. This requires internalizing, experiencing, knowing oneself, and empathy Most of all it calls for the acceptance of grief as a healthy emotion that requires expression. Fortunately, most people cope with the sorrow of bereavement without undue turmoil. However, they need an opportunity to work through their grief if subsequent ill health is to be prevented. To those survivors who are unable to work through the grief process nurses can offer support, counsel, referral on occasion, and encouragement about their progress. References I. Whelan, Elaine. Support for the survivor. Geriatr.Nurs, 6:21-23, Jarr-Feb. 1985.
2. Block, Marilyn. Women Over Forty: Visions of Realities. (Focus on Women Series No.4) New York, Springer Publishing Co., 1981, pp_ 96-99. 3. Lopata. H.Z. Women As Widows: Support Systems. Westport, CT, Greenwood Press. 1979, pp. 381-385. 4. Wakin, Edward. Living as a widow--only the name is the same. U.S. Catholic 40:23-28, July 1975.
Geriatric Nursing March/April 198685