Grief Workbook: Loss and Bereavement
Source: the “Loss and Bereavement” section of raw/nsg210_wk09_CDeathDyingCommunicationWorkshopFALL2026.docm.
Objectives
- Describe types of loss that trigger grief
- Discuss Kübler-Ross’s theory of grieving
- Tell normal from maladaptive responses to loss
- Describe nursing interventions for people who are grieving
- Identify criteria for evaluating that care
What Grief Is
- A natural response to loss; emotional suffering that can also affect sleep, eating, and thinking
- The more significant the loss, the more intense the grief
- Any loss can cause grief, not only death: divorce, loss of health, job loss, financial loss, miscarriage, retirement, death of a pet, loss of a dream, a loved one’s serious illness, loss of a friendship, loss of safety after trauma, selling the family home
- Small transitions (moving, graduating, changing jobs) can also trigger grief
The Grieving Process
- Highly individual; no right or wrong way
- Depends on personality, coping style, life experience, faith, and how significant the loss was
- No normal timetable: weeks, months, or years
Myths and Facts
| Myth | Fact |
|---|---|
| Ignoring pain makes it go away faster | Avoiding it makes it worse; healing requires facing it |
| You need to “be strong” | Sadness, fear, and loneliness are normal; crying is not weakness |
| Not crying means you are not sorry | People show pain in different ways |
| Grief should last about a year | There is no set time frame |
| Moving on means forgetting | Moving on means accepting the loss, while keeping the memory |
Coping
- Acknowledge the pain
- Accept that grief brings many unexpected emotions
- Know your grief is unique
- Seek face-to-face support
- Take care of your physical health
- Know the difference between grief and depression
Kübler-Ross Five Stages (1969)
Denial, anger, bargaining, depression, acceptance.
- Based on patients facing terminal illness, later applied to other losses
- Not everyone goes through all the stages, and not in order; some people resolve grief without any of them
- Kübler-Ross said the stages were never meant to be a rigid framework
- Alternative image: grief as a roller coaster, with deeper lows early that become shorter and less intense over time; anniversaries and milestones can bring grief back years later
Symptoms of Grief
Emotional:
- Shock and disbelief (numbness, expecting the person to appear)
- Sadness (emptiness, yearning, loneliness, crying)
- Guilt (things said or not said, relief after a long illness, feeling the death could have been prevented)
- Anger (at self, God, doctors, the person who died)
- Fear (anxiety, helplessness, panic, fear of one’s own mortality)
Physical: fatigue, nausea, lowered immunity, weight loss or gain, aches and pains, insomnia.
Support
- Lean on friends and family and tell them what you need
- Accept that people may feel awkward and say the wrong thing
- Faith and mourning rituals
- Support groups (hospitals, hospices, funeral homes, counseling centers)
- Therapist or grief counselor if grief feels like too much
- Social media memorial pages can help but carry risks (inappropriate comments, trolls); a closed group is safer; it does not replace face-to-face support
Self-Care While Grieving
- Face feelings; unresolved grief can lead to depression, anxiety, substance abuse, and health problems
- Express feelings creatively (journal, letter to the person, scrapbook, a cause they cared about)
- Keep hobbies and routine
- Do not let anyone dictate how you should feel
- Plan for triggers: anniversaries, holidays, milestones
- Sleep, eat well, exercise; avoid alcohol and drugs to numb the pain
Complicated Grief
Being stuck in intense mourning that keeps the person from resuming life. Signs:
- Intense longing for the person
- Intrusive thoughts or images
- Denial or disbelief, imagining the person is alive
- Searching for the person in familiar places
- Avoiding reminders
- Extreme anger or bitterness
- Feeling that life is empty or meaningless
A sudden, violent, or traumatic death can lead to psychological trauma or PTSD.
Grief vs Depression
Grief comes in waves, with moments of pleasure even early on. Depression is constant emptiness and despair. Signs that point to depression:
- Intense, pervasive guilt
- Thoughts of suicide or preoccupation with dying
- Hopelessness or worthlessness
- Slow speech and movement
- Inability to function at home, work, or school
- Hallucinations
Antidepressants: normal grief generally does not need them. They do not treat the cause (the loss) and can delay mourning.
When to Refer to a Professional
- Feels life is not worth living
- Wishes they had died with the loved one
- Blames self for the loss
- Numb and disconnected for more than a few weeks
- Trouble trusting others since the loss
- Cannot perform normal daily activities
Untreated complicated grief and depression can lead to serious health problems and suicide.