COUNSELING PROGRAM UNIT

Subject : Loss and Grief

Topik : Overcoming Loss and Grief
Target : Undergraduate nursing student 3rd semester class off 2 A STIKes
Rajawali Bandung
Implementation of activities
The place : Room 202, 2nd floor
Date : Wenesday, 08 January 2020
Time : 08.00 – 08.35 Am
Counselor : Ratih Mulyaningsih

A. Institusional Goals
After counseling students know how to deal with clients when dealing with loss and
grieving.
B. General Instruksional Goal
After the counseling material lasts about 35 minutes it is expected that students and
students will not only understand but also apply how to deal with clients who are losing
or grieving.
C. Characteristics of Extension Participants
nursing students who deal with patients with problems
loss and grieved
D. Task Analysis
1. Know
a. Definision loss and grief
b. Cause of loss and grief
c. Stages of loss and grief
d. Signs and symptoms of loss and grief
e. overcome loss and grief
2. Do
Providing responses and questions during counseling
3. Show
Listen attentively during counseling
E. Spesific Instruksional Goals
1. Explain the meaning of loss and grief.
2. Mention the causes of loss and grief.
3. Mention the stages of loss and grief.
4. Mention the signs and symptoms of loss and grief
5. Mention how to overcome loss and grief.
6. Mention the role of the family in caring for patients.

F. Counseling Material
1. Definition
2. Causes
3. Stages of grief
4. Signs and symptoms
5. How to deal with loss and sadness
6. The role of the family in caring for patients

G. Time Allocation
1. Apperception : 5 minute
2. Opening Activities : 5 minute
3. Explanation/description of the material : 15 minute
4. Evaluation and closing : 10 minute

H. Method
a. Lecture
b. Question and answer
c. Discussion

I. Media dan Alat Teaching Tools

a. Leaflet
b. Projector
c. Laptop
J. Strategy Instruksional
1. Explain counseling material
2. Using media and practice to facilitate the understanding of the counseling
participants,
3. Providing oppurtunities to participants to ask during counseling
4. Carry out an evaluation

K. Variasi of teaching
1. Voice : Intonation and volume are used to clarify the statements and questions
raised.
2. Non-verbal expression and communication in the form of body movements and eye
sight.
3. Using the Silence time to calm the mind
4. Using a variety of TEACHING media such as leaflets

L. Source
Patricia A. Potter et al. 2009 Fundamentals of Nursing, 2nd Book 7 ͭ ͪ Edition Jakarta:
salemba Medika

M. Learning Process
No. Step Counseling The Activities Method Time
Activities of the
counseling
participants
1. Pre 1. Prepare 5
equipment minute
2. Room
arrange
2. opening 1. Say hello 1. Answer lecture 5
grettings and greetings minute
introduce 2. Listen to the
yourself delivery of
2. Explain the the intent and
aims and purpose of
objectives of counseling
counseling
3. Explain the
benefits of
counseling
4. Make a time
contract
5. Handing out
leaflets
2. Presentation/description 1. Explain 1. Listen to the 1. Lecture 15
material about
of material explanation 2. Discussion minute
loss of grief
2. Give given by
participants a
counsellor
chance to ask
questions 2. Giving
3. Answering
question
questions that
have been about the
asked relating
material
to material
that has been presented
submitted
3. Closing 1. The consellor 1. Listen to 1. Lecture 10
gives an evaluations 2. Discussion Minute
evaluation. and
2. Make conclusions
conclusions conveyed by
from the the
material consellor.
presented 2. Answering
what is
 3. Give a post known after
test to counseling
participants. delivered by
4. Give a closing the
greeting and a counsellor.
group photo. 3. Answer
greetings

N. Evaluation
1. It is expected that participants understand clearly the information that has been given
2. It is expected to apply the knowledge provided by the consellorr
3. Procedure : Post test
4. Type of Test : Spoken
5. Item of questions : 5 questions
1) Explain the meaning of loss and grief?
2) Explain the cause of loss and grief?
3) Explain the stages of loss and grief?
4) Mention the signs and symptoms of loss and grief ?
5) Explain how to overcome of loss and grief?

O. Inset
Material loss and grief
 Health Education Material

A. Definition
Losing and grieving are a natural part of life, loss is a condition that is interrupted or
separated or starts something without a meaningful thing since that event. Loss may occur
gradually or suddenly, can be non-violent or traumatic, anticipated or unexpected /
suspected, partial or total and may return or may not return.
Loss is an individual state that is separated from something that previously existed, then
became non-existent, either partially or completely (Iyus Yosep, 179).
Individuals experience loss when other individuals, controls, body parts, the environment
that is known, or self-feelings have changed or no longer exist
Loss is an experience that every individual has experienced in his life span. From birth the
individual has experienced loss and is likely to experience it again even though in a
different form.
Losing is a condition in which a person experiences a deficiency or does not exist from
something that once existed or was once owned. Losing is a state of separation from
something that previously existed to no, either partially or wholly
Grieving is an emotional response to loss, which is manifested by individuals in a special
way, based on personal experiences of cultural expectations, and spiritual beliefs
(Hooyman and Kramer, 2006)
Coping in the grieving process involves a period of mourning, appearance, social
expression of grieving, and behavior related to loss.
Loss term combines between grieving and mourning, and include emotional responses and
behaviors outside of someone who is experiencing a sense of loss (End-of-life Nursing
education Consortium [ELNEC], 2003).

B. Cause
Feelings of loss and grief for someone can arise due to various reasons
1. Necessary loss
is a part of life, we learn to hope that most of the loss needed is eventually replaced
by the better. However, some loss causes us to experience permanent changes in
our lives and threatens our feelings of ownership and security. for example, losing
someone we love, divorce or losing freedom will change our lives forever and
significantly interfere with physical, psychological and spiritual health.
2. Maturasional Loss
A form of loss that is important and involves all life expectancy that normally
changes throughout life. Maturational loss associated with normal life transitions
will help individuals develop adaptation skills to use when experiencing an
unplanned, unwanted, or unexpected feeling of loss. For example a mother feels lost
when her daughter leaves home on the first day of school. An elementary school
student does not want to lose his favorite teacher and classroom.
3. Unexpected external events cause a sense of situational loss.
Some sense of loss seems unnecessary and is not part of the expected adult
experience. as an example, a car accident may cause trauma due to physical killings
 that make it impossible for a person to return to work or school, causing loss of
function of life purpose or self confidence.
4. Actual Loss
Occurs when someone no longer feels to hear or recognize someone or an object,
for example among others. Loss of body parts, death of family members, or loss of
work. Missing valuable objects include everything that was used or misplaced,
stolen or damaged by disaster. a child can be sad because of losing his favorite toy
due to flooding.
5. Perceived loss
Uniquely defined by someone who experiences a sense of loss that is not very clear
to other individuals. Is an axample, some individuals feel rejection from friends, or
a sense of loss of trust or status in the group.

Loss type
1. sense of loss goods or objects ( for example: theft, setback, misplaced or
destruction)
2. sense of loss of the know environment ( for example: leaving home, hospital
treatment, New Job, Get out of the rehabiltation)
3. sense of loss something significant (for example: Divorce, loss of friends,
trusted service providers, or pets)
4. sense of loss of self aspect (for example: past of body, work, Psychological or
physiological functions)
5. sense of loss of life (for example: Death of a family, friends, colleague, or
someone loved)
Implications feel for loss
1. the level of grief depends on the value of the object, the feelings contained
therein, or its usefulness.
2. Feel loss occurs through a maturational event or through trauma/disease.
Loneliness in an unknown place threatens self-confidence, hope or ownership.
3. Close friends, family members, or pets meet psychological needs, security,
loved, and confidence.
4. Illness, trauma or developmental changes cause a loss feel of valuable aspects
of self, change personal identity and self-concept.
5. Feel of loss of life causes feeling of grief for those left behind. Individuals who
now also feel sadness or pain due to fear, loss control, and dependence on
onthers.

C. Stage of Death or Grief

1. Denial, individuals act like nothing happened and refuse to accept the reality of loss.
Individuals show as if they do not understand what has happened.
2. Anger, to feel loss individuals express defenses and sometimes feel intense anger
toward God, other individuals, or situations.
3. Bargaining. Protect and delay awareness feel of loss by trying to prevent it from
happening. Individuals who are grief or dying make a promise with themselves,
 God, someone who are loved that they will live or believe differently if they can be
avoided from that terrible loss.
4. Depression, some individuals feel sad, hopeless, and excessive solitude bacause
experienced something bad, they sometimes withdraw from relationships and life.
5. Acceptance, individuals put a sense of loss into life and find a way to move forward.

D. Signs and Symptoms

a. Feeling
 Grief
 Fright
 Angry
 Feel guilty or self-blame
 Anxiety
 Solitude
 Fatigue
 Helplessness/Despair2q
 Loging
 Freedom
b. Awreness or mindset:
 Distrust
 Confusion or memory problems
 Problems with decision makers
 Inabiity to concentrate
 Feelings of the presence of people who have died
c. Physical sensation:
 Headache
 Nausea and appetite disorders
 Tightness in the chest area and throat
 Insomnia
 Too sensitive to sound
 There is nothing real
 Shallow breath
 Choking Feeling
 Muscle weakness
  Lack of energy
 Dry mouth
d. Behavior
 Cry and often Complain
 Keep distance from people
 Dazed
 Dreaming of people who have died
 Keeping the dead person’s room intact
 Loss of interest in events everyday life
 Using object that belong to people who have died

E. Way overcome Loss and Grief

Task 1: Accept the reality of loss. Even when a death is expected, survivor to state some
doubt and surprise that the incident actually happened. Task 1 involve the process
Acceptance that the individual or object has left and will never return.
Task 2: Through the pain will grief. Although individuals respond differently to loss, it
is impossible to eliminate a significant sense without some emotional feeling.
Individuals give reactions in the form of sadness, solitude, Despair, or remorse and will
work through feelings of pain by using adaptation mechanism that is most known and
comfortable for them.
Task 3: Adapt to the environment in which the person died. An individual is not fully
aware of the effects of loss for at leasts 3 months. Family members or friends pay little
attention to individuals who feel loss in the same period of time, As the end of loss
comes true. Individuals who complete this task begin to take roles that were filled by
people who have died, Including some jobs they don’t want.
Task 4: Relocating people who have died emotionally and get on with life. People who
have died cannot be forgotten, But it is more likely to place it differently and less
prominently in the emotional lives of individuals who are still alive. Individuals feels
afraid that if they make a new relationship they will forget the person they love or look
unfaithful, making this task difficult to complete. Realizing that it is possible to love
another individual without betraying the person who has died, the individual must
advance.
F. The role of the family in caring for people who have experienced loss.
1. Hoping for the best care that has been given, and the belief that death is the end of suffering
and pain that has been determined by god.
2. Participate in care and sharing with staf nurse.
3. Give support to clients, with clients support get through angera, sadness, Denial. Support
can be used as coping with changes that occur.
4. Pray according to belief in order to get strength from god,
 COUNSELING PROGRAM UNIT

Overcoming loss and Grief

Submitted to Fulfill One of The individual English Tasks of 3rd Semester

Coordinator: Lisbet Octavia Manalu, S.Kep.Ns., M.Kep

By :
Ratih Mulyaningsih
1118028

UNDERGRADUATE NURSING STUDY PROGRAM

INSTITUTE OF HEALTH SCIENCE RAJAWALI
BANDUNG
2020