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LOSS Is an actual or potential situation in which a valued object, person or the like is inaccessible or changed so that it is no longer perceived as valuable.

BEREAVEMENT Is the subjective response to a loss through the death of a person with whom there has been a significant relationship.

GRIEF Is the total response to the emotional experience of the loss and is manifested in thoughts, feelings and behaviors.

MOURNING - Is the behavioral process through which grief is eventually resolved or altered, it is often influenced by culture and custom.

DEVELOPMENT OF THE CONCEPT OF DEATH

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INFANCY TO 5 YEARS OLD Does not understand concept of death Believes death is reversible, a temporary departure or sleep.

5 to 9 years old Understands that death is final Believes own death can be avoided Associates death with

9 to 12 years Understands death as the inevitable end of life. Begins to understand own mortality.

12 to 18 years Fears of lingering death. May fantasize that death can be defied, acting out defiance through reckless behavior. Views death in religious and philosophic terms.

18 to 45 years - Has attitude toward death influenced by religious and cultural beliefs

45 to 65 years Accepts own mortality. Encounters death of parents and some peers. Experiences peaks of death anxiety.

65 years + Fears prolonged illness. Encounters death of family members and peers. Sees death as having multiple meanings. E.g. freedom from pain, reunion with already deceased family members.

STAGES OF GRIEVING
KUBLER-ROSS STAGES OF GRIEVING DENIAL - Refuses to believe that loss is happening. - Is unready of family members and peers. - May assume artificial cheerfulness.

ANGER - Client or family may direct anger at nurse or hospital about matters that normally would not bother them.

BARGAINING - Seeks to bargain to avoid loss. - May express feeling of guilt or fear of punishment for past sins, real or imagined.

DEPRESSION - Grieves over what has happened and what cannot be. - May talk freely or may withdraw.

ACCEPTANCE - Comes to terms with loss. - May have decreased interest in surroundings and support. - May wish to begin making plans.

MARTOCCHIOS FIVE CLUSTERS OF GRIEF.

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SHOCK AND DISBELIEF A feeling of numbness following the death of a loved one.

YEARNING AND PROTEST The anger that the bereaved feel may be directed towards others.

ANGUISH, DISORIENTATION, AND DESPAIR When the reality of the loss is genuinely admitted, depression can set in. Weeping is common. The bereaved lose interest and motivation in pursuing the future, and may lack confidence and purpose.

IDENTIFICATION IN BEREAVEMENT - The bereaved may take on the behavior, personal