What Is Bereavement and End-of-Life Support?

Grief and bereavement are experienced by anybody dealing with a significant loss in their life. Death is a major emotional crisis and one of life’s most stressful events, and people will cope with their loss differently. Those who work with bereaved people, like end-of-life nurses, often must help facilitate the process of grieving, and to do that, it’s beneficial to understand what bereavement and grief look like for different people.

Written by Brian Greenberg
CEO / Founder & Licensed Insurance Agent

Last updated: December 20th, 2022

What Is Bereavement?

Bereavement is the time period during which the survivor has to adjust to life without their loved one. It’s similar to grief, but it is more about the period of time from the beginning of the grieving process until acceptance has been reached. The bereavement period includes the days after the death occurs, the funeral proceedings, and the remaining grieving process afterward. It is different for every person because people respond to grief and mourning in a variety of different ways. Aspects like age, physical health, emotional health, culture, and previous losses are all factors in how a person grieves during this period.

Letting Go

“Letting go” is a phrase often explored with death and dying, especially among family members providing care for a terminally ill loved one. This is a process that ends with the recognition that their loved one is dying, but it comes with the freedom from the intense emotions that usually accompany this knowledge. The process of letting go has four attributes: a shift in thinking, recognition of the fact that despite the best efforts to help a loved one, all hope for prolonged life is gone, acknowledgment of the impending loss, and no longer trying to impede the inevitable death.

Support for the Bereaved

Informal and formal support are important to help bereaved individuals through their loss. Support will look different for every person, but for those looking out for them, there should be regular assessments of grief during the bereavement period to get a sense of the best ways to offer support. Formal support for the bereaved can come in the way of memorial services, grief support groups, and individual or group counseling. Informal support comes from visits from family, friends, and the community at large. The biggest way people can offer their support for the bereaved is by engaging in active listening so the bereaved can express their feelings and feel heard and supported.

Support for the Nurse

After the loss of a loved one, the focus is often on the family going through the loss. However, many end-of-life patients have a nurse on call who has helped the family care for the recently deceased. In those cases, the nurse has developed a relationship with the deceased and the family, and after the loss, the nurse feels the pain as well. Nurses whose entire job revolves around this may feel the burden of loss over time, especially if they aren’t well-supported. They witness a lot of pain from their patients and the families of the patients, and the cumulative loss can lead to emotional distress. Several factors can affect how nurses adapt, such as their personal death history, education level, life changes, and support system. In formal settings, nurses can debrief with a superior following the death of a patient and attend memorial ceremonies. In informal settings, many nurses find solace in religious or spiritual services and engaging in self-care activities.

What Is Grief?

Grief is a process that sometimes starts long before the loss happens, when the patient and family have feelings of loss in anticipation of the death. It’s an emotional response to loss that stays with people forever, as nobody ever truly gets over the death of a loved one. But they can find ways to live with the sadness without their loved one. Generally, grief has three stages: notification and shock, experiencing the loss, and reintegration. The first stage is when the individual first learns about the loss, as their first instinct is often to be shocked and numb. The second stage is when the person truly experiences the loss, which can come with a whole host of emotions, like anger, emptiness, and depression, as well as related symptoms like insomnia and loss of appetite. The final stage is when the individual begins to heal from the loss and reintegrate back into their life.

Types of Grief

Grief is not a one-size-fits-all thing. There are different types of grief, and they affect people differently. However, some types of grief are common and not cause for alarm, while others signify a struggle to cope with the loss.

Normal or Uncomplicated Grief

This grief is the universal reaction to loss. Individuals dealing with normal grief will have behavioral, cognitive, emotional, and physical reactions to the loss but will eventually adjust and move forward. The amount of time it takes may vary from person to person and depends on the type of loss, the type of relationship, and other individual factors.

Anticipatory Grief

This type of grief occurs before a loved one dies and starts when a terminal diagnosis is made. Patients and family members can both feel an anticipatory loss. For patients, it’s the anticipation of their loss of comfort, function, and independence. For loved ones, it is watching the pain and suffering their loved one is going through and realizing that there are still things they wanted to share with the patient that they won’t be able to. Those who go through anticipatory grief are more likely to have their reaction to the loss cushioned because they’ve had the time to process it.

Complicated Grief

Complicated grief has four levels of severity: chronic grief, which includes a normal grief reaction that continues for extended periods of time; delayed grief, which is when normal reactions are suppressed; exaggerated grief, or an intense reaction to the loss that could lead to nightmares, new phobias, and thoughts of suicide; and masked grief, where the individual isn’t aware that their actions are a result of their loss. This type of grief often requires professional assistance, especially if the loss was sudden or traumatic. A lack of support or concurrent stressors in their life can be big contributors to complicated grief situations.

Disenfranchised Grief

Disenfranchised grief occurs when a loss has not been validated or recognized because the loved one died from a stigmatized illness, like AIDS, or in a socially unacceptable way, like during an abortion. Divorce and other severed relationships can also lead to disenfranchised grief. Individuals are not able to mourn openly due to the circumstances surrounding the loss, which leads to disenfranchised grief.

Unresolved Grief

When the bereaved hasn’t moved through the stages of grief to find acceptance of their loss, this is called unresolved grief. Factors that contribute to this include lack of formal closure if the body was never found and laid to rest, multiple losses, or social isolation.

Manifestations of Grief

Grief consists of behavioral, cognitive, emotional, and physical reactions, and the bereaved person can feel the pain of loss in any of these ways. Physical manifestations include feeling physically ill, a feeling of heaviness/pressure, headaches, muscle aches, exhaustion, insomnia, and tremors. Cognitive manifestations include confusion, disbelief, preoccupation with the deceased, hallucinations, and an inability to concentrate. Emotional responses include guilt, anger, sadness, feelings of helplessness, and sometimes even relief. Behavioral manifestations include impaired performance at school or work, withdrawal, avoiding anything that might remind the individual of the deceased, or holding onto constant reminders of the deceased.

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