Grief

Alignment with learning outcome(s): Assessment task 3 aligns with the following Learning
Outcomes:
Communicate effectively in the context of individual responses to loss and grief, existential
challenges, uncertainty and changing goals of care;
Appreciate and respect to the diverse human and clinical responses of each individual
throughout their illness trajectory;
Understand the principles of assessment and management of clinical and supportive care
needs; and
Reflect and evaluate their own professional and personal experiences and their cumulative
impact on self and others.
Details of task: Choose one (1) of the following topics and write a comprehensive essay in a
scholarly voice and using APA 6th referencing style:
Topic 1.
Grief is accepted as a normal reaction to bereavement. Choose either the Dual Process
Model of Coping with Grief (Stroebe and Schut, 1995; 1999) or Worden’s Four Tasks of
Mourning (2008) and define grieving and bereavement, then explore the process of grief
according to your chosen theory.
Or
Topic 2.
Compare and contrast curative and palliative care paradigms. As a nurse/midwife in
training outline how the key goals of care change between these two approaches to care.
Or
Topic 3.
How can nurses/midwives in training avoid heterosexist assumptions in palliative care
planning for LGBTIQA+ (Lesbian, Gay Bisexual, Transgender, Intersex, Queer, and
Asexual) persons
Word limit: 2000 words

Topic 1. Worden’s Four Tasks of Mourning (2008)
Introduction

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Grief is accepted a normal reaction to bereavement, yet it is a complex phenomenon that
has sought to be explained by several theories such as Worden’s Four Tasks of Mourning (2008).
Worden (2008) defines grief to be the experience one goes through during a loss (and
specifically for this book, the loss of a loved one due to death). Mourning indicates the process
one undergoes as he or she endeavors to adapt to a loss and bereavement.
He further suggests that grieving should be considered as an active process that involves
engagement with four tasks: (1) to accept the reality of the loss; (2) to process the pain of grief;
(3) to adjust to a world without the deceased (including both internal, external and spiritual
adjustments); and (4) to find an enduring connection with the deceased in the midst of embarking
on a new life.
Worden also identifies seven determining factors that are critical to appreciating in order
to understand the client’s experience and these include: (1) who the person who died was; (2) the
nature of the attachment to the deceased; (3) how the person died; (4) historical antecedents; (5)
personality variables; (6) social mediators; and (7) concurrent stressors (Worden, 2008). These
determinants include many of the risk and protective factors identified in the research literature
and provide an important context for appreciating the peculiar nature of the grief incident (Hall,
2011).
The initial process by which Worden starts with is to address the concept of attachment,
and according to him, grief is a difficult or unexplainable a part from attachment. Attachment is
the tendency in human beings to create strong affectional bonds”— to someone (or something) is
what makes the loss of that something (or someone) something that needs to be grieved (Worden
2008).

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Bowlby’s Attachment Theory

According to the theory, the aspect of attachment arises from the personal need to feel
secure and safe which an individual does adapt as they grow. The attachment is directed towards
certain individuals whom a person has established a form of bond with them. The main reason
for the attachment behavior is to form and maintain affectionate bonds from childhood
throughout to adulthood. According to Bowlby (1961), grief responses are biologically general
responses to separation and loss. Similarly, behavioral responses that make up the grieving
process are pro-survival mechanisms geared towards restoring the lost bonds.

Dimensions of grief

There are different dimensions of grief. Hall (2012), suggested that grief is a state in
which the bereaved person has lost someone or something of personal value. Whenever an
individual experiences loss, the strongest forms of attachment behavior become active as the
individuals try their best to restore the connection. The different series of behaviors that people
exhibited as they go through grief is physical sensation, and response interlinked to one’s
emotion, behavior change, cognition alteration (Worden, 1991).
Grief is fundamentally an emotional reaction to bereavement, which does manifest itself
in the form of gloominess, distress, tiredness, dejection, panic attacks, trauma, fury, and remorse
(Hall, 2012). The emotional responses may lead to a lack of sleep and appetite. Some individuals
who have lost their loved ones may withdraw from social contact by isolating themselves from
social support, and this may be considered to be abnormal.
Grief brings out emotional disruption and physical signs that include: constriction of the
chest and throat, weakness in the muscle tissue, fatigue, difficulty in breathing, and negative

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reaction to noise (Hall, 2012). The signs normally manifest themselves in situations of grief. The
physical manifestations are often transient, but in some cases, there is acceleration if help is not
provided resulting in the admission of the individual to the hospitals or mental institution (Gettig,
2010).

Grief Patterns

There may be patterns that occur at the early stages of mourning, and in most cases these
are temporary. However, persistent maladaptive thoughts may trigger feelings that can lead to
depression or anxiety (Worden, 2008). One of the initial cognitive reactions would be disbelief
especially if the death were sudden. Other cognitive responses include chaotic feelings, thought
disorganization, and excessive engagement in activities surrounding the dead person. These
responses often cause an individual’s mind to center on the incident that leads to the death of
their loved one (Cohen, Mannarino, and Deblinger, 2016).
There are also behavioral dimensions that are associated with grief, which fade after a
given timeframe. The most commonly reported behaviors include alteration of sleeping patterns,
lack or increase in an individual’s appetite, avoidance behavior, disengagement from reality
mentally, and socially in which the bereaved may go to great lengths to avoid any situations or
objects that remind them of the deceased (Martell, 2011). Crying is another response that does
prominently manifest itself in grief. It is believed that crying does provide one with release from
the emotional pressure the scientific mechanism associated to it has not yet been determined
(Kubbler-Ross and Kessler, 2014).
Worden also identifies seven determining factors that are critical to appreciating in order
to understand the client’s experience and these include: (1) who the person who died was; (2) the

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nature of the attachment to the deceased; (3) how the person died; (4) historical antecedents; (5)
personality variables; (6) social mediators; and (7) concurrent stressors (Hall, 2014). All these
factors affect the length and intensity of grief, of those affected.
Mourning

Mourning is not a mental state but a process where certain tasks take place to ensure its
successful finalization (Pearlman, Wortman, Feuer, Farber, and Rando, 2014). Different theories
that describe the process of grief and mourning have been developed.
Worden’s four tasks of mourning

According to Worden (2008), there are four tasks of mourning, which may take place in
any order. Task 1 is accepting the reality of the loss, and this involves coming to terms with the
fact that the person is dead and will not return (Worden (2008). At this stage, the bereaved tend
to deny the loss that has occurred and pretends or believe that the person is not dead. The denial
can take different forms such as denying the facts of the loss and denying that death is
irreversible. The belief here is that we need to help people to go through the process of denial so
that they can deal and cope up with the losses that they have been faced with.
Task 2 centers on walking as one to experience the pain of grief. The expression of grief
is encouraged in some societies for a specified period, later on; the individuals are given subtle
messages to move on with their life (Weisssman, Markowwitz, and Klerman, 2008).
It is highly recommended by counselors that individuals need to feel pain rather than
avoiding it and this may differ from one individual to another. The mourning process at times is
prevented when people decide to think only happy thoughts about the deceased, engaging in

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activities that take most of their time, hence preventing them from thinking about their grief,
idealizing the dead, avoiding reminders of the dead, and using alcohol or drugs to desensitize
(Tyson, 2013).
Task 3 is to adjust to the environment in which the deceased is missing, and this can be
done by the death taking on new roles and adjusting to the changing dynamics in their
environment (Worden (2008). Often, it may take some time for the bereaved to accept the fact
that their loved ones are no more. For people who have lost a spouse, this process may take time
because they have a problem with taking up the responsibilities of their spouses. However, with
time the spouses find new ways and techniques of adjusting by learning new skills. This enables
them to manage the change in their roles (Parkes and Prigerson, 2013).
Also, the people dealing with grief have to carry out a self-reflection where they reshape
their identity. This is important, especially in situations where they had neglected themselves in
the process of caring for others following the death (Worden (2008). If the bereaved fail in
taking up the roles and responsibilities of the deceased, their self-esteem may be affected a great
deal. The self-helplessness of the bereaved can also be increased should they fail to use or
develop skills that they do require to cope up with the loss of their loved ones. This may make
the bereaved person withdraw from the world, and this leads to failure of facing the requirements
of the situation (Haegeman, 2008).
Task 4 is to emotionally relocate the deceased and move on with life (Worden (2008).
Emotional relocation requires that the bereaved forms an ongoing relationship with the memories
associated with their loved one who has passed on. This is encouraged to provide the grieving
person with an opportunity to get closure and move on with their own lives after the loss

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(Buglass, 2010). This process involves letting go of the past attachments and to allow
development of a new relationship with the memories of the departed.
The change is identified as the process of altering the relationship with the person who
has died from one of presence to one of reminiscence (Wolfelt, 2012). The task does not mean
that the person does detach themselves from the deceased, but provides them with an opportunity
to discover healthy ways to establish a new bond. Some of the ways of doing this are to find
activities and relationships that are energizing and help create meaning in one’s life. Some of
these activities include setting aside reflection time each day, picking up a new hobby,
welcoming change and accepting emotions (Duffey, 2015).
Counselling

The field of grief and bereavement has undergone a transformational change regarding
how the human experience of loss is understood and how the goals and outcomes of grief therapy
are conceptualized (Duffey, 2015). Some individuals can walk through the aftermath of death
alone whereas others may find it hard to resolve their feelings and emotions. The individuals
who cannot handle the reactions to death on their own often seek counseling to help them get
over grief in a normal way (Klass, Silverman, and Nickman, 2014).

Counselling Model

Worden (2008) proposed a model in which objectives for counselling include; (a) helping
the person to accept the reality that their loved one has died; (b) assisting the person to work

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through the emotions centered on fury, remorse, apprehension, and helplessness that he or she is
feeling; and (c) reassuring the person that what he or she is experiencing is normal. According to
this model, an individual may require help to face a future in which they must perform the roles
and responsibilities of the deceased.
In most cases, the counselor is responsible for providing support to the deceased over a
given period. They also prepare the deceased for important events such as anniversaries and
Christmas that evoke emotional responses. The counseling process may start 24 hours after the
individual has processed the news of the death or may be delayed until when the person feels
depressed (Worden, 2008).
In some situations, the normal process of mourning can turn into a complicated mourning
process. The reasons are quite many, and they include multiple in a family within a short span of
time, a person’s history of grieving experiences, the personality of the bereaved person, and
social factors surrounding the death such as how the person died and the unavailability of social
support (Worden, 2008).
The process of mourning culminates when the individual can experience happiness, take
on new roles, look forward to new events, and when memories of the deceased no longer evoke
physical responses of sorrow and pain, although occasional feelings of sadness may remain
(Worden, 2008).

Conclusion

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In conclusion, grief is a painful event to any individual as discussed in the essay. There
are various reactions that people portray as they are going through the grieving process. Different
models and theories have also been tackled in the essay to shed light on the grief process.
Moreover, counseling is seen as a way of helping an individual overcome their grief and restore
their lives back to a state of normalcy.

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References

Bowlby, J. (1961). Processes of mourning. The International journal of psycho-analysis, 42, 317.
Buglass, E. (2010). Grief and bereavement theories. Nursing Standard, 24(41), 44-47
Cohen, J.A., Mannarino, A. P., & Deblinger, E. (2016). Treating trauma and traumatic grief in
children and adolescents. Guilford Publications.
Duffey, T. (Ed.). (2015). Creative Interventions in grief and loss therapy: When the music stops, a
dream dies. Routledge.
Duffey, T. (Ed.). (2015). Creative Interventions in grief and loss therapy: When the music stops, a
dream dies. Routledge.
Elif, K. A. R. A. (2009). J. William Worden, Grief Counseling, And Grief Therapy: A Handbook
For The Mental Health Practitioner, 4. Bs., Springer Publishing Company, 2008, 314s. Hitit
Üniversitesi İlahiyat Fakültesi Dergisi, 8(16), 185-188.
Gettig, E. (2010). Grieving: an inevitable journey. Genetic counseling practice: Advanced concepts
and skills, 95-124.
Haegeman, P. (2008). Towards a” new” vision on grief and mourning. Percursos.
Hall, C. (2011). Beyond Kubler-Ross: recent developments in our understanding of grief and
bereavement. InPsych: The Bulletin of the Australian Psychological Society Ltd, 33(6), 8.

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Hall, C. (2012). The Australian Centre for Grief and Bereavement: The interface of bereavement
education, research, and counseling. Grief Matters: The Australian Journal of Grief and
Bereavement, 15(3), 58.
Hall, C. (2014). Bereavement theory: recent developments in our understanding of grief and
bereavement. Bereavement Care, 33(1), 7-12.
Klass, D., Silverman, P. R., & Nickman, S. Eds. (2014). Continuing bonds: New understanding of
grief. Taylor & Francis.
Kubbler-Ross, E., & Kessler, D. (2014). On grief and grieving: Finding the meaning of grief
through the five stages of loss. Simon and Schuster.
Martell, M. M. (2011). Bereavement and Loss: Using Bowlby’s Grief Stages to Analyze Books for
Preschool Children (Doctoral dissertation, University of Akron).
Parkes, C.M., & Prigerson, H. G. (2013). Bereavement: Studies of grief in adult life. Routledge.
Pearlman, L. A., Wortman, C. B., Feuer, C. A., Farber, C. H., & Rando, T. A. (2014). Treating
traumatic bereavement: A practitioner’s guide. Guilford Publications.
Tyson, J. (2013). Turning a tragedy into a tribute: A literature review of creating meaning after loss
of a loved one. Illness, crisis & loss, 21(4), 325-340.
Weissman, M. M., Markowitz, J. C., & Klerman, G. (2008). Comprehensive guide to interpersonal
psychotherapy. Basic Books.
Wolfelt, A. D. (2012). Companioning the grieving child: A soulful guide for caregivers.
Companion Press.

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Worden, J. W. (2008). Grief counseling and grief therapy: A handbook for the mental health
practitioner. Springer Publishing Company.