The Clinical Guide to Supportive and Palliative Care for HIV/AIDS

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A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 16: Grief and BereavementTASKS OF THE GRIEF PROCESS■ Many grief theorists use attachment theory to develop their understanding of how grief works.British psychiatrist John Bowlby proposes that human beings tend to make strong affectionalbonds with others as part of a need for security and safety. 21 When these bonds are threatenedor broken, strong emotional reactions occur; we name these responses grief.Recent grief theorists have built on Bowlby’s work (see Table 16-1). There are distinctionsamong each theory, but most include an initial phase of shock or numbness, a time of disorganizationand a process of reorganization.These traditional models have been challenged in recent years. One issue is the use of “stages”to describe the grief process; this term implies a passive reaction to loss, and critics assert thatmoving through grief is an active process. 5 Some believe that traditional models focus too heavilyon emotional responses to loss and de-emphasize cognitive responses. 5, 17, 22 Another concern isthat in these models the aim of the grief process is for resolution, or a return to the premorbidstate of being. Rando encourages the term accommodation rather than resolution, recovery, orcompletion. 2 Accommodation implies an active process of adapting to fit specific circumstances,rather than a linear process with a final endpoint. Recent models of bereavement highlightgrief as a dynamic process around which certain themes can be distinguished and personalgrowth and transformation emerge as possible outcomes. 23Traditional bereavement models usually describe grief that results from a single loss; AIDSrelatedgrief experiences of multiple loss and bereavement overload challenge these frameworks.1The work of William Worden is used to illustrate the grief process in this chapter. His “tasks ofmourning” are a way to understand the grief process more fully. 8 The word “tasks” is usedintentionally to emphasize that dealing with the responses to grief takes effort; hence “griefwork.” Worden acknowledges that the tasks do not have to follow a specific order and thatpeople can work on more than one task at a time.TASK I:ACCEPT THE REALITY OF THE LOSSThe first task of grieving is to acknowledge and accept the reality that the person is dead andwill not return. This task can take time, as the bereaved often experiences a period of numbness,shock and disbelief even if the death was expected. 8 The bereaved may experience a periodof searching or yearning for their loved one. Some people report they expect to see theirloved one when they arrive at home, or attempt to contact them by calling out or reaching for thetelephone before remembering that the person is gone. Many people find themselves continuingtheir old routine, such as setting the table for two people even though one spouse/partnerhas died. The bereaved may even refer to their deceased loved one in the present tense or usethe present and past tense together in the same conversation. These are all examples of workingto accomplish the first task: accepting the reality of the loss.Traditional rituals such as funerals or memorial services can help people accomplish this task.This public method of saying good-bye helps people confront the finality of the death. Often thefirst visit to the cemetery reinforces the finality of the loss as well.334U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau
A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 16: Grief and BereavementSanders (1989):Phases of Grief26 picasShockTable 16-1: Contemporary Theories of the Grieving ProcessBowlby (1961):Phases of GriefAwareness of the lossParkes (1974):Phases of GriefWorden (1982):Tasks of GriefNumbingDisbeliefAccept the reality of the lossSearching/yearningSearching/yearningExperience the pain of griefDisorganization/despairIsolation/lonelinessAdjust to life withoutthe deceasedReorganization/new lifeMitigationWithdraw emotional energyand reinvest in lifeReinvestment/new identitySources: References 6, 8, and 35.XVIRando (1983):Grief ProcessesRecognize the lossReact to the separationRecollect/re-experiencethe deceasedRelinquish old attachmentsReadjustmentReinvestmentWithdrawalHealingRenewalU.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau 335
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DedicationA Clinical Guide to Suppo
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Lynn A Jansen, RN, PhDAssistant Res
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TABLE OF CONTENTSPart IChapter 1Cha
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IChapter 1.26 picasHIV and Palliati
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IA Clinical Guide to Supportive and
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A Clinical Guide to Supportive and
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IIIChapter 3.Assessment of Physical
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Chapter 6.26 picasPulmonary Symptom
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Chapter 8.26 picasOral ProblemsDavi
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Chapter 10.26 picasPsychiatric Prob
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Chapter 11.26 picas Substance Use P
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Chapter 19.Palliative 26 picas Care
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Chapter 25.26 picas Prevention of S
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Chapter 26.26 picasResourcesMagda B
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DRUGS AND THERAPIES INDEXNOTES: Ent
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