The subject of grief and loss is a crucial topic in the healthcare practice not only because almost every service user and healthcare worker experience it, but also because of the debates and developments surrounding it that have been developed over time. Grief can be described as a complex response that the body of someone goes through after the loss of a person with whom they had a bond of connection. Grief commences when one identifies a stressor or loss, which maybe loss of a child, property, or part of a body such as a limb (Reed, 2003). Though the major part of the response to loss is emotional, grief also comprises other dimensions such as cognitive, physical, social, cultural, behavioral, philosophical, and spiritual (Bradbury, 2001). Evidently, grief is normal and an essential part of human life and that is why scientists have never attempted to develop a drug or treatment for grief. Instead, the important nature of grief in human life has motivated several studies and theories that attempt to explore and understand the centrality of grief. It has thus, undergone historical evolution and the concept has been explored through different lenses: psychological, philosophical, and scientific in nature. In this paper, I seek to identify the historical advancement of loss and grieving and examine how complexity, human science, and critical ontologies have informed nursing practice from a loss and grieving area of interest.
Historical Evolution of Loss and Grief
Grief and loss drew the interest of theorists as a topic substantial for study in the early 20th century. Exploring the concept of grief and loss started with Freud whereby in his influential essay, "Mourning and Melancholia", he noted that grief is a natural process that should not be tampered with. In the essay, Freud attempted to remove the perception that grief was part of depression as earlier thought (Bradbury, 2001). To differentiate grief from depression, he went further to illustrate that in grief a person must work through some powerful emotions in order to attain detachment from the deceased, recover, and become renewed. Additionally, Freud explained that mourning needed no medication while depression (melancholia) is a dangerous illness that requires treatment due to its suicidal nature (Bradbury, 2001). Other elements that Freud used to differentiate grief from depression are that depression is not caused by any loss of a person or object and is unconscious unlike grief, which is a conscious feeling. The explanations put forward by Freud on grief and loss formed the basis for exploration of the concept (Bradbury, 2001). In light of this, psychologists examined his theory and concluded that grief is a pathology warranting its inclusion in the psychological domain.
Another theorist who contributed to the exploration of the idea of loss and grief was Elisabeth Kubler-Ross who in her book, On Death and Dying (1969), developed the five stages of grief. These stages were identified as denial, anger, bargaining, depression, and finally acceptance. Kubler-Ross developed the stage theory model, which represents the stages of emotional progress assumed by a grieving person (Cowles & Rodgers, 1991). The stages are more or the same of what is experienced by a terminally ill person. The first stage is denial, where the person clings to a false reality by failing to believe the diagnosis. The second stage is anger, which is characterized by frustrations when they realize that they can no longer deny what they are going through. The third stage is bargaining, which involves negotiation and hope that one can escape the cause of grief. The fourth stage is depression where an individual becomes very sad and lose all hope in life (Cowles & Rodgers, 1991). They think that it would even be better if they just die. At this stage, one becomes sullen and avoids interaction with people (Bradbury, 2001). The final stage is acceptance where one realizes that they cannot fight the grief and everything is just going to be fine (Jacob, 1993). All they have to do is embrace reality and thus, achieve calmness and stable emotions.
Complexity Theory of Loss and Grief
Complexity theory is defined as "a collection of individual agents who are free to act in ways that are not totally predictable and whose actions are interconnected, such that one agent's actions change the context for other agents" (Paley, 2011, p.268). The complexity theory in human system attempts to understand all the components of the system and how they are interconnected (Mitchell et al., 2012). Complexity moves from a cause and effect approach to suggest that systems are dynamic, unpredictable and made up of a collection of interrelated relationships and elements. Complexity theory focuses on the nonlinear way of looking at things. As such, approach to an issue or a problem should take this view of considering systems as dynamics and interconnected. For instance, in healthcare, when evaluating issues of obesity and other chronic diseases, a great deal of factors interconnected to each other contributes to the conditions. As such, intervention strategies should take into consideration the complex factors that cause the conditions.
In relation to grief and loss, complexity theory suggests that grief and loss should be viewed as a complex interconnectedness of various factors (Rogers, 1992). Grief should not be taken as a mere emotional response that requires one to simply go through the proposed stages to overcome. In essence, understanding grief should involve a complex evaluation of interconnected elements that may impact grief and loss (Mitchell, Jonas & Cross, 2012). For instance, cultural, spiritual, social, and cognitive dimensions are important factors that need consideration when evaluating the concept of grief. According to Reed (2003, p.77), "Each individual has their own variables physiological, psychological, sociocultural, spiritual, and developmental typically functioning harmoniously and responsible for their basic structure". The process of grieving starts when a person identifies a stressor, which can be a loss due to the death of a loved one (Bateman, 1999).
As an example, application in the healthcare field, practitioners using this perspective acknowledge that loss affects each person differently because clients have their unique variables that determine how they react to loss. For instance, some individuals apply past. Looking at grieving and loss from this perspective, healthcare workers can develop intervention strategies that take into account the complex issues involved in the grieving process such as complications and the efficiency of the treatments applied (Cody, 1991). For example, professional counselors in mental health have recognized unique cultural elements that influence grief and loss (Boucher, 2004). As such, they observe cultural values and observe sensitivity to the client's culture during interventions (Boucher, 2004). The ethical issue that arises from this theory is that its application in evaluating grief may cause bias in assessment because it ignores the individuality element.
Human Science of Loss and Grief
The Human Caring Theory is the foundation of the humanitarian caring process, phenomena, and experiences that are founded in relational ontology and the perception of interconnectedness (Pratt, 2012). The human caring theory is the foundation of nursing practice and other art and humanities disciplines. The human caring theory helps nurses to embrace positive energy in a healthcare setting. The theory promotes a positivity that flows from the mind, body, and even spirit, which is both rewarding to the patient and the nurse (Mitchell et al., 2012). By engaging in caring activities, the nurse promotes the patient's ability to self-heal. In connection to loss and grieving, human science theory of caring gives nurses a different perspective of looking at things in order to ensure effective healing for the patient (Boucher, 2004). Nurses can influence people experiencing grieving to self-heal by impacting positivity and energy in them (Bateman, 1999). As such, nurses should develop and maintain emotional sensitivity throughout their care for service users going through grieving and loss. The concepts of this theory in nursing entail caring values such as embrace, nurture, inspire, trust, forgive, balance, deepen, co-operate, minister, and open.
Based on Watson's human caring theory, the human theory allows healthcare workers to apply the concept of the transpersonal caring-healing moment in dealing with people experiencing loss (Cowles & Rodgers, 1991). According to Watson's definition of transpersonal, "Transpersonal refers to an inter-subjective human-human relationship in which the person of the nurse affects and is affected by the person of the other" (Clark, 2016, p. 2). Essentially, this concept requires that nurses and other healthcare workers go beyond the personal realm to the personal state of being. For example, in handling people undergoing grief and loss, they go beyond the normal state of body experiences related to the ego to the transpersonal state of consciousness of the person (Boucher, 2004). It is important to explore these non-ordinary experiences because they limit a person's view of the world.
In support of the transpersonal concept, Pratt (2012) further explains that the perspective of the human caring theory is to allow understanding of people and how they interpret significant experiences. Thus, the theory is essential in nursing practice because it provides a lens through which nurses can gain an insight of the inner feelings of the individual, and thus allow them to be with and care for them effectively.
In the phase of grieving, individuals may experience conflict, but this should not be taken as a negative response as it provides a way of clarifying perspectives. Thus, nurses utilizing a human science approach refrain from placing judgment on patients, and families. Instead, they seek dialogue with the person to understand the meaning of lived experiences from the perspective of the patient (Parse, 1992). It is, therefore, advisable that nurses develop the understanding of their being with the service user and carers, as well as the importance of suppressing the urge to "do something."
Critical Theory of Loss and Grief
Critical theory is a concept that seeks reflective assessment, as well as a critique of the social aspect of society in an attempt to change it. The theory is based on analysis using knowledge applied from humanities and social sciences. The aim of critical theory in the society is not only to uncover knowledge about aspects of the society but also to use this knowledge to change it. Thus, it critical theory uncover barriers to understanding the dynamics of the world. Thus, the theory provides an adequate base for evaluating the process of grieving through examination of an individual's lived experiences (Bateman, 1999). The theory challenges nurses to go beyond the usual and examine oppressive forces behind grieving such as political, social, and economic elements. The theory works on four concepts including taking informed actions, identifying assumptions, assessing validity and accuracy, and considering different perspectives (Bateman, 1999).
Ideally, the process of grieving is not a simple pattern but is influenced by a myriad of issues beyond the obvious ones known to the nurses. Thus, the critical theory offers a framework for exploring different dimensions in grieving and loss in relation to societal factors (Bateman, 1999). This knowledge would be important for nurses to help them create changes a...
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