Although the terms "grief," "mourning," and "bereavement" are often used interchangeably, their definitions are different. Grief is a normal reaction to a loss; mourning is the process by which individuals adjust to the loss; and bereavement is the period of time during which grief and mourning occur. Psychosocial support of the family is essential throughout the duration of palliative care and can help decrease the risks of morbidity, substance abuse, and mortality that have been found among spouses and other loved ones of people who have died. Greif comprises a range of feelings, thoughts, and behaviors that fall in the realm of the physical, emotional, and social domains. Individuals may have trouble sleeping, changes in appetite, or other physical symptoms or illness. Emotions can include sadness, anxiety, guilt, and anger. Return to work, activities with friends, and taking care of family can be beneficial.
Grief counseling for the family and end-of-life patient ideally begins when the patient is alive, with a focus on life meaning and the contributions from the patient's family. An understanding of the mediators of the grief response can help professionals and other members of the healthcare team recognize the family who may be at increased risk for adapting poorly to the loss. These mediators are:
- Nature of attachment (how close and/or dependent the individual was with regard to the person who died)
- Mode of death (the suddenness of the death)
- Historical antecedents (how the individual has handled loss in the past)
- Personality variables (factors related to age, gender, ability to express feelings)
- Social factors (availability of social support, involvement in ethnic and religious groups)
- Changes and concurrent stressors (number of other stressors in the individual's life, coping styles)
Satisfactory adaptation to loss depends on "tasks" of mourning. Previous research referred to "stages" of mourning, but the term "task" is now used because stages were not clear-cut and were not always followed in the same order. These tasks include:
- Accepting the reality of the loss
- Experiencing the pain of the loss
- Adjusting to the environment in which the deceased is missing (external, internal, and spiritual adjustments)
- Finding ways to remember the deceased while moving forward with life
Bereavement support ideally begins immediately after the loss of a loved one. Dr. Nikolaidis helps clients and families identify and emphasize strengths of the family that will help them cope with the loss and Dr. Nikolaidis offers help with specific issues. Regular appointments help clients with grieving, coping strategies. Appointments are especially beneficial at the time of the first holidays without the loved one, significant days for the family (the loved one's birthday, spouse's birthday), and the anniversary of the loved one's death. Bereavement services ideally extend for at least one year after the loved one's death, and a longer period may be necessary. Dr. Nikolaidis invites you to contact him with questions or to make an appointment at his Newport Beach, Orange County offices at (949)791-7127.