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Health Consequences of Bereavement

According to Ayers (2007), bereavement is the objective situation of someone experiencing the loss of a family member or any other person they loved. Grief is the emotional and psychological response to bereavement. Grief is a normal, healthy, and suitable reaction to loss. It can be referred to as an adaptation process having a number of manifestations that constitute part of the sorrowful experience. Grief may as well come before a loss, and in this case it is referred to as a defensive grief. This is when grief becomes a process of gradually reconciling to the possible loss of an important individual, as it can be realized in a caregiver of an individual with a prolonged ill health.

The manifestation and duration of usual bereavement differ significantly between both ethnic groups and individuals. Some individuals experience bereavement as overwhelming, and in this case grief results into complicated or pathological lamentation, with depressing implication for physical or functioning health. Convoluted grief constitutes a failure to go back to pre-loss stages of functioning or states of emotional well-being in the period of eighteen months from the time of death. This is demonstrated by inadequate global performance, poorer quality of sleep, depressed mood, and inferior self-pride (Reis & Sprecher, 2009).

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Bereavement is a nerve-racking process that involves mortality and morbidity. The lately bereaved report by Lee & DeMaris (2007), shows that bereavement increases depression, weakening physical health, and leads to consumption of alcohol, tranquilizers, and tobacco. From the report it has been found that a 30 percent increase in mortality rates amongst widowers within the first six months as from the time their spouses passed away. In addition to bereavement, is severe psychological stress, which has been linked to malfunctioning of the immune function. Approximately between 22 and 27 percent of bereaved individuals remains unhappy one year after a death, and up to 28 percent of bereaved individuals display symptoms of depression after two years.

Grief is experienced in phases, in which one phase progressively follows the next phase. The process of unsophisticated grief can be regarded as an interlocking form of varying emotional conditions, motivational levels, and bodily symptoms. These phases lie on top of another, just as the components in the phases do (Ayers, 2007).

The first phase is referred to as a shock phase. The phase starts straightaway after a loss and it usually goes for up to two weeks. Throughout this period the involved individual is generally in a condition of insensitive disbelief. The somatic symptoms in this case constitute of crying, chest tightness, dysphagia, nausea, as well as a feeling of emptiness in the abdomen. The survivors may feel dazed, lost, helpless, stunned, and disordered. This phase is generally more evident if a sudden or unexpected death is experienced. Comparable experiences may arise following a survivor learning of a grave diagnosis, even when death is not about to happen (Reis & Sprecher, 2009).

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Phase two constitutes of obsession with the departed. This phase is identified by a sense of unreality as well as reduction of the feeling of skepticism. Lack of emotions experience in this phase gives way to completely going through the painful sorrow of the loss and this is when crying spells endure. Symptoms constitute of fatigue, loss of appetite, and insomnia. Most attribute of this phase is an intense, preoccupation with the remembrance of the departed and past grievances, guilt, anger, and other unsettled conflicts are reviewed. Dreams about the deceased may be extremely vivid. Temporary unreal episodes may take place in which the departed person's voice is heard and some times strangers may be by mistake identified as the departed. A period of nervousness and social withdrawal is also characteristic. This phase is generally well produced by three months and may continue for a period of six months or more. Repetitions of these symptoms may take place on anniversaries, and birthdays that enable the survivor to remember the deceased (Ayers, 2007).

Phase three is referred to as a period of resolving, annunciated by the survivor's ability to remember events with over-romantic happiness and repossession of concentration in activities. Fresh social contacts are progressively completed and life is restructured around new interests and activities. Feelings of emptiness, crying spells, and desire for the departed still come about, but start to reduce in duration and intensity. Bodily symptoms and obsession with memories start to diminish. The survivor in this phase does not continue being obsessed with the departed and is not constrained psychologically and socially as a result of the bereavement (Ayers, 2007).

 
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According to Reis & Sprecher (2009), the disturbing pain of bereavement and grief has physical magnitude, generally when the death is abrupt and unanticipated, with survivors probably experiencing considerable mortality or morbidity. Grief is the typical mind-body trouble; grief is characterized by a multidimensional loss. Our vocabulary about bereavement and death forms a sensation of loss, change, and separation. A physician's role in caring for the departed continues ahead of death itself. This is because the departed is a member of a given household, and in considerate care of the deceased, the physician is as well caring for the family unit.

Physicians are not supposed to enforce their own ideas concerning the meaning of healthy or unhealthy grief but have to refer from the assumptions of the culture regarding good and bad, and health and unhealthy.

There seems to be an aggregate increased risk of untimely death for survivors in the years directly subsequent to the death of a spouse. The bereaved individuals are most likely at an increased risk of death particularly in the first year of their loss, and men are at greater risk, but the risk becomes constantly small in absolute terms. Blackburn & Dulmus (2007) have shown that, apart from the increased risk of death following death of a spouse, there is even great risk following the way a spouse is hospitalized. Care giving by itself, during the patient's decline and illness, is great risk issue for mortality, most likely when the caregiver goes through strain.

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The physiologic nervous tension brought about by the blow of loss, has been connected with altered endocrine, immune, and autonomic response. The association between interrupted sleep and despair of the immune system was made by Ayers (2007). Normal sleep forms at six months following death of a spouse correlate with better energy and emotional health a year later. Constant exercise at least once a week and constant consideration to suitable caloric intake associate with improved survivors' health as well. Among the goals in future research concerning bereavement is to build up a stronger identification of a probable cause-and-effect association between the experience of loss and physiologic immune and neuro-endocrine changes that may modify medical outcome.

Emotional undertakings for the survivor include building sense of the death, determining the meaning, reconstructing integrity, managing influence, and realigning relations, managing feelings, as well as the relationship with the departed. How the survivor makes out in their sorrowful experience is connected to how their loved one passed away, who the departed was, and the bond type between the survivor and the departed.

Ayers (2007) saw the process of grief as a step towards healing. In a little observational sequence of survivors with a risk elements for non-adaptive grief, a number of relations were distinguished that probably added to personal growth as a result of grief. Such adaptive grief characteristics consist of the ability to make out some good outcome from the death, getting an opportunity to attend a farewell of the deceased, inherent spirituality, and spontaneous positive memories of the deceased.

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Clinicians are capable of helping patients and families grieve in a way that is standard and healthier if they can be able to give adequate forewarning for the parties involved that death is on the way to happen, giving them the chance to at least start to process the occurrence instead of being forced to face it more abrupt. However the anticipatory grief has never been revealed to adjust the experience of real grief. This is somewhat a gently warning to take unusual time together, to possibly allow for a conversation regarding life and death, and in most cases this gives relieve to survivors.

The healthcare providers also are required to provide sufficient notice of pending death so that the family members and relatives can be present at the death if possible since failure to be present possibly may result to guilt. The personnel in healthcare should as well make available soothing care to consist of focus on experiential issues where necessary since problems in the experience of death can be related with problems of the survivor. Honoring and giving respect to the religious and cultural practices of both patient and family can bring about open minded perspectives from the healthcare officials to allow for the less traumatic death experience for the survivors. It is very important for clinicians to follow through with survivors as a sign of caring and the evaluation for any available problems with the process of grieving since some standard experiences of bereavement might be interpreted as signs of mental illness in varied situation (Blackburn & Dulmus, 2007).

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Both clinical depression and grief are syndromes that have common built-in symptoms for instance appetite and sleep disorder, as well as extreme sadness, but in a grief response there is no loss of self esteem that is associated with depression. Pharmacotherapy is very important for symptoms of real depression in survivors. Official grief counseling is not always helpful and should perhaps be set aside for those bereaved truly appearing to be non adaptive.

By Reis & Sprecher (2009) it is apparent that in some cases survivors may feel that the departed member is present, for instance most children feel observed by their departed parent for the period of up to 2 years. Transient hypnagogic delusions in which the departed are heard or seen are reported by 50% of widows and possibly they may be misconceived as signs of mental ill health. During the phase of searching and yearning, environmental reminders can be supposed and construed as the real existence of the departed. Seeing or hearing a dream of a dead colleague is culturally associated, and is generally a satisfying experience.

According to Smit (2007), nurture of spirituality may develop both the departing individual's understanding about death and the survivors' understanding concerning bereavement. For example, Swedish parents discuss on the issue of death with their departing children, discussion of experiential issues like the idea of life after death, and this affects quality of the dying familiarity for the family unit. Spirituality may have a say to coping strategies and well-being.

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Successful soothing care allows a departing individual a chance to adapt to the condition and get quality in the spiritual, existential, social, and psychological fields in spite of the decline in functional and physical domains. The supposition is that, enhanced adaptation for patient to the experience of dying may assist the survivor in adjustment to the loss. Two studies concerning the fatally ill cancer patients was carried out and the scores of experiential well-being associate with physical well-being and psychological symptoms in spite of physical pain, and hopelessness and depression were reciprocally connected to spiritual well-being. Considering a group of ethnically different cancer patients, spirituality was revealed to have a positive relationship with quality of life having influenced on it just like physical well-being (Linda, et al. 2006)..

Spiritual beliefs have been revealed to be of significant in anticipating clinical result for departing patients, in supervision of death suffering, and in an incidence of end-of-life depression. The existence of religious beliefs may trim down reliance on healthcare professionals by cancer patients as they are passing away. One study considered the way spiritual beliefs in survivors may aid in adaptation to loss, and no study has hitherto examined the way nurturing spiritual belief and experiential soothe in the dying individual might assist the survivor.

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Culture determines the experience and meaning of death and dying as well as mourning activities. For the benefit of both the survivors and the departed, religious ceremonies of death should be privileged. Physicians should maintain an accommodating attitude toward unusual practices and beliefs and be prepared to compromise and negotiate when world views disagreement. Rituals, customs, and how that family works as a subunit of its culture all bring in variables. Misinterpretations can build up from the most elementary differences in body language, address, or custom (Linda, et al. 2006).

Practitioners can aid in the recovery of both the bereaved family and friends of their departing patients in a varied number of ways:

1. Build decisions in advance concerning how to confront approaching death, informing the patient and family that hopes need to be changed and varying conditions need to be adjusted to.

2. Offer the patient with enough support in the process dying as possible. Availability of support systems that are rendered may assist the family as well as the patient.

3. Grant the family with opportunity to be at the bedside when death happens if possible.

4. Center on the family and the patient for the duration of the death.

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5. Do investigation into cultural beliefs and ceremonies in dying and death.

6. Acknowledge as typical those experiences of survivors that involve visitations of the deceased.

7. Recognize those survivors at a threat for right referral since among many studies of treatments with positive results there have been observations of intervention-associated impairment.

8. Promotion of a healthy standard of living during the time of caregiver burden as well as during bereavement.

Even though bereavements are most common in old age, their occurrence and inevitability trim down the possibility that the bereaved will not be ready for them. Also there is little need for the old people to contend for a place in the world that remains to be theirs, and many come all the way through the tension of bereavement without experiencing the lifelong sorrow which identifies younger bereaved individuals.

Even if the majority of the published work on bereavement has centered on bereavement by death, the occurrence of grief comes after most of the slings and arrows of disgraceful fortune. Thus the apprehension of the psychology of bereavement is essential to all those taking part in the care of individuals who are experiencing psychosocial transitions.

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As a theoretical framework, the nervous tension and coping paradigm has most generally been used to direct both care giving and bereavement research. This paradigm is grounded on the supposition that the moment a stressful life event for instance loss of a loved one is met, the consideration of the stressor, as well as physical and mental health effects, will be a purpose of the exceptional set of threat and defensive factors that a person brings to the situation. These elements can be contextual for instance circumstances neighboring the loss, social for instance accessibility of social support, or personal for instance coping resources (Blackburn & Dulmus, 2007).

As a crisis happening and significant life changeover, bereavement is supposed to aggravate psychologic and physical dysfunction. The manifestation and duration of usual bereavement differ significantly between both ethnic groups and individuals. Some individuals experience bereavement as overwhelming, and in this case grief results into complicated or pathological lamentation, with depressing implication for physical or functioning health. Convoluted grief constitutes a failure to go back to pre-loss stages of functioning or states of aroused well-being in the period of eighteen months from the time of death. This is demonstrated by more inadequate global performance, poorer quality of sleep, depressed mood, and inferior self-pride. However, in spite of an increasingly growing body of research, the fundamental association between bereavement and the following morbidity remains unresolved. Amongst spouses, bereavement hopelessness was considerably related with poor prior mental and physical health and disappointment with caretaking capabilities. Analyses of the outcomes of bereavement in terms of health-care exploitation found strong effects of despair on physician use.

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Clinicians are capable of helping patients and families grieve in a way that is standard and healthier if they can be able to give adequate forewarning for the parties involved that death is on the way to happen, giving them the chance to at least start to process the occurrence instead of being forced to face it more abrupt. However the anticipatory grief has never been revealed to adjust the experience of real grief. This is somewhat a gently warning to take unusual time together, to possibly allow for a conversation regarding life and death, and in most cases this gives relieve to survivors.

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