BAB III

TELAAH ARTIKEL
3.1 Article 1
In this section of the NCLEX-RN examination, you will be expected to
demonstrate your knowledge and skills of grief and loss in order to:
Grieving is a normal response to a loss; grieving, as defined by the National
North American Nursing Diagnosis Association International, is "a normal,
complex process that includes emotional, physical, spiritual, social and
intellectual responses and behaviors by which individuals, families, and
communities incorporate a loss into their daily lives"
There are theories and conceptual frameworks that provide nurses, and other
health care providers, with insight into grief, loss, the grieving process and ways
that nurses can meet the needs of clients who are affected with normal grief and
unresolved complicated grief. These theories include those summarized below:

1. Warden's Four Tasks of Mourning: This theory has four tasks that people
go through after the loss of a loved one. These four tasks are typically
completed by the person after about a year of grieving. These tasks are
accepting the loss, coping with the loss, altering, modifying and changing the
environment to cope with and accommodate for the absence of the lost person,
and, finally, resuming one's life while still having a healthy connection with
the loved one.
2. Engel's Stages of Grieving: Engel's Stages of Grieving theory describes these
steps in this proper sequential order:
a. Shock and disbelief e. Idealization
b. Developing awareness f. Outcome
c. Restitution
d. Resolving the loss

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 The client denies the loss and refuses to accept the fact that the loss has
actually occurred during the shock and disbelief stage; during the developing
awareness stage of this theory, the client discards the previous denial and
begins to develop an awareness and acknowledgement of the loss; the
grieving person works through the mourning process and they often perform
spiritual and cultural rituals during this stage; the resolution stage is
characterized with the affected person's seeking out of social support systems
to resolve the grief after which the client may deify and idealize the lost one;
the final stage of Engel's theory is the outcome phase during which time the
affected client will adjust to and cope with the loss.

3. Sander's Phases of Bereavement: Sander's phases of bereavement in correct

sequential order are:
a. Shock
b. Awareness of the loss
c. Conservation and withdrawal
d. Healing or the turning point
e. Renewal

These phases are quite similar to those of Engel with some variations. For
example, during the conservation and withdrawal phase, the person will
withdraw from others and attempt to restore their physical and emotional
wellbeing; and during the healing stage, the person will move from emotional
distress to the point where they are able to learn how to live without the loved
one. During the renewal phase, the person is able to independently live without
the loved one.

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4. Kubler Ross's Stages of Grieving: This theory is perhaps the most popular of
all theories and conceptual frameworks relating to grief and loss. This theory
has five stages in this sequential order.
a. Denial
b. Anger
c. Bargaining
d. Depression
e. Acceptance

Kubler Ross's Stages of Grieving are similar to other theories in terms of

denial, anger, depression and acceptance. The bargaining stage, however, is
unique to Kubler Ross's Stages of Grieving. In this context, bargaining entails
the client's negotiation with their maker or higher power to delay their
inevitable death. For example, they may pray to their god to let them live long
enough to be able to participate in a major event like the birth of a grandchild,
the graduation of a child, or the wedding of their god daughter.
Assisting the Client in Coping with Suffering, Grief, Loss, Dying, and
Bereavement

The defining characteristics of grief and loss can include altered immune
responses, distress, anger, sleep disturbances, blame, withdrawal, pain, panic,
suffering and alterations with neuroendocrine functioning, among other signs
and symptoms.

Coping and coping mechanisms to grief can vary greatly among individuals.
This coping can be impacted by a number of factors and forces such as one's
cultural background, spiritual or religious background, the client's past
experiences with losses, the person's level of growth and development which
impacts on one's perception of death and loss such as a lack of understanding
about the finality of death, one's level of social supports and interpersonal
relationships, socioeconomic status, ethnicity, and the client's perception of the
gravity and severity of the loss.

22 | K E S E H A T A N J I W A
Nurses assist the client with the grieving process and with coping with the
suffering, grief, loss, death and bereavement. As with all other nurse-client
relationships, the nurse initiates the relationship by establishing trust with the
client and then encouraging the person to ventilate their feelings within the
trusting, supportive and nonjudgmental environment. The nurse also assists the
client in terms of their coping with grief and loss by encouraging the client to
learn about and employ effective coping strategies, by encouraging the family
members and significant others to care for and support the affected the client,
and, when needed, the nurse makes referrals for the client so that available
community resources are utilized. Some of these referrals may include
psychological, social, religious and spiritual support, individual counseling,
group and family therapy, and peer support groups in the community to
promote adaptive grieving and to prevent complicated grieving.

Complicated grieving is a failure of the client to go through the grieving

process in a normal manner without prolonged signs and symptoms and the
resumption of the normal activities of daily living and socialization within a
reasonable amount of time. The client should be assessed for complicated
grieving and, at times, standardized tests and tools such as the Pathological
Grief Items Checklist, the Hamilton Rating Scale for Depression, the Hogan
Grief Reaction Checklist, the Beck Depression Inventory, the Texas Inventory
of Grief, and the Social Adjustment Scale are used to more comprehensively
assess the client.

Supporting the Client in Anticipatory Grieving

As previously mentioned, grief can be categorized and classified as normal

grief, dysfunctional complicated grief, anticipatory grief, disenfranchised grief,
and grief that occurs as the result of a public tragedy. Anticipatory grief is grief
that is experienced prior to an actual loss. Anticipatory grieving gives the client

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 and the family members the opportunity to begin the grieving process before a
client is actually lost.

Anticipatory grieving can occur as the result of a terminal illness, the

anticipated loss of a bodily part as the result of a planned surgical procedure and
other losses.

Informing the Client of Expected Reactions to Grief and Loss

Clients typically react in different ways to grief and loss. Nurses assess these
reactions and they also educate and inform the client about these reactions and
how they are the normal results of the grieving process when indeed they are.
This acknowledgement and the support of the nurse can help the client to
understand that they are not alone and that they are experiencing normal
feelings, signs and symptoms of grief.

Providing the Client with Resources to Adjust to Loss/Bereavement

As previously mentioned, clients who are experiencing loss and bereavement

can often be helped with resources such as individual therapy, group therapy
and peer support groups in the community.

Evaluating the Client's Coping and Fears Related to Grief and Loss

Nurses evaluate the client's coping and their fears related to grief and loss.
Some of the expected outcomes for these clients can include:

1. The client will be free of complicated grieving

2. The client will verbalize and express their true feelings
3. The client will seek the help and support of others
4. The client will identify their own strengths and weaknesses

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5. The client will utilize effective coping mechanisms
6. The client will resume their normal life in one year of less
7. The client will discuss the meaning of their loss

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3.2 Article 2

NURSING CARE AT THE END OF LIFE : Grief and Bereavement

Grief and bereavement are universal experiences that people go through when they
are dealing with a loss in their lives. In end-of-life care, nurses must understand the
fundamentals about grief, loss, and bereavement on the part of patients and families,
and also within themselves. Individuals each express and cope with losses differently
and a nurse should expect to see that when working with patients and families at the
end of life. According to ELNEC (2010), the role of the nurse includes three things:
(1) the nurse must facilitate the grieving process by assessing the grief;
(2) the nurse must assist the patient with issues and concerns related to the grief; and
(3) the nurse must support the survivors. The purpose of this chapter is to identify the
main components related to grief, bereavement and mourning in the context of
end-of-life care, to describe the various types of grief, and to explore the support
needed to help individuals cope and live with the loss.
What is Grief?
Similar to the stages of dying, individuals go through a process to help them
eventually cope and be able to live with that loss. This process has been referred to as
“grief work” and as with the stages of dying, people can go through the stages in
varying order. People never get over their loss, but find ways to live with the loss and
without their deceased loved one (ELNEC, 2010).

A three-stage model of grief was developed by Corless (2010) and includes the
following components: notification and shock, experiencing the loss, and
reintegration. The first stage, notification and shock, is when the individual first
learns or acknowledges the loss. They often feel shock and numbness and may isolate
from others during this initial phase. In the second stage, the individual really
experiences the loss both emotionally and cognitively. A host of feelings can occur
during this stage including; anger, sadness, emptiness, as well as physical

26 | K E S E H A T A N J I W A
manifestations (insomnia, loss of appetite). The final stage is when the individual
reorganizes and reintegrates into their life without the person they have lost. This last
stage characterizes the healing that should ideally take place at the end of grief.

Types of Grief

There are several different types of grief reactions that people can have. Some of
these are considered to be normal while others signify an alteration in coping with the
loss.

Normal or uncomplicated grief

This type of grief symbolizes the most desirable and universal reaction to loss and is
considered to be normal Corless (2010). The individual will have physical, emotional,
cognitive, and behavioral reactions following the loss and will eventually move
toward adjusting to it. The period of time for this can vary from person to person and
is dependent on the type of relationship, type of loss and individual factors related to
the bereaved. The nurse should support the family to take the time that they need for
this normal grief processes to happen.

Anticipatory grief

Anticipatory grief is grief that occurs before the loss of a loved one. Sometimes
anticipatory grief starts at the time of a terminal diagnosis and can proceed until the
person dies. Both patients and family members can feel anticipatory loss. For the
patient, they can anticipate the loss of independence, function or comfort. This can
cause a lot of pain and anxiety if not given the proper support. For the family, they
often start grieving for the loss of their loved one before they die. Perhaps it is
because they bear witness to the pain or suffering they see their loved one go through
or maybe they are also envisioning their own life without their loved one in it. They
start to think about all the things that they still wanted to share with their loved one,

27 | K E S E H A T A N J I W A
who will likely not live long enough to do. This type of grief has been shown to help
cushion a person’s bereavement reaction (Corless, 2010).

Complicated grief

Complicated grief may require professional assistance depending on its severity and
can be further classified into four different types as shown in Table 12.1. Individuals
could be at risk for complicated grief if they experience losses that are sudden or
traumatic or resulting from suicide/homicide. If the person has already had recent
losses or previous losses from which they did not resolve their grief, it can contribute
to developing complicated grief reaction with the new loss. Lack of a support
network or concurrent stressors such as ailing health or relationships, also can
contribute to this type of grief (ELNEC, 2010).

Table 12.1 Four Types of Complicated Grief

Type Characterized by

Chronic Grief Normal grief reactions that continue for an extended period of time.

Normal grief reactions which are suppressed or postponed because

Delayed Grief
the survivor avoids the pain of loss (consciously or unconsciously).

Exaggerated An intense reaction to the loss that can include thoughts of suicide,
Grief phobias or nightmares.

Masked Grief Survivor is not aware that their behaviors are a result of the loss.

(ELNEC, 2010)

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Disenfranchised grief

This type of grief is defined as grief that has not been validated or recognized
(ELNEC, 2010). This type of grief often develops in individuals who have lost loved
ones to stigmatized illnesses, such as AIDS, or through socially unacceptable ways,
such as abortion. The loss of a previously severed relationship, such as with divorce,
can also contribute to this type of grief because the individual may not be able to
mourn as openly for that loved one due to the circumstances surrounding their
relationship.

Unresolved grief

In this type of grief, the bereaved has failed to move through the stages of grief and
accomplish the work needed to come to terms with the loss (Corless, 2010). Many
factors can contribute to the manifestation of this type of grieving and can include:
lack of formal closure (loved one’s body never found or laid to rest), multiple or
concurrent losses, or social isolation.

Manifestations of Grief

As mentioned before, grief can consist of physical, emotional, cognitive, and

behavioral reactions to the loss. The bereaved person can feel the pain from their loss
in any or all of these ways. Some of the physical manifestations of grief can include:
feeling physically ill from the loss, headaches, heaviness or pressure, tremors, muscle
aches, exhaustion and insomnia. Cognitive manifestations can include: inability to
concentrate, sense of confusion or disbelief, preoccupation with the deceased, and
hallucinatory experiences. Emotional responses include: anxiety, guilt, anger,
sadness, feelings of helplessness, and relief. Lastly, behavioral manifestations can
include: withdrawal, impaired performance at work or school, avoiding anything that

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reminds one of the deceased, or possessing constant reminders of the deceased
(ELNEC, 2010).

Support for the Nurse

While this chapter has mainly focused on the family who is grieving the loss of a
loved one, it is also important to recognize the health of the nurse who cares for
patients at the end of life. Much of what has been written in this text focuses on the
importance of establishing an effective nurse-patient-family relationship which will
foster effective communication. In Chapter 10, we discussed the various components
that can enable the nurse to enter into this type of strong relationship. While these tips
will help to make the patient and family feel connected to their nurse, it can also
make the nurse feel connected with the patient. In end-of-life care, with each
connection will come a subsequent loss as patients die. Over time, multiple losses
that are not well-supported could take their toll on the nurse. Nurses witness much
pain, suffering, and distress in patients and families alike. They also can experience
distress related to ethical or moral issues that are encountered as a result of the
various health care decisions that occur at the end of life. Hospice nurses in particular
can be vulnerable to “cumulative loss.” Cumulative loss is when nurses experience
multiple successions of losses, often on a daily basis, without adequate time for
resolution before the next loss (ELNEC, 2010). Over time, this can lead to emotional
distress in the nurse.

Factors that can affect the way nurses who care for dying patients adapt to the losses
experienced in the workplace include: nurse’s educational level, personal death
history, life changes, and support systems (ELNEC, 2010). Nurses who work with
this population have to find a way to balance the losses they experience through
healthy expressions of their feelings. In hospice care, nurses usually have formal team
debriefing meetings following the death of patients, as well as memorial ceremonies

30 | K E S E H A T A N J I W A
 they can attend to help them find closure. These are formal types of support that are
available to nurses, depending on their setting. Informal support systems, such as
talking with co-workers or peers, can also help provide a supportive environment for
the nurse. The nurse may find solace from spiritual or religious services or support
from their own clergy. Engaging in self-care activities, such as massage or vacations,
can also help the nurse cope with the effects of their role. Finally, nurses who work in
end-of-life care should continue to engage in continuing education activities which
can help provide knowledge and skills about ways to effectively cope with the effects
of their role (ELENC, 2010).

References

Corless, I. B. (2010). Bereavement. In B.R. Ferrell & N. Coyle (Eds.), Oxford Textbook
of Palliative Nursing (pp. 597-611). New York: Oxford University Press.

End of Life Nursing Education Consortium (2010). ELNEC – core curriculum training
program. City of Hope and American Association of Colleges of Nursing. Retrieved
from http://www.aacn.nche.edu/ELNEC

Lowey, S. E. (2008). Letting go before a death: A concept analysis. Journal of Advanced

Nursing, 63(2), 208-215

31 | K E S E H A T A N J I W A
3.3. Artikel 3

Konsep Kecemasan (Anxiety) pada Lanjut Usia (Lansia)

Syamsu Yusuf (2009: 43) mengemukakan anxiety (cemas) merupakan

ketidakberdayaan neurotik, rasa tidakaman, tidak matang, dan kekurangmampuan
dalam menghadapi tuntutan realitas (lingkungan), kesulitan dantekanan kehidupan
sehari-hari. Dikuatkan oleh Kartini Kartono (1989: 120) bahwa cemas adalah
bentukketidakberanian ditambah kerisauan terhadap hal-hal yang tidak jelas.
Kemudian Shah (dalam M. Nur Ghufron & Rini Risnawita, S, 2014: 144)
membagi kecemasan menjadi tigaaspek, yaitu.
1. Aspek fisik, seperti pusing, sakit kepala, tangan mengeluarkan keringat,
menimbulkan rasa mual padaperut, mulut kering, grogi, dan lain-lain.
2. Aspek emosional, seperti timbulnya rasa panik dan rasa takut.
3. Aspek mental atau kognitif, timbulnya gangguan terhadap perhatian dan memori,
rasa khawatir,ketidakteraturan dalam berpikir, dan bingung.

Jenis-Jenis Kecemasan (Anxiety)

Menurut Spilberger (dalam Triantoro Safaria & Nofrans Eka Saputra, 2012: 53)
menjelaskan kecemasan
dalam dua bentuk, yaitu.
1. Trait anxiety
Trait anxiety, yaitu adanya rasa khawatir dan terancam yang menghinggapi diri
seseorang terhadapkondisi yang sebenarnya tidak berbahaya. Kecemasan ini
disebabkan oleh kepribadian individu yangmemang memiliki potensi cemas
dibandingkan dengan individu yang lainnya.

32 | K E S E H A T A N J I W A
2. State anxiety
State anxiety, merupakan kondisi emosional dan keadaan sementara pada diri
individu dengan adanyaperasaan tegang dan khawatir yang dirasakan secara sadar
serta bersifat subjektif.
Sedangkan menurut Freud (dalam Feist & Feist, 2012: 38) membedakan kecemasan
dalam tiga jenis, yaitu.
1. Kecemasan neurosis
Kecemasan neurosis adalah rasa cemas akibat bahaya yang tidak diketahui. Perasaan
itu berada padaego, tetapi muncul dari dorongan id. Kecemasan neurosis bukanlah
ketakutan terhadap insting-instingitu sendiri, namun ketakutan terhadap hukuman
yang mungkin terjadi jika suatu insting dipuaskan.
2. Kecemasan moral
Kecemasan ini berakar dari konflik antara ego dan superego. Kecemasan ini dapat
muncul karenakegagalan bersikap konsisten dengan apa yang mereka yakini benar
secara moral. Kecemasan moralmerupakan rasa takut terhadap suara hati. Kecemasan
moral juga memiliki dasar dalam realitas, di masalampau sang pribadi pernah
mendapat hukuman karena melanggar norma moral dan dapat dihukumkembali.
3. Kecemasan realistik
Kecemasan realistik merupakan perasaan yang tidak menyenangkan dan tidak
spesifik yang mencakupkemungkinan bahaya itu sendiri. Kecemasan realistik
merupakan rasa takut akan adanya bahaya-bahayanyata yang berasal dari dunia luar.

FAKTOR-FAKTORT YANG MEMPENGARUHI KECEMASAN (ANXIETY)

Blacburn & Davidson (dalam Triantoro Safaria & Nofrans Eka Saputra, 2012: 51)
menjelaskan faktor-faktoryang menimbulakan kecemasan, seperti pengetahuan yang
dimiliki seseorang mengenai situasi yang sedangdirasakannya, apakah situasi tersebut
mengancam atau tidak memberikan ancaman, serta adanya pengetahuan
menyatakan terdapat dua faktor yang dapat menimbulkan kecemasan, yaitu.
1. Pengalaman negatif pada masa lalu

33 | K E S E H A T A N J I W A
Sebab utama dari timbulnya rasa cemas kembali pada masa kanak-kanak, yaitu
timbulnya rasa tidakmenyenangkan mengenai peristiwa yang dapat terulang lagi pada
masa mendatang, apabila individumenghadapi situasi yang sama dan juga
menimbulkan ketidaknyamanan, seperti pengalaman pernahgagal dalam mengikuti
tes.
2. Pikiran yang tidak rasional
Pikiran yang tidak rasional terbagi dalam empat bentuk, yaitu.
a. Kegagalan ketastropik, yaitu adanya asumsi dari individu bahwa sesuatu yang
buruk akan terjadipada dirinya. Individu mengalami kecemasan serta perasaan
ketidakmampuan danketidaksanggupan dalam mengatasi permaslaahannya.
b. Kesempurnaan, individu mengharapkan kepada dirinya untuk berperilaku
sempurna dan tidakmemiliki cacat. Individu menjadikan ukuran kesempurnaan
sebagai sebuah target dan sumber yangdapat memberikan inspirasi.
c. Persetujuan
d. Generalisasi yang tidak tepat, yaitu generalisasi yang berlebihan, ini terjadi pada
orang yang memiliki sedikit pengalaman.

DAFTAR PUSTAKA
Syamsu Yusuf. (2009). Mental Hygine: Terapi Psikopiritual untuk Hidup Sehat
Berkualitas. Bandung:
Maestro.
Triantoro Safaria & Nofrans Eka Saputra. (2012). Manajemen Emosi: Sebuah
panduan cerdas bagaimana
mengelola emosi positif dalam hidup Anda. Jakarta: Bumi Aksara

34 | K E S E H A T A N J I W A
3.4. Artikel 4

PROSES BERDUKA AKIBAT KEMATIAN ORANG YANG DICINTAI YANG

DIALAMI OLEH LANSIA DI KABUPATEN NGADA

Hasil pengamatan yang dilakukan pada lansia di Kabupaten Ngada pada

saat mengalami peristiwa kehilangan akibat kematian orang yang dicintai,
menggambarkan bahwa sangat sulit bagi mereka untuk menerima peristiwa
kematian itu sebagai suatu bentuk kehilangan yang aktual dan wajar, yang secara
perlahan suka atau tidak suka harus diterima dan diikhlaskan sebagai sesuatu yang
sudah seharusnya terjadi.Mereka akan selalu tampak sedih, mengkritik diri
sendiri, memiliki pandangan hidup yang pesimis, kurang memperhatikan
perawatan diri, menarik diri dari pergaulan bahkan dengan anggota keluarganya
sendiri, berbicara lambat dengan nada suara lemah, dan lebih banyak
menundukdan merenung sendiri dalam kesehariannya. Kejadian ini dapat
berlangsung dalam jangkawaktu yang lama yaitu sepanjang kehidupannya.
Informan harus bersosialisasi lebih sering dan lebih intensif melalui
berbagai cara yangmasih dapat dilakukannya, baik itu dengan tetangga di
lingkungan tempat tinggalnya maupundengan anak-anaknya yang tinggal terpisah
dengannya.
Kegiatan ini ditujukan agar informantidak terlalu terfokus pada peristiwa
kematian yang telah terjadi dan perlahan-lahan dapatmenerima peristiwa
kematian yang telah terjadi sebagai sesuatu yang wajar terjadi danmemang sudah
seharusnya terjadi.Pihak keluarga dan orang terdekat harus lebih memberikan
perhatian dan meningkatkanintensitas komunikasi serta pertemuan dengan lansia,
agar pikiran dan fokus lansia terhadapperistiwa kematian yang terjadi bisa
berkurang dan perlahan-lahan bisa menerima peristiwakematian itu sebagai
sesuatu yang sudah seharusnya terjadi dan harus diikhlaskan.

35 | K E S E H A T A N J I W A
DAFTAR PUSTAKA
Azizah, L. M. (2011). Keperawatan Lanjut Usia. Yogyakarta; Graha Ilmu
Keliat, B.A., Novy H.C.D., & Pipin, F. (2011). Manajemen Keperawatan Psikososial
danKader Kesehatan Jiwa. Jakarta; EGC
Riyadi, S & Teguh, P. (2009). Asuhan Keperawatan Jiwa. Yogyakarta; GRAHA
ILMU
Sunaryo. (2004). Psikologi untuk Keperawatan. Jakarta: EGC
Suseno, T. A. (2004). Pemenuhan Kebutuhan Dasar Manusia: Kehilangan, Kematian
danBerduka dan Proses Keperawatan. Jakarta; Sagung Seto.

36 | K E S E H A T A N J I W A
3.5. Artikel 5

Hubungan Tingkat Pengetahuan dengan Tingkat Kecemasan Perawat dalam

Melakukan Asuhan Keperawatan pada Pasien Flu Burung

Hasil penelitian menunjukkan bahwa perawat berpengetahuan baik, tidak

mengalamikecemasan 2 orang(6,7%), dan perawat mempunyai pengetahuan sedang,
tidak mengalami kecemasan 17 orang(56,7%). Dari hasil tersebut secara prosentase
perawat yang mempunyai tingkat pengetahuan baik dan sedang mempunyai
kecenderungan tidak mengalami kecemasan dalam melakukan asuhan keperawatan
pada pasien flu burung. s
Hasil penelitian ini sejalan dengan pernyataan WHO bahwa tingkat
pengetahuanseseorang memiliki hubungan positif terhadap tingkat kecemasan yang
dirasakanseseorang.13 Dengan demikian tingkat pengetahuan yang baik tentang
asuhan keperawatanpada pasien flu burung pada perawat merupakan salah satu faktor
yang mempengaruhitingkat kecemasan perawat. Faktor lain yang mempengaruhi
kecemasan antara lain ancamanterhadap integritas biologi yaitu meliputi
ketidakmampuan fisiologis yang akan datang ataumenurunnya kapasitas untuk
melakukan aktifitas sehari-hari dapat berupa penyakit traumafisik dan ancaman
terhadap konsep diri dan harga diri yaitu meliputi proses kehilangan,perubahan peran,
perubahan hubungan, lingkungan dan status ekonomi.

DAFTAR PUSTAKA
DEPKES RI. Pedoman Penatalaksanaan Flu Burung di Sarana Pelayanan
Kesehatan.Jakarta. 2006.

37 | K E S E H A T A N J I W A
 BAB IV
PENUTUP
4.1. Simpulan
Kehilangan adalah suatu keadaan Individu berpisah dengan sesuatu yang
sebelumnya ada, kemudian menjadi tidak ada, baik terjadi sebagian atau
keseluruhan. Kehilangan merupakan pengalaman yang pernah dialami oleh
setiap individu selama rentang kehidupan, sejak lahir individu sudah mengalami
kehilangan dan cenderung akan mengalaminya kembali walaupun dalam bentuk
yang berbeda. Sehingga dapat disimpulkan bahwa kehilangan merupakan suatu
keadaan gangguan jiwa yang biasa terjadi pada orang- orang yang menghadapi
suatu keadaan yang berubah dari keadaan semula (keadaan yang sebelumya ada
menjadi tidak ada).
Dukacita adalah proses mengalami psikologis, social dan fisik terhadap
kehilangan yang dipersepsikan(Rando, 1991). Dukacita merupakan respon
individu atau reaksi emosi dari kehilangan dan terjadi karena kehilangan seperti :
kehilangan hak, kehilangan hak hidup, menuju kematian. Berkabung adalah
keadaan berduka yang ditunjukkan selama individu melewati reaksi berduka,
seperti mengabaikan keadaan kesehatan secara ekstrim. Berkabung adalah proses
yang mengikuti suatu kehilangan dan mencakup berupaya untuk melewati
dukacita.
Berduka merupakan respon normal pada semua kejadian kehilangan.
NANDA merumuskan ada dua tipe dari berduka yaitu berduka diantisipasi dan
berduka disfungsional.
Tipe dari kehilangan mempengaruhi tingkat distres. Misalnya, kehilangan
benda mungkin tidak menimbulkan distres yang sama ketika kehilangan
seseorang yang dekat dengan kita. Nanun demikian, setiap individu berespon
terhadap kehilangan secara berbeda. Kematian seorang anggota keluarga
mungkin menyebabkan distress lebih besar dibandingkan kehilangan hewan

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 peliharaan, tetapi bagi orang yang hidup sendiri kematian hewan peliharaan
menyebaabkan disters emosional yang lebih besar dibanding saudaranya yang
sudah lama tidak pernah bertemu selama bertahun-tahun. Kehilangan yang
bersifat actual dapat dengan mudah diidentifikasi, misalnya seorang anak yang
teman bermainya pindah rumah. Kehilangan yang dirasakan kurang nyata dan
dapat di salahartikan ,seperti kehilangan kepercayaan. Seseorang dapat tumbuh
dari pengalaman kehilangan melalui keterbukaan, dorongan dari orang lain, dan
dukungan yang adekuat. Di dalam menangani pasien dengan respon kehilangan,
diperlukan prinsip-prinsip keperawatan yang sesuai, misalnya pada anak atau
pada orang tua dengan respon kehilangan (kematiananak).

4.2. Saran
Setelah kami membuat kesimpulan tentang asuhan keperawatan pada klien
dengan respon kehilangan dan berduka (Loss and Grief), maka kami menganggap
perlu adanya sumbang saran untuk memperbaiki dan meningkatkan mutu asuhan
keperawatan.

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