Nursing diagnosis – GRIEVING

GRIEVING

DEFINITION

A normal complex process that includes emotional, physical, spiri-

tual, social, and intellectual responses and behaviors by which indi-

viduals, families, and communities incorporate an actual,

anticipated, or perceived loss into their daily lives

DEFINING CHARACTERISTICS

• Altered communication patterns

• Change in eating, sleep and dream patterns, activity level, or libido

• Denial of potential loss of life

• Difficulty taking on different roles

• Expressed guilt, anger, sorrow, and bargaining

• Expressions of distress over potential loss of life

RELATED FACTORS

• Anticipatory loss of significant object or other

• Death of a significant other

• Loss of significant object (e.g., possession, job, status)

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Growth and Development

• Roles/relationships

• Risk management

• Behavior

• Emotional

• Communication

• Values/beliefs

EXPECTED OUTCOMES

The patient will

• Express and accept feelings about anticipated death.

• Progress through stages of grieving process in his or her own way.

• Practice religious rituals and use other coping mechanisms appro-

priate to end of life.

• Have participation of family members or significant other in pro-

viding supportive care and comfort to patient.

SUGGESTED NOC OUTCOMES

Coping; Family Coping; Grief Resolution; Psychosocial Adjustment:

Life Change

INTERVENTIONS AND RATIONALES

Determine: Assess stage of grieving to establish a baseline.

Perform: Demonstrate acceptance of patient’s response to his or her

anticipated death, whatever that response may be: crying, sadness,

anger, fear, or denial. Each patient responds to dying in his or her

own way. Helping patient express feelings freely will enhance ability

to cope.

Help patient progress through psychological stages associated with

anticipated death, including shock and denial, anger, bargaining,

depression, and acceptance, to help you anticipate the dying

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patient’s psychological needs. Keep in mind, however, that not all

dying patients go through each stage.

Provide time for patient to express his or her feelings about death

or terminal illness. Active listening helps the patient lessen feelings

of loneliness and isolation. Refrain from approaching patient with a

busy, hurried attitude, which can block communication.

Establish a relationship that encourages patient to express

concerns about death. Basic nursing care combined with genuine

interest in the patient fosters trust and understanding.

Guide patient in life review. Encourage patient to write or tape-

record his or her life history as a lasting gift to family members.

Life review allows patient to survey events from his or her past and

give them meaningful interpretation.

Inform: Inform patient about hospice services that emphasize symp-

tomatic relief and caring, with the aim of improving patient and

family comfort until death occurs, instead of prolonging life for its

own sake. Hospice care is an appropriate alternative for a patient

with an incurable illness.

Attend: Encourage family members to become involved in the care

of the dying patient. Communicate with patient and family members

honestly and compassionately. Giving family members a role in

patient care helps relieve anxiety and lessen feelings of regret and

guilt. Honest communication is important because family members

need an opportunity to acknowledge their loss and say farewell.

Support patient’s spiritual coping behaviors. For example, arrange

for patient to have objects that provide spiritual comfort (such as a

copy of Bible, prayer shawl, pictures, statues, or rosary beads) at the

bedside. Even patients for whom religious practice hasn’t been a

dominant part of life may turn to religion when confronted by

death or serious illness.

Manage: Involve an interdisciplinary team (including a psychologist,

nurse, the patient, a nutritionist, physician, physical therapist, and

chaplain) in providing care for a dying patient. Each team member

offers unique expertise for meeting the dying patient’s needs.

Provide referrals for home healthcare assistance if the patient will be

cared for at home to support the patient’s decision to remain at home.

SUGGESTED NIC INTERVENTIONS

Anticipatory Guidance; Coping Enhancement; Family Support; Grief

Work Facilitation

Reference

Zimmerman, C., & Wennberg, R. (2006, August–September). Integrating pal-

liative care: A postmodern perspective. The American Journal of Hospice
and Palliative Care, 23(4), 255–258.

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