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
• 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
• 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
• Risk management
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:
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
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
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
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.