Nursing diagnosis – RISK FOR COMPLICATED GRIEVING

RISK  FOR  COMPLICATED  GRIEVING

DEFINITION

At risk for a disorder that occurs after the death of a significant other,

in which the experience of distress accompanying bereavement fails to

follow normative expectations and manifests in functional impairment

RISK FACTORS

• Death of a significant other

• Emotional instability

• Lack of social support

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Coping

• Roles/relationships

• Emotional status

• Sleep/rest

• Nutrition status

• Values/beliefs

EXPECTED OUTCOMES

The patient will

• Express appropriate feelings of loss, guilt, fear, anger, or sadness.

• Identify loss and describe meaning of loss.

• Appropriately move through stages of grieving.

• Maintain healthy patterns of sleep, activity, and eating.

• List personal strengths.

• Use healthy coping mechanisms and social support systems.

• Seek fulfillment through preferred spiritual practices.

• Begin planning for future.

SUGGESTED NOC OUTCOMES

Grief Resolution; Life Change Adjustment

INTERVENTIONS AND RATIONALES

Determine: Identify areas of hope in patient’s life to help decrease

anger and feelings of frustration.

Identify previous losses and assess for depression to establish a

baseline.

Perform: Perform interventions to promote sleep such as giving

snack, pillows, backrub, or shower to enhance rest.

Inform: Teach patient relaxation techniques such as guided imagery,

meditation, or progressive muscle relaxation to promote feelings of

comfort.

Attend: Encourage patient to express grief and feelings of anger,

guilt, and sadness. Inability to express these feelings may result in

maladaptive behaviors.

Encourage patient to express feelings in a way he is most comfort-

able with, for example, crying, talking, writing, and/or drawing.

Dysfunctional grieving may result from an inability to express

feelings freely.

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Encourage patient to keep a journal to express feelings of grief

and loss. The act of writing about feelings may aid in grieving

process. Help patient form goals for the future to place the loss in

perspective and to move on to new situations and relationships.

Manage: Refer patient to community support systems to assist with

grieving process. Contact patient’s preferred spiritual leader if

patient desires. This may provide relief from spiritual distress.

SUGGESTED NIC INTERVENTIONS

Coping Enhancement; Counseling; Emotional Support; Family Ther-

apy; Grief Facilitation Work

Reference

Pilkington, F. B. (2008, January). Expanding nursing perspectives on loss and

grieving. Nursing Science Quarterly, 21(1), 6–7.

Nursing diagnosis – COMPLICATED GRIEVING

COMPLICATED  GRIEVING

DEFINITION

A disorder that occurs after the death of a significant other, in which

the experience of distress accompanying bereavement fails to follow

normative expectations and manifests in functional impairment

DEFINING CHARACTERISTICS

• Decreased functioning in life roles

• Decreased sense of well-being

• Depression

• Fatigue

• Grief avoidance

• Longing for the deceased

• Low levels of intimacy

• Persistent emotional distress

• Preoccupation with thoughts of the deceased

• Rumination

• Searching for the deceased

• Verbalization of anxiety; distress about the deceased; detachment

from others; self-blame; disbelief, mistrust, failure to accept the
death; feeling dazed, empty, in shock, or stunned; persistent
painful memories

RELATED FACTORS

• Death of a significant other

• Lack of social support

• Emotional instability

• Sudden death of significant other

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Coping

• Emotional

• Sleep/rest

• Values/beliefs

• Nutrition

• Roles/relationships

EXPECTED OUTCOMES

The patient will

• Express appropriate feelings of loss, guilt, fear, anger, or sadness.

• Identify the loss and describe what it means to him.

• Appropriately move through stages of grief.

• Maintain healthy patterns of sleep, activity, and eating.

• Verbalize understanding that grief is normal.

• Use healthy coping mechanisms and social support systems.

• Seek fulfillment through preferred spiritual practices.

• Begin planning for future.

SUGGESTED NOC OUTCOMES

Grief Resolution; Life Change; Psychosocial Adjustment

INTERVENTIONS AND RATIONALES

Determine: Identify previous losses and assess for depression. Older

patients may experience losses frequently and without adequate

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recovery time before the next loss. Multiple losses contribute to

depression.

Perform: Help patient identify an area of hope in his or her life.

Focusing on a life purpose may decrease anger and feelings of frus-

tration.

Help patient focus realistically on changes the loss has brought

about. This will assist patient in forming plans for the future and

improving social relationships.

Help patient formulate goals for the future to place loss in

perspective and move on to new situations and relationships.

Attend: Encourage patient to express grief and feelings of anger,

guilt, and sadness. Inability to express these feelings may result in

maladaptive behaviors.

Encourage journaling to express grief and loss. Writing and

exploring feelings is an active process, which may assist in grieving.

Encourage patient and family to engage in reminiscing to give

purpose and meaning to the loss and assist in maintenance of self-

esteem.

Manage: Contact patient’s preferred spiritual leader, if patient

desires, to provide relief from spiritual distress.

Refer patient to community support systems to help him deal with

his bereavement and grief process.

SUGGESTED NIC INTERVENTIONS

Coping Enhancement; Counseling; Emotional Support; Family Ther-

apy; Grief Facilitation Work

Reference

Szanto, K., et al. (2006, February). Indirect self-destructive behavior and overt

suicidality in patients with complicated grief. Journal of Clinical Psychiatry,
67(2), 233–239.