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.

161
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

159

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.

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

157

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.