Grieving, Nursing Diagnosis for Grieving, and Nursing Care Plans for Grieving.

Grieving, Nursing Diagnosis for Grieving, and Nursing Care Plans for Grieving.

This article is a guide about grieving, nursing diagnosis for grieving, and nursing care plans for grieving. It can be employed in the creation of educational nursing care plans for grieving.

Grieving

Grieving, Nursing Diagnosis for Grieving, and Nursing Care Plans for Grieving.
Grieving

What is grieving?

Grieving is an individual’s normal response to a loss that may be perceived or actual. It can also be defined as a response of an individual to a perceived (anticipatory grieving) or actual loss. The loss may include having poor overall health or losing a body part, or may also be having a terminal illness that may cause an impending death.

Signs and Symptoms of Grieving

What are the 7 signs of grieving?

  • feelings of sadness, emptiness, hopelessness
  • Angry outbursts
  • Irritability
  • Withdrawn and avoids socializations
  • Loss of interest in most normal activities such as hobbies
  • Sleep disturbances
  • Lack of energy
  • Discrepancies in eating habits (either overeating or loss of appetite)
  • Restlessness and anxiety
  • Sluggish thinking, speaking
  • Feelings of worthlessness, particularly from past failures

Nursing Diagnosis for Grieving

What is a nursing diagnosis for grieving?

Grieving, Nursing Diagnosis for Grieving, and Nursing Care Plans for Grieving.
Nursing Diagnosis for Grieving

Assessment is necessary in order to identify potential problems that may have led to grief and also name any event that may happen during nursing care. The following are the assessment cues for grieving nursing diagnosis:

Assessment Rationale
Distinguish behaviors indicative of the grieving process. Crying, loud vocalizations, or wide movements of the hands or body are behavioral indications of grief. These manifestations are greatly influenced by factors such as age, gender, and culture.
Mourning, Grief, and Bereavement
  • Mourning
This is an external expression of grief. It includes rituals that signify someone’s death, such as funerals, wakes, or memorial services. Mourning is greatly influenced by a person’s religious, spiritual, and cultural beliefs and practices.
  • Grief
This is a common reaction to the loss of a significant or loved one. It can further be a response to the loss of relationships, physical ability, opportunities, or future hopes and dreams.
  • Bereavement
This is the state of having suffered the loss of a significant or loved one. It is the period after a loss during which grief is experienced and mourning occurs.
Assess the phase of grieving being experienced by the patient and significant others. The patient may need several months to adapt to the loss and go back to normal daily functioning. Patients and their families revisit the phases of grief repeatedly.
The Five Stages of Grief by Elizabeth Kübler-Ross
  • Denial
Denial is the first of the five stages of grief. When a person first hears or discovers a loss, it’s typical to think, “This isn’t happening.” The person may feel upset or senseless. This is a temporary way to deal with the rush of overwhelming emotion. It’s a defense mechanism.
  • Anger
Anger is a necessary stage of the healing process. As reality sets in, the person is faced with the pain of the loss. He or she may feel frustrated and weak. These emotions later turn into anger. The person might point it toward other people, a higher power, or life in common. To be angry with a loved one who died and left is natural, also.
  • Bargaining
Before a loss, it seems like the person will do anything if only his or her loved one would be saved. During this stage, he or she dwells on what could’ve been done to counteract the loss. General thoughts are “If only…” and “What if…” The person may also try to strike a bargain or compromise with a higher power.
  • Depression
Next to bargaining, the attention moves considerately into the present. Sadness sets in as the person begins to understand the loss and its effect on life. Indications of depression include crying, sleep issues, and a decreased appetite. He or she may feel defeated, frustrated, and empty.
  • Acceptance
Acceptance is frequently confused with the perception of being “all right” or “okay” with what has occurred. In this final stage of grief, the person accepts the reality of the loss. It can’t be reversed. Although he or she still feels sad, he or she is ready to start moving on in life.
Evaluate whether the patient and significant others vary in their stages of grieving. Conflicts and differences among patients and family members may transpire in the process of grieving. Some may become impatient if others do not reconcile their feelings as quickly as they do. Older adults may take longer to reintegrate the loss and reconcile their grief.
Determine the potential for a complicated grieving response. Grieving becomes more complicated in situations like multiple losses, lack of social support, unresolved family relationships and issues, or losses as a result of violence and injustice.
Assess the patient’s ability to make decisions. Grief may limit a person’s cognitive ability that is needed in decision-making and problem-solving.
Know the availability of support systems for the patient. If the patient’s main support is the object of perceived loss, the patient may need help in naming other sources of support.
Support sharing of common problems with others. There are people with the same experience that may be helpful in dealing with grief.
Evaluate the need for referral to social services, legal consultants, or support groups. It is necessary to engage with support systems as early as possible to analyze and estimate the possible financial considerations and other special needs before the anticipated loss occurs.

Nursing Care Plans for Grieving

What are important nursing care guidelines for supporting grieving families?

Grieving, Nursing Diagnosis for Grieving, and Nursing Care Plans for Grieving.
Nursing Care Plans for Grieving

The following are the therapeutic nursing interventions for Grieving that you can use for your Nursing Care Plan (NCP):

Nursing Interventions Rationale
Anticipate increased or exaggerated affective behavior. During this time, all affective behavior may seem increased or exaggerated. Older adults may be preoccupied with thoughts of impending death and uncertainty. Displaced anger and resentment may transpire when the loss does not occur as anticipated by those grieving. Regression may transpire during this time.
Communicate therapeutically with patient and family members and allow them to verbalize feelings. Sharing feelings with a healthcare provider may help the patient find significance in the experience of loss.
Support patient and significant others share mutual fears, concerns, plans, and hopes for each other. Keeping secrets won’t do any help during this time. These times of stress can be used as an opportunity for growth and family development.
Review and point out strengths and progress to date. Reviewing the patient’s progress is very helpful and provides perspective in the whole process.
Encourage significant others to manage their own self-care needs for rest, sleep, nutrition, leisure activities, and time away from the patient. Alteration in normal activities is evident during this time of stress. Care should be taken to treat these symptoms so that emotional reconstitution is not complicated by illness.
Initiate a process that provides additional support and resources. The patient and family may benefit from spiritual support resources.
Strengthen the patient’s efforts to go on with his or her life and normal routine. Allow the patient and family to feel that they are enabled to do this by supporting them.
Consider the patient’s or family’s denial about the loss for it is part of the grieving process. The nurse needs to recognize and understand these events as a time during which an individual or family member incorporates his or her strength to go on to the next stage of grief.
Acknowledge the patient’s need to review the loss experience. In this way, the patient and family members integrate the event into their experience.
Refer the patient and family to community resources. Support in the grieving process will come in many forms. Having the same experience from community groups is helpful in allowing the family to go through such a painful event and going on with life.

Examples of Nursing Care Plans for Grieving

Nursing Care Plan 1

Cancer

Nursing Diagnosis: Anticipatory Grieving related to anticipatory loss of body part secondary to mastectomy due to breast cancer, as evidenced by verbalization of anger about her disease, expression of fear of life after surgery, loss of appetite, and inability to sleep

Desired Outcome: The patient will be able to identify and express feelings in an appropriate manner without inflicting harm to oneself or others.

Intervention Rationale
Using open-ended questions, ask the patient to express her fear of life after surgery, and how she feels about her disease and treatment. To provide an atmosphere of acceptance and to establish rapport with the patient. It is important to use open-ended questions to allow the patient enough time to speak, rather than asking questions that are only answerable by “Yes” or “No.”
Re-assure the patient that his/her statements will be held in utmost confidentiality and privacy and will only be shared to named members of her healthcare team. To re-assure that patient regarding his/her privacy and confidentiality, encouraging him/her to be open and honest about the situation.
Assess the stage of grief of the patient and her significant other or dependents. Explain the grieving process as appropriate. To provide knowledge about the grieving process and to discuss the normality of feelings of anger while dealing with the patient’s circumstances.
Allow the patient to make choices and promote active participation on creating the personal development plan. Encouraging decision making and active participation promotes gradual acceptance of the situation. It also provides a sense of control over anticipated life events such as surgery and recovery.
Involve the family and friends in the patient’s care and planning. To help the patient in establishing a stronger support system.
Refer the patient to a breast cancer support group and the mental health team after explaining the benefits of these referrals and gaining her consent. A referral to the mental health team can help the patient learn different methods to improve her perception of self and body image. The patient will have more opportunity to speak up about herself and receive feedback from others in a group setting which can help her vent out her feelings and thoughts about the disease and surgery.
Reinforce the positive aspects of the situation, such as new research-based breast cancer treatments, revitalizing complimentary therapies, and strong support groups and communities. These promote hope for the patient’s future. They help avoid having feelings of hopelessness and helplessness for the breast cancer patient.

Nursing Care Plan 2

 Terminal Illness

Nursing Diagnosis: Anticipatory Grieving related to perceived potential death of the patient, as evidenced by bargaining, expression of fear of death, low mood, loss of appetite, and inability to sleep

Desired Outcome: The patient will be able to identify and express feelings in an appropriate manner and continue activities of daily living as normal. He/she will also be able to verbalize understanding of the dying process and express feeling supported throughout the grieving process.

Intervention Rationale
Using open-ended questions, ask the patient to express her fear of death and dying, and how she feels about her terminal illness. To provide an atmosphere of acceptance and to establish rapport with the patient. It is important to use open-ended questions to allow the patient enough time to speak, rather than asking questions that are only answerable by “Yes” or “No.”
Re-assure the patient that his/her statements will be held in utmost confidentiality and privacy and will only be shared to named members of her healthcare team. To re-assure that patient regarding his/her privacy and confidentiality, encouraging him/her to be open and honest about the situation.
Assess the stage of grief of the patient and her significant other or dependents. Explain the grieving process as appropriate. To provide knowledge about the grieving process and to discuss the normality of feelings of anger while dealing with the patient’s circumstances.
Allow the patient to make choices and promote active participation on creating the personal development plan. Encouraging decision making and active participation promotes gradual acceptance of the situation. It also provides a sense of control over anticipated life events such as surgery and recovery.
Involve the family and friends in the patient’s care and planning. To help the patient in establishing a stronger support system.
Refer the patient to a palliative nurse or end of life care team if the patient provides consent. A referral to a palliative nurse or end of life care team can help the patient learn different methods to improve her perception of self and body image.
Refer to hospice program or home health agency as appropriate. A hospice program or home health agency can help provide support for the terminally ill patient by means of assisting him/her with satisfying physical and emotional needs.

Grieving, Nursing Diagnosis for Grieving, and Nursing Care Plans for Grieving.

 

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