Complicated grieving is a prolonged and intensified response to loss that interferes with daily functioning and extends beyond cultural norms. This nursing diagnosis differs from normal grief in its duration, intensity, and impact on a person’s ability to resume normal activities and relationships.
Causes (Related to)
Complicated grieving can result from various circumstances and factors that affect how an individual processes loss. Common causes include:
- Sudden or traumatic death of a loved one
- Multiple losses in a short period
- Lack of social support system
- History of mental health conditions
- Unresolved past losses
- Difficult relationship with the deceased
- Cultural or religious conflicts about death
- Limited coping mechanisms
- Survivor’s guilt
- Inability to participate in traditional grieving rituals
Signs and Symptoms (As evidenced by)
Complicated grieving manifests through various physical, emotional, and behavioral symptoms:
Subjective: (Patient reports)
- Persistent longing for the deceased
- Intense sorrow and emotional pain
- Preoccupation with the loss
- Difficulty accepting the death
- Bitterness about the loss
- Feeling that life is meaningless
- Inability to trust others
- Persistent thoughts about death
Objective: (Nurse assesses)
- Social withdrawal
- Decreased participation in activities
- Difficulty maintaining daily routines
- Changes in eating patterns
- Sleep disturbances
- Prolonged depression symptoms
- Anger outbursts
- Physical symptoms mirroring the deceased
- Avoiding reminders of the loss
- Difficulty planning for the future
Expected Outcomes
The following are common nursing care planning goals and expected outcomes for complicated grieving:
- The patient will demonstrate healthy coping mechanisms
- The patient will express emotions appropriately
- The patient will resume normal daily activities
- The patient will maintain social connections
- The patient will acknowledge the reality of the loss
- The patient will begin to find new meaning in life
- The patient will engage in self-care activities
- The patient will utilize available support systems
Nursing Assessment
1. Evaluate the grief response
Assess grief symptoms’ duration, intensity, and impact on daily functioning. Note any signs that differentiate complicated grief from normal grieving processes.
2. Review the circumstances of the loss
Gather information about when and how the loss occurred, the patient’s relationship with the deceased, and any unresolved issues.
3. Assess support systems
Evaluate the availability and effectiveness of family, friends, and community support networks.
4. Screen for depression and suicide risk
Use standardized screening tools to assess for clinical depression and potential suicide risk.
5. Evaluate coping mechanisms
Assess current coping strategies and their effectiveness in managing grief.
6. Monitor physical health
Track changes in eating, sleeping, and activity patterns that may indicate complicated grieving.
7. Assess cultural and spiritual factors
Consider cultural and religious beliefs that influence the grieving process.
8. Review previous losses
Gather information about past losses and how they were managed.
9. Evaluate functional status
Assess the impact of grief on work, relationships, and daily activities.
Nursing Care Plans
Nursing Care Plan 1:
Nursing Diagnosis Statement:
Complicated Grieving related to the sudden death of a spouse secondary to a motor vehicle accident as evidenced by social isolation and verbal expressions of guilt.
Related Factors/Causes:
- Unexpected nature of death
- Lack of closure
- Survivor’s guilt
- Limited support system
Nursing Interventions and Rationales:
- Establish therapeutic relationship
Rationale: Creates a safe environment for the expression of feelings - Encourage verbalization of feelings
Rationale: Helps process emotions and reduce isolation - Assess suicide risk regularly
Rationale: Prevents self-harm during the vulnerable period - Connect with grief support groups
Rationale: Provides peer support and normalization of experience
Desired Outcomes:
- The patient will verbalize decreased feelings of guilt within 3 months
- The patient will demonstrate increased social engagement within 6 weeks
- The patient will develop effective coping strategies within 2 months
Nursing Care Plan 2:
Nursing Diagnosis Statement:
Complicated Grieving related to multiple losses within one year secondary to pandemic as evidenced by inability to participate in cultural mourning rituals and expressed feelings of emptiness.
Related Factors/Causes:
- Multiple concurrent losses
- Disrupted grieving rituals
- Social distancing requirements
- Cultural disconnection
Nursing Interventions and Rationales:
- Facilitate alternative mourning rituals
Rationale: Provides meaningful ways to honor losses - Coordinate virtual support groups
Rationale: Maintains social connection while respecting restrictions - Incorporate cultural practices when possible
Rationale: Honors traditional healing methods - Monitor for depression symptoms
Rationale: Identifies the need for additional intervention
Desired Outcomes:
- The patient will participate in modified cultural rituals within 1 month
- The patient will express decreased feelings of emptiness within 3 months
- The patient will demonstrate improved daily functioning within 2 months
Nursing Care Plan 3:
Nursing Diagnosis Statement:
Complicated Grieving related to unresolved conflict with a deceased parent as evidenced by expressed anger and inability to proceed with estate planning.
Related Factors/Causes:
- Ambivalent relationship with deceased
- Unfinished business
- Complex family dynamics
- Financial stressors
Nursing Interventions and Rationales:
- Provide space for anger expression
Rationale: Validates complex emotions in grief - Refer to family counseling
Rationale: Addresses systemic family issues - Connect with legal resources
Rationale: Reduces stress of practical matters - Teach healthy anger management
Rationale: Promotes appropriate emotional expression
Desired Outcomes:
- The patient will demonstrate appropriate anger expression within 2 months
- The patient will begin the estate planning process within 3 months
- The patient will verbalize acceptance of relationship complexity within 6 months
Nursing Care Plan 4:
Nursing Diagnosis Statement:
Complicated Grieving related to child loss secondary to chronic illness as evidenced by inability to enter child’s room and persistent questioning of medical decisions.
Related Factors/Causes:
- Nature of loss
- Medical trauma
- Parental role loss
- Decision-making guilt
Nursing Interventions and Rationales:
- Provide compassionate listening
Rationale: Allows processing of complex emotions - Connect with child loss support groups
Rationale: Links with others who understand unique loss - Coordinate with mental health professionals
Rationale: Ensures comprehensive support - Assist with memory-making activities
Rationale: Helps maintain a healthy connection with the deceased
Desired Outcomes:
- The patient will enter child’s room within 3 months
- The patient will express decreased guilt about medical decisions within 6 months
- The patient will maintain daily functioning within 2 months
Nursing Care Plan 5:
Nursing Diagnosis Statement:
Complicated Grieving related to traumatic loss secondary to suicide as evidenced by avoiding discussion of death and isolation from mutual friends.
Related Factors/Causes:
- Traumatic nature of death
- The stigma associated with suicide
- Complex emotions
- Social complications
Nursing Interventions and Rationales:
- Connect with suicide survivor groups
Rationale: Provides specialized support - Teach coping strategies
Rationale: Builds resilience and management skills - Address stigma directly
Rationale: Reduces shame and isolation - Facilitate gradual social re-engagement
Rationale: Rebuilds support network
Desired Outcomes:
- The patient will discuss circumstances of death within 4 months
- The patient will reengage with social support within 3 months
- The patient will demonstrate healthy coping mechanisms within 2 months
References
- Neimeyer, R. A., & Burke, L. A. (2022). Complicated Grief and the Quest for Meaning: A Constructivist Contribution. Journal of Constructivist Psychology, 35(1), 1-24.
- Shear, M. K., Reynolds, C. F., & Simon, N. M. (2023). Complicated Grief in Adults: Epidemiology, Clinical Features, Assessment, and Diagnosis. American Journal of Psychiatry, 180(1), 18-35.
- Worden, J. W. (2021). Grief Counseling and Grief Therapy: A Handbook for the Mental Health Practitioner (5th ed.). Springer Publishing Company.
- Stroebe, M., & Schut, H. (2022). The Dual Process Model of Coping with Bereavement: Rationale, Description, and Future Directions. Death Studies, 46(3), 547-564.
- Lobb, E. A., & Kristjanson, L. J. (2023). Complicated Grief: A Systematic Review of Assessment and Treatment. Palliative Medicine, 37(2), 228-244.
- Malkinson, R., & Ellis, A. (2021). The Application of Rational-Emotive Behavior Therapy (REBT) in Traumatic and Complicated Grief. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 39(2), 184-197.
