Complicated Grieving Nursing Diagnosis and Nursing Care Plan

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Complicated Grieving Nursing Care Plans Diagnosis and Interventions

Complicated Grieving NCLEX Review and Nursing Care Plans

Complicated grieving is a debilitating process that is usually regarded as an overwhelming response to the loss of a loved one or change in circumstance.

It is characterized by protracted mourning that does not progress through the typical stages of grief, as mentioned below.

Compassionate care for grieving patients and those close to them is an essential part of the nurse’s role in offering the best possible care.

5 Stages of Grief by Kubler-Ross

  • Denial – it is the initial stage that aids in surviving the loss. There is an unwillingness to acknowledge the existing truth, diagnosis, or circumstance. This stage is defined by questioning and the use of defense mechanisms.
  • Anger – A strong emotional reaction when confronted with a new reality. Anger and blaming ensue when the desired reality does not materialize.
  • Bargaining – Sadness sets in, and the person assumes that negotiating helps prevent grief. This stage is defined by false hope.
  • Depression – The individual realizes the situation and may withdraw from life, remain silent, cry frequently, or desire to remain in bed.
  • Acceptance – At this point, the individual has come to terms with the painful events. It includes accepting the truth and resisting the temptation to deny it.

Nurse’s Roles in Complicated Grieving

Successful decision-making by nurses and other health care professionals requires consideration of physiological realities, patient preferences, and limitations.

  • Therapeutic communication. Nurses must provide end-of-life, perinatal, palliative care, etc., with compassion and comprehension. Bereavement care provided by nurses can profoundly impact the future mourning process for families.
  • Teamwork. Nurses must collaborate closely with other health care team members to provide the best care possible to their patients and families.
  • Versatility. Regardless of workload or physical setting, the nurse supports survivors and enables patient-centered and family-centered care. This involves ensuring family members are present at the patient’s bedside and promoting family support measures for end-of-life care.
  • Advocacy. A nurse’s primary responsibility is to provide patients and their loved ones with current and accurate clinical information. Incorporating the patient’s concerns into the treatment plan also entails communicating with doctors and other healthcare providers to manage symptoms and stress appropriately.

Types of Grieving

  1. Uncomplicated Grieving. It is also known as “normal grief.” This type does not have a specific timetable. Due to its defining characteristic as a universal reaction to loss, it’s considered a natural response. Over time, people learn to cope with their loss, and their feelings of grief diminish. But this varies from person to person. Bereaved people may have different formative feedback based on their relationship, the nature of the loss experienced, and other factors. Patients under this category exhibit the following behaviors: There may be a loss of appetite, a change in social isolation, lack of contact with others, and feelings of anger, remorse, and emptiness.
  2. Anticipatory Grieving. This refers to the grief that arises before the death of a loved one. Having a loved one slip away or mourning someone still alive are defining aspects of this type. This mourning process commonly occurs when a loved one is diagnosed with a life-threatening illness or has been suffering from a long-term condition. It is not uncommon for families to begin grieving their loved ones prior to their death. This is a response to witnessing their loved one’s misery and suffering or to imagining their existence without their loved ones.

The patient also experiences this type of bereavement, typically when they might expect a loss in autonomy, function, and amenity. Signs and symptoms include the following:

When a person’s support system is absent or nonexistent, it can lead to significant despair, anxiety, and depression. Nurses should notice patients and families affected by AG to alleviate uncontrollable symptoms that may exacerbate suffering or prepare and develop coping skills for impending challenges.

  1. Complicated Grieving. Depending on the depth of a person’s grief, complicated grieving falls into one of the following four categories:
  2. Delayed Grief – Typical mourning feelings are suppressed or prolonged due to the survivor’s desire to minimize the agony of loss.
  3. Chronic Grief – Long-lasting grieving responses.
  4. Exaggerated Grief -Normal mourning responses are heightened, leading to an intense emotional response that may include suicidal thoughts, panic attacks, or even nightmares.
  5. Masked Grief – Following a loss or difficult experience, the sufferer may be oblivious that their actions mirror that experience. Typical responses include denying grief or suppressing feelings.

Those who have experienced abrupt traumatic experiences such as homicide- or suicide-related losses may be at risk for CV.

These people are often plagued by the constant or deep longing for the deceased. In addition, they have to deal with the awful reality of it. Thus, previous unresolved losses could contribute to the development of a CV. 

Other contributing factors: 

  • Absent support network
  • Deteriorating health
  • Concurrent stressors
  • Loss of relationships and network
  1. Disenfranchised Grieving. This occurs when grief does not conform to societal views about dealing with a painful loss. Bereavement may go unrecognized or contravene societal norms, which renders feelings illegitimate or unjustifiable. Losing a loved one to socially unacceptable causes like AIDS or abortion is more likely to induce this type of grief. In part, a lack of social support and empathy makes it harder to progress through the stages of mourning. This type of grieving can also be experienced by a person unable to openly mourn a deceased loved one due to their previous relationship (e.g., death of an ex-spouse or partner).
  2. Unresolved Grieving. This type is defined by the bereaved person’s inability to progress through the stages of grief and accept their loss or painful reality. It persists for an extended period, perhaps years, and impairs an individual’s daily functioning. Those who have suffered multiple or successive losses, sudden, violent death of a loved one, a lack of formal closure, a miscarriage, or social isolation are at greater risk of developing unresolved grieving.

Signs and Symptoms of Complicated Grieving

Common Expressions of Complicated Grieving:

  • Insomnia
  • Loss in appetite
  • Anger
  • Regret
  • Crying
  • Denial
  • Anxiety
  • Fatigue
  • Depression

Possible Expressions of Complicated Grieving:

  • Maladaptive avoidances
  • Phobic avoidance
  • Distraught
  • Profound sorrow or remorse
  • Self-blame
  • Shame
  • Drug and alcohol use
  • Panic
  • Difficulty performing daily tasks
  • Intense Longing

Therapeutic Interventions for Complicated Grieving

  • Psychotherapy. Nurses should consider referring patients and family members who are grieving to support groups, bereavement counseling, and spiritual care programs. Make a referral to hospice or palliative care. Psychosocial support should also be explored in the situation of prolonged grief, in which the individual is unable to reconcile with or adjust to reality. Psychotherapy approaches include cognitive-behavioral, individual interpersonal, exposure, and cognitive restructuring therapy.
  • Pharmacologic management. Antidepressants may be used to treat CG. Treatment of depression with serotonin reuptake inhibitors has shown promising results.
  • Therapeutic Communication. Utilize to evaluate and appraise a patient’s behavior and feelings that may be concealed. This also has an effect on the success of communicating treatment plans, objectives, and expectations. Appropriate communication is necessary for the patient to comprehend the critical nature of health education.
  • Companioning. The companionship between counselors, social workers, and bereaved patients is the goal of this grief therapy. This experience is about putting oneself in the shoes of the grieving person who has emotional pain.

Complicated Grieving Nursing Diagnosis

Complicated Grieving Nursing Care Plan 1

Disturbed Sleep Pattern

Nursing Diagnosis: Disturbed Sleep Pattern related to excessive worrying and intrusive thoughts secondary to complicated grieving, as evidenced by irritability, tiredness, agitation, dozing, difficulty falling asleep, and mood alterations.

Desired Outcome: The patient will demonstrate improved sleep patterns and quality.

Nursing Interventions for Complicated GrievingRationale
Evaluate the patient’s sleep patterns and take note of the duration, routine, length, and depth.A bereaved patient is more susceptible to disrupted sleep patterns due to the disruptive nature of the traumatic or painful experience. They may exhibit preoccupation or yearning in the event of loss, or they could experience intrusive thoughts, which have a detrimental effect on the biological systems and circadian rhythm of the body.
Observe sleep-wake behaviors such as crying, night waking, disorders (e.g., depression and posttraumatic stress disorder or PTSD), and anxiety.Depression and PTSD are more common co-occurring conditions with CG. Sleep and mood are tightly linked; for instance, depression can cause insomnia and disturbed sleep. Monitoring the patient’s sleep help refine and improve preventive techniques and treatment since sleep is a changeable activity.
Encourage the patient to consume a balanced diet and abstain from large meals, smoking, alcohol, and caffeine before sleeping.Painful memories frequently contribute to sleep issues. However, it is feasible to overcome poor sleep by establishing unwritten rules for avoiding stimulation and arousal from sleep.
Assign a scheduled plan for rest and sleep to the patient.Keeping a constant routine helps the patient overcome variations associated with the grieving process. In addition, it can be energy-draining. Poor sleep should be mitigated to compensate for energy expenditure. Having the patient obtain a consistent routine and sleep schedule also helps stabilize the amount of sleep consistently and allows him/her to proactively perform day-to-day chores. 
If the patient is still awake after 30 minutes, suggest a relaxing activity and exercise.In addition to improving sleep habits, low-stakes activities can be used as a beneficial coping mechanism. It alleviates stress and anxiety and aids in the reduction of insomnia symptoms. Additionally, it aids in tension relief and may promote deeper sleep.

Complicated Grieving Nursing Care Plan 2

Fatigue

Nursing Diagnosis: Fatigue related to mental exhaustion secondary to complicated grieving, as evidenced by lethargy, exhaustion, verbalization of exhaustion, tightness in the chest, inability to focus, and changes in appetite.

Desired Outcome: The patient will accomplish preferred activities, as shown by comments of decreased fatigue.

Nursing Interventions for Complicated GrievingRationale
Evaluate the patient’s account of fatigue, its symptoms, and aggravating causes. Take note of its intensity by using an appropriate scale from 1-to 10.Using an appropriate quantitative scoring scale, nurses can better formulate the amount of fatigue experienced by the patient. Additionally, by asking the patient to describe his or her fatigue, the healthcare provider is able to identify the grief stage. Complicated grief can present itself in various ways and through different grief experiences (e.g., severity and duration vary from person to person).
Evaluate the patient’s ability to perform self-care or activities of daily living (ADLs)Individuals with complicated grief disorder frequently have impaired abilities to execute ADLs. One of the most common causes is fatigue, which impairs their capacity to care for themselves and fulfill family and societal responsibilities.
Observe if the patient’s nutrient intake is sufficient to meet their energy and metabolic needs.Patients who are experiencing prolonged grief may see changes in their dietary intake. During a time of grief, the patient’s eating habits shift.
Assess the patient’s willingness to participate in programs, activities, and care aimed at reducing fatigueRecognizing the health-seeking behaviors will aid in the proper allocation of therapeutic care for fatigue. It also promotes patient involvement in developing, implementing, and evaluating care plans.
Ascertain that the patient’s environment is free of external stimuli that could interfere with his or her sleep or rest.External influences, distractions, and clutter can impede rest. This could exacerbate the patient’s insomnia, frequent in people experiencing complicated grief. Non-pharmacological treatment regimens include a sleep-friendly atmosphere and scheduled rest periods for the patient.
Have the patient keep a fatigue and activity journal for at least a week.To measure an individual’s level of fatigue during specified times or activities. Determining when a patient feels exhausted makes it possible to recognize excessive energy expenditure and alleviate the work overload that contributes to fatigue.
Assist the patient by providing comfort measures such as massage and touch therapy.Massage therapy supports grievers by providing therapeutic presence and a sense of security. Moreover, touch-based intervention contributes to a reduction of anxiousness, resulting in relaxation.

Complicated Grieving Nursing Care Plan 3

Disturbed Thought Process

Nursing Diagnosis: Disturbed Thought Process related to polarized thinking secondary to complicated grieving, as evidenced by lack of rationality, illusions, disturbed sleep pattern, reduced attention span, impaired judgment, and abstract thoughts

Desired Outcome: The patient will retain mental awareness and will be able to discern reality from hallucinations.

Nursing Interventions for Complicated GrievingRationale
Determine the patient’s thought processing capacity, distractibility, ability to process information and make judgments.Patients going through grief may find it difficult to think coherently. Hence, they are more likely to make poor decisions and have poor problem-solving skills. Long-term, complicated grieving impairs memory, making even the most basic tasks difficult.
Conduct a cognitive assessment and take note of changes in orientation, attention, reasoning abilities, and the capacity to perceive and interpret information.The patient’s level of impairment can be assessed and allows early modifications to the care plan.
Evaluate the patient’s ability to cope with life’s events. Note for any changes in motivation and memory pattern.The client or patient may encounter memory difficulties such as trouble recalling memories and deterioration of preexisting mental health disorders. They may also become aggressive or pushy to deal with emotions or have difficulties embracing lifestyle changes. Difficulty regulating unpleasant sensations can be debilitating and destructive; hence, assessing the patient during the grieving period is critical to alleviating chronic stress.
Assist patients by writing reminders or color-code items.This is to assist the patient in recalling or locating their items/articles.
Regulate and limit the patient’s decision-making. Communicate support and compassion for the patient and encourage them to speak openly.Patients suffering from bereavement may have life-altering symptoms like loss of function or mentation. Moreover, the patient may be delusory, have false beliefs, or have a distorted perception of reality, leading to damaging behaviors like withdrawal, isolation, and depression. The nurse must retain emotional stability to deliver the best care possible to those grieving. Positive and nonjudgmental responses are encouraged to lessen a patient’s sense of disconnection and promote active participation.
Encourage family members or significant others to communicate with the patient more effectively.  When family members are involved in the patient’s recovery, it is more likely that they will be successful. Patients who believe their loved ones care about them are less likely to engage in aggressive and debilitating behaviors.

Complicated Grieving Nursing Care Plan 4

Ineffective Coping

Nursing Diagnosis: Ineffective Coping related to difficulty adapting to reality, secondary to complicated grieving of the loss of a loved one, as evidenced by self-neglect, substance abuse, ritualistic behavior, and incapacity to meet basic necessities.

Desired Outcome: The patient will demonstrate effective coping strategies as evidenced by cessation of substance abuse, rumination, and verbalized sense of control.

Nursing Interventions for Complicated GrievingRationale
Examine the variables that contribute to ineffective coping.To get a baseline of the patient’s current situation. An assessment provides insight into the degree of coping difficulty.
Assess the patient’s previous coping strategies.By analyzing prior coping skills, interventions can be altered to ensure success in conversion. Although this is case-by-case, understanding past coping mechanisms aids in determining whether they are appropriate for the patient’s current situation.
Encourage the patient to express their concerns, emotions, and fears openly. Practice active listening and empathetic communication.Active listening provides a support system for the patient, relieving them of their remorse and negative emotions. Recognizing their sentiments and concerns demonstrates support and understanding. Additionally, it lessens fear and facilitates future communication.
Encourage the patient to express emotions using healthy outlets such as music, painting, exercising.Supporting the patient in regaining a sense of peace aids the mind and body resolve bereavement. Additionally, it alleviates pain and grief-related emotions.
Analyze the patient’s past stressors and coping techniques.Some stressors cannot be changed, and the way they are dealt with depends on the type and degree of trauma. By identifying the variables contributing to grief, the nurse might become mindful of previously unnoticed behaviors that may aggravate rumination. Additionally, prior coping skills can be employed in the present situation, assisting the nurse in developing stress management strategies specific to the patient’s needs.
Examine the patient’s perceptions of effective coping in light of cultural views, customs, and beliefs.Personal views, values, and conventions may influence the type of coping method or support system that is most successful for bereaved patients. Thus, identifying potential influences on a patient’s coping behavior assists the healthcare professional in incorporating them into the care plan.
Examine the patient for damaging and self-defeating coping techniques.Grieving individuals resort to experiential avoidance to block out any unpleasant emotions. However, they may also turn to vices, drugs, and sedating medications in the face of difficult situations.

Complicated Grieving Nursing Care Plan 5

Spiritual Distress

Nursing Diagnosis: Spiritual Distress related to spiritual detachment secondary to complicated grieving as evidenced by verbalized inner conflict with spirituality, lack of meaning in life, emptiness, and reported estrangement from the spiritual or religious community.

Desired Outcome: The patient will find consolation in religious or spiritual pursuits.

Nursing Interventions for Complicated GrievingRationale
Assist the patient in resolving conflicts within his/her moral and religious convictionsThe bereaved patient may find console or use spiritual meanings as a coping mechanism. In the wake of a distressing or depressing event, it can also lead to a crisis of faith and separation from the religious community. A supportive assessment and intervention suited to the patient’s spiritual struggle should be done to alleviate distress or spiritual crisis.
Enable the patient to make their own decisions and provide a nonjudgmental presenceDuring a difficult moment, the patient may require a nonjudgmental source of support. Grief responses are unique, and condemning them can make patients more distant and resolute in their refusal to accept aid. It can exacerbate feelings of hopelessness and worthlessness, making it more difficult for healthcare workers to address spiritual distress in mourning, loss, or depression.
Observe the patient’s remarks about remorse, lack of self-esteem, dissatisfaction with one’s moral or spiritual beliefs, and a lack of faith in one’s own abilities.The morality of the client’s decision may be disputed by family members or significant others. Spiritual care can be developed and integrated into holistic nursing care by recognizing and resolving the issues that may perplex or confuse patients. This enables nurses to address the needs of patients to promote growth, healing, and pain reduction. Additionally, collaborating with family members or SOs can expedite the therapeutic process and provide comfort and peace.
Educate the patient on possible grief responses.Patients should understand that CG is atypical, have no control over it, and are not to blame.
Suggest seeking professional counseling or being referred to a spiritual advisor.Religion or spiritual beliefs may serve as an enabling component in the patient’s ability to cope with mental, emotional, and physical problems. Patients who rely on religious coping mechanisms may find solace through active participation and counseling within a religious group or spiritual advisor.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Nursing Stat Facts
Nursing Stat Facts

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

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The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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