Grieving

Grieving 5 Nursing Care Plans Diagnosis and Interventions

Grieving NCLEX Review Care Plans

5 Nursing Care Plans on Grieving

Grieving is 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

  • 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  • Withdrawn and avoids socializations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

Stages of Grief

Understanding the stages of grief helps a nurse or any healthcare provider to establish rapport with the patient and his/her significant other, while providing a safe space, as well as physical and social support that they need.

Nursing Stat Facts

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Nursing Stat Facts

Several theories have been made in relation to grieving, death, and dying. One of these theories is called the “Kubler-Ross Grief cycle.” Psychiatrist Elisabeth Kubler-Ross published her theory in 1969 describing the five stages of grief that patients and their family members may go through.

These stages are called “DABDA” which stands for Denial, Anger, Bargaining, Depression, and Acceptance.

  1. Denial.  Denial is the most common initial reaction to learning about having a long-term or grave illness, poor prognosis, or impending death. This shows the patient or significant other’s disbelief on the announcement of an unfortunate news. An example verbalization of denial is: “I feel healthy, so I think you are mistaken. I do not have cancer!” In the Denial stage, the nurse should exercise active listening skills and show empathy to the patient and significant other despite the possibility of them being argumentative.
  2. Anger. This can result from fear of death and dying. The patient may say, “I hate myself!” or “I do not need your help! I am not a weakling.” The person may also be verbally or even physically aggressive due to impaired thinking and uncontrolled emotions. In the Anger stage, the nurse must be calm and not show anger towards the patient. Instead, the nurse should maintain being a patient advocate by listening to the patient but setting limits firmly. For instance, the nurse can say “I understand your anger and I am here for you, but please tone down your voice as other patients are resting and might feel uncomfortable with loud noises.”
  3. Bargaining. In this stage, the patient is starting to calm down and attempt to accept his or her fate while trying to reduce the cruelty of the situation by saying that he/she will give or do anything. The patient may say, “I will go to church everyday just so God will heal me.” This is an opportunity for the nurse to advise the patient on how he/she can participate to treatment and daily care.
  4. Depression. The patient may feel hopeless, helpless, fatigued, and unmotivated. He/she may say, “I don’t want visitors today. I don’t have energy to talk. Nothing is going my way.” The nurse should be supportive by saying that he/she is available to listen. The nurse should also watch out for any signs of major depression or impending suicide.
  5. Acceptance. In this stage, the patient has accepted his/her fate and is willing to do activities that can improve the quality of his/her life such as comfort measures and relaxation techniques. The nurse should also encourage the patient to speak to family and friends and arrange last will of testament and other things that need to be settled.

Nursing Care Plans on 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.

InterventionRationale
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.

InterventionRationale
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.

Nursing Care Plan 3

Loss of Body Part

Nursing Diagnosis: Dysfunctional Grieving related to the Depression stage of grief secondary to diabetes-related amputation of legs as evidenced by withdrawal from group gatherings or social events, anxiety, impaired perception, inability to meet basic needs and role expectations

Desired Outcome: The patient will demonstrate improved social interaction by increased participation in social events.

InterventionRationale
Explore the patient’s reasons for social withdrawal without judging or giving suggestions at first. Assess the anxiety level of the patient, anxiety triggers and symptoms by asking open-ended questions.To establish a baseline observation of the anxiety level of the patient. Open-ended questions can help explore the thoughts and feelings of the patient regarding social isolation.
Discuss with the patient regarding referral to psychiatry team. Psychotherapy involves speaking with a licensed therapist and going through how to gradually cope with the situation.
Support the patient’s efforts to verbalize and explore the meaning behind the tendency to become withdrawn.The patient should first recognize and accept the tendency to become withdrawn before change can happen.
Encourage him/her to join social events gradually. Include his/her interests/previous hobbies in the activities of a social group.To provide chances for the patient to interact socially.
Encourage the patient to perform activities like crafts and games with one or more persons during the day and discourage sleeping during the day.Sleeping during the day can make the patient less sleepy at night, which can cause insomnia. Encouraging socialization can help the patient cope with depression.
Teach the patient to perform relaxation techniques such as deep breathing exercises, guided imagery, meditation, and progressive muscle relaxation.To promote relaxation and reduce stress levels.

Nursing Care Plan 4

Death of a Family Member

Nursing Diagnosis: Dysfunctional Grieving related to losing the infant due to SIDS as evidenced by anger and crying outbursts, verbalization of being a worthless parent, increasing tension, decreased attention span, restlessness, shortness of breath, disorganized thought process, and verbalization of feeling hopeless

Desired Outcome: The patient will be able to proceed with the acceptance of losing the child.

InterventionRationale
Assess the stage of grief of the parent. Check the anxiety level, anxiety triggers and symptoms by asking open-ended questions.To determine how the nurse can approach and speak to the parent. To establish a baseline observation of the anxiety level of the patient. Open-ended questions can help explore the thoughts and feelings of the patient regarding the situational crisis.
Allow time for the parent/s to hold their child and say goodbye.To help the parent/s grieve and say goodbye.
Ensure to speak in a calm and non-threatening manner to the patient. Maintain eye contact when communicating with him/her. Provide a comfortable environment by providing sufficient lighting, good ventilation, and reduced noise levels. Respect the personal space of the client but sit not too far from him/her.A calm voice and a comfortable environment can help the patient feel secured and comfortable to speak about his/her worries and fears. The client may become more relaxed and open for discussion if he/she sees the nurse as calm and appears to be in control.
 Re-assure that the healthcare team are here to help him/her. Do not leave him/her especially when the anxiety levels are high.To ensure the parent’s safety.  
Provide a supportive approach by giving simple and short directions or information. Re-assure her and the partner that it is normal to grieve and allow time to heal.The patient has a limited attention span and is irritable or restless during a panic attack, thus simple and short directions are important in helping the patient cope with the situation.
Discuss relaxation techniques such as deep breathing exercises, guided imagery, meditation, and progressive muscle relaxation.To promote relaxation and reduce stress levels.
Refer the parent/s to a local support group on SIDS and/or to counseling or psychological help if needed. Offer to be referred to a clergy.  To expand the mother and partner’s support system and re-assure them that they are not alone in their healing journey.

Nursing Care Plan 5

Nursing Diagnosis: Dysfunctional Grieving related to situational crisis of metastasis of lung cancer as evidenced by anger outbursts, decreased attention span, restlessness, disorganized thought process, crying, and verbalization of feeling hopeless

Desired Outcome: The patient will be able to proceed with the acceptance of having poor prognosis of cancer.

InterventionRationale
Use open-ended questions to ask how the patient is feeling about the diagnosis, prognosis, treatment, and life in general.Open-ended questions can help explore the thoughts and feelings of the patient regarding the situational crisis.
Ensure to speak in a calm and non-threatening manner to the patient. Maintain eye contact when communicating with him/her. Provide a comfortable environment by providing sufficient lighting, good ventilation, and reduced noise levels. Respect the personal space of the client but sit not too far from him/her.A calm voice and a comfortable environment can help the patient feel secured and comfortable to speak about his/her worries and fears. The client may become more relaxed and open for discussion if he/she sees the nurse as calm and appears to be in control.
Do not leave the patient when showing anger outbursts and the anxiety levels are high. Re-assure that the healthcare team are here to help him/her.To ensure the patient’s safety against self-harm. Leaving the patient alone during heightened levels of anxiety is dangerous.  
Offer to be referred to psychiatry service as appropriate. Psychotherapy involves speaking with a licensed therapist and going through how to gradually cope with the situation.  
Teach the patient to perform relaxation techniques such as deep breathing exercises, guided imagery, meditation, and progressive muscle relaxation.To promote relaxation and reduce stress levels.
If the patient continues to become aggressive, tell him/her that the team is here for him/her, but firmly say that shouting or verbal/physical abuse against staff is not tolerated.To exhibit being a client advocate but also showing the patient that any form of abuse is not acceptable.

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. (2017). 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

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

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

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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