Grieving is a normal response to loss, but when it interferes with a patient’s daily functioning or health, it becomes a nursing concern. This nursing diagnosis focuses on the patient’s emotional and physical responses to loss, which can include the loss of a loved one, a job, a body part, or even one’s health status. Understanding and addressing grieving is crucial for providing holistic, patient-centered care.
Causes (Related to)
Grieving can result from various types of losses or anticipated losses. The following are common causes of grieving:
- Death of a loved one (family member, friend, or pet)
- Diagnosis of a terminal illness in self or a loved one
- Loss of body function or body part (amputation, paralysis)
- Loss of job or financial stability
- End of a significant relationship
- Major life transitions (retirement, moving to a new place)
- Loss of independence or autonomy
- Cultural or spiritual losses
- Miscarriage or infertility
- Loss of cognitive function (dementia)
Signs and Symptoms (As evidenced by)
Grieving can manifest with a variety of signs and symptoms. In a physical assessment, a patient experiencing grief may present with one or more of the following:
Subjective: (Patient reports)
- Feelings of sadness, anger, guilt, or numbness
- Difficulty concentrating or making decisions
- Changes in sleep patterns (insomnia or excessive sleeping)
- Loss of appetite or increased appetite
- Feeling overwhelmed or helpless
- Loneliness or social withdrawal
- Questioning of spiritual or religious beliefs
Objective: (Nurse assesses)
- Crying or emotional outbursts
- Changes in activity level (restlessness or lethargy)
- Neglect of personal hygiene or appearance
- Physical symptoms (headaches, stomach pain, fatigue)
- Decreased participation in usual activities
- Verbal expressions of distress or loss
- Changes in vital signs (elevated heart rate, blood pressure)
Expected Outcomes
The following are common nursing care planning goals and expected outcomes for grieving:
- The patient will verbalize understanding of the grieving process
- Patient will demonstrate improved coping skills within [specific timeframe]
- The patient will report a gradual return to normal sleep and eating patterns
- Patient will engage in self-care activities and maintain personal hygiene
Nursing Assessment
The first step of nursing care is the nursing assessment, during which the nurse will gather physical, psychosocial, emotional, and diagnostic data. The following section will cover subjective and objective data related to grieving.
- Assess the patient’s understanding of the loss and grieving process.
Understanding the patient’s perception of their loss and knowledge of grief can help tailor interventions and education. - Evaluate the patient’s support system.
Identify family members, friends, or community resources available to support the patient through grieving. - Assess for risk factors that may complicate grieving.
Look for factors such as a history of depression, substance abuse, or multiple concurrent losses that may impact the grieving process. - Monitor for signs of complicated grief or depression.
Be alert for prolonged or intense grief reactions that may indicate a need for specialized mental health intervention. - Assess the patient’s cultural and spiritual beliefs related to loss and grieving.
Cultural and spiritual factors can significantly influence how a person experiences and expresses grief. - Evaluate the patient’s coping mechanisms.
Identify both positive and negative coping strategies the patient is using to deal with their grief. - Assess for physical symptoms related to grief.
Monitor for changes in appetite, sleep patterns, energy levels, and the presence of somatic complaints. - Evaluate the impact of grief on daily functioning.
Assess how grief is affecting the patient’s ability to perform activities of daily living, work, or maintain relationships. - Assess for suicidal ideation or self-harm behaviors.
Grief can sometimes lead to thoughts of self-harm or suicide, especially in cases of complicated grief.
Nursing Interventions
Nursing interventions and care are essential for supporting the patient through grieving. In the following section, you’ll learn about possible nursing interventions for a patient experiencing grief.
- Provide a supportive and non-judgmental environment.
Create a safe space for the patient to express their emotions and thoughts about their loss. - Educate the patient about the normal grieving process.
Provide information about the stages of grief and common reactions to help normalize the patient’s experience. - Encourage expression of feelings.
Use active listening skills and open-ended questions to facilitate the patient’s expression of emotions related to their loss. - Assist in identifying and strengthening coping mechanisms.
Help the patient recognize and build upon positive coping strategies they have used in the past or could adopt. - Promote self-care activities.
Encourage the patient to maintain regular sleep patterns, eat balanced meals, and engage in physical activity as appropriate. - Facilitate connection with support systems.
Help the patient identify and connect with family, friends, or support groups that can provide ongoing emotional support. - Provide information on grief counseling or support groups.
Offer resources for professional counseling or local support groups specific to the type of loss experienced.
Nursing Care Plans
Nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for grieving.
Care Plan #1
Nursing Diagnosis Statement:
Grieving related to death of spouse as evidenced by verbal expressions of sorrow, social withdrawal, and disrupted sleep patterns.
Related factors/causes:
Death of spouse, loss of long-term relationship, change in social support system.
Nursing Interventions and Rationales:
- Provide a supportive environment for the patient to express feelings about the loss.
Rationale: Allowing the expression of emotions helps validate the patient’s experience and promotes healthy grieving. - Assess the patient’s understanding of the grieving process and provide education as needed.
Rationale: Understanding the normal stages of grief can help normalize the patient’s experience and reduce anxiety. - Encourage the patient to participate in self-care activities and maintain a routine.
Rationale: Maintaining a routine can provide a sense of normalcy and control during the grieving process. - Assist the patient in identifying and mobilizing their support system.
Rationale: A strong support system can provide emotional comfort and practical assistance during grieving.
Desired Outcomes:
- Patient will verbalize understanding of the normal grieving process within 1 week.
- The patient will demonstrate improved sleep patterns within 2 weeks.
- Patient will engage in at least one social activity per week within 1 month.
Care Plan #2
Nursing Diagnosis Statement:
Grieving related to loss of body function secondary to stroke as evidenced by expressions of anger, frustration, and decreased participation in rehabilitation activities.
Related factors/causes:
Loss of physical abilities, change in body image, fear of dependency.
Nursing Interventions and Rationales:
- Encourage the patient to express feelings about the loss of function.
Rationale: Acknowledging and processing emotions related to the loss can facilitate acceptance and adjustment. - Collaborate with physical and occupational therapists to set realistic goals for recovery.
Rationale: Achievable goals can provide hope and motivation during the rehabilitation process. - Provide education on adaptive techniques and assistive devices.
Rationale: Knowledge of adaptive strategies can promote independence and reduce feelings of helplessness. - Facilitate participation in a support group for stroke survivors.
Rationale: Connecting with others who have had similar experiences can provide emotional support and practical coping strategies.
Desired Outcomes:
- Patient will verbalize acceptance of current physical limitations within 2 weeks.
- The patient will demonstrate increased participation in rehabilitation activities within 1 week.
- Patient will express hope for the future and engage in goal-setting within 3 weeks.
Care Plan #3
Nursing Diagnosis Statement:
Grieving related to job loss as evidenced by expressed feelings of worthlessness, social isolation, and neglect of personal appearance.
Related factors/causes:
Unexpected termination of employment, loss of financial stability, change in social role.
Nursing Interventions and Rationales:
- Assess the patient’s perception of the job loss and its impact on their life.
Rationale: Understanding the patient’s perspective helps tailor interventions to their needs and concerns. - Encourage the patient to maintain a daily routine, including regular sleep and meal times.
Rationale: Structure can provide a sense of purpose and normalcy during periods of uncertainty. - Assist the patient in identifying transferable skills and exploring new career opportunities.
Rationale: Focusing on skills and potential can help rebuild self-esteem and provide direction for the future. - Provide information on local resources for job search assistance and financial counseling.
Rationale: Practical support can help address immediate concerns and reduce stress related to job loss.
Desired Outcomes:
- Patient will verbalize improved self-worth within 2 weeks.
- The patient will engage in at least one job-seeking activity per day within 1 week.
- Patient will demonstrate improved personal hygiene and grooming within 3 days.
Care Plan #4
Nursing Diagnosis Statement:
Grieving related to miscarriage as evidenced by expressed feelings of guilt, avoidance of pregnant women or babies, and difficulty discussing the loss.
Related factors/causes:
Loss of an anticipated child, the perceived failure of the body, societal expectations around pregnancy and motherhood.
Nursing Interventions and Rationales:
- Provide a safe, non-judgmental space for the patient to discuss feelings about the miscarriage.
Rationale: Validating the patient’s grief can help counteract societal tendencies to minimize pregnancy loss. - Educate the patient and partner about the physical and emotional aspects of miscarriage.
Rationale: Understanding the process can help reduce self-blame and promote healing. - Offer information on support groups specific to pregnancy loss.
Rationale: Connecting with others who have experienced similar losses can reduce feelings of isolation. - Collaborate with the healthcare team to address any physical concerns related to the miscarriage.
Rationale: Addressing physical health can support overall well-being during the grieving process.
Desired Outcomes:
- Patient will express feelings about the miscarriage without self-blame within 1 week.
- The patient will engage in a grief support activity (e.g., support group, counseling) within 2 weeks.
- Patient will verbalize understanding of the miscarriage process and its emotional impact within three days.
Care Plan #5
Nursing Diagnosis Statement:
Grieving related to terminal illness diagnosis as evidenced by expressed fear of death, withdrawal from loved ones, and refusal to discuss end-of-life plans.
Related factors/causes:
Life-limiting diagnosis, anticipatory grief, fear of the unknown.
Nursing Interventions and Rationales:
- Assess the patient’s understanding of their diagnosis and prognosis.
Rationale: Ensuring accurate understanding can help guide discussions and interventions. - Provide opportunities for the patient to discuss their fears and concerns about death and dying.
Rationale: Open dialogue about end-of-life issues can reduce anxiety and promote acceptance. - Facilitate family meetings to discuss care preferences and end-of-life planning.
Rationale: Involving loved ones in care planning can provide support and ensure the patient’s wishes are respected. - Collaborate with the palliative care team to manage symptoms and enhance quality of life.
Rationale: Effective symptom management can reduce physical distress and allow focus on emotional and spiritual needs.
Desired Outcomes:
- Patient will express willingness to discuss end-of-life concerns within 1 week.
- The patient will engage in meaningful interactions with loved ones daily.
- Patient will participate in creating an advance care plan within 2 weeks.
References
- Buglass, E. (2010). Grief and bereavement theories. Nursing Standard, 24(41), 44-47.
- Worden, J. W. (2018). Grief counseling and grief therapy: A handbook for the mental health practitioner (5th ed.). Springer Publishing Company.
- Kübler-Ross, E., & Kessler, D. (2014). On grief and grieving: Finding the meaning of grief through the five stages of loss. Scribner.
- Stroebe, M., Schut, H., & Boerner, K. (2017). Cautioning health-care professionals: Bereaved persons are misguided through the stages of grief. OMEGA – Journal of Death and Dying, 74(4), 455-473. https://doi.org/10.1177/0030222817691870
- Shear, M. K. (2015). Complicated grief. New England Journal of Medicine, 372(2), 153-160. https://doi.org/10.1056/NEJMcp1315618
- Neimeyer, R. A. (2019). Meaning reconstruction in bereavement: Development of a research program. Death Studies, 43(2), 79-91. https://doi.org/10.1080/07481187.2018.1456620
