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Grieving a loss is a normal process that has implications for both patient and family well-being. NANDA formally recognizes the dimensions of grief with the nursing diagnoses of Grieving and Complicated Grieving. Recall that grief can be experienced due to many types of loss, in addition to death. For example, when patients receive a diagnosis of breast cancer, they may demonstrate signs of various stages of grief, such as denial, anger, bargaining, depression, and acceptance. When undergoing mastectomy and chemotherapy, the patient may grieve over the loss of prior body image. Communities can also experience grief. For example, when a town experiences a significant tragedy, such as a devastating flood or a tornado, there can be widespread community grief as families grieve the loss of life, property, or a previous way of life. In these situations, nurses are cognizant of the multiple factors that may impact an individual’s health and grieving process. Identifying these factors can help ensure that appropriate resources are mobilized to facilitate coping and progression through the grief process. AssessmentGrief assessment includes the patient, family members, and significant others. It begins when a patient is diagnosed with an acute, chronic, or terminal illness and/or when the patient is admitted to a hospital, nursing facility, or assisted living facility. It continues throughout the course of a terminal illness for the patient, family members, and significant others and then continues through the bereavement period for the survivors. During the bereavement period, the nurse monitors for symptoms of complicated grief.[1] Grief can be manifested by physical, emotional, and cognitive symptoms. Physical symptoms can occur, such as feeling ill, headaches, tremors, muscle aches, exhaustion, insomnia, loss of appetite, or weight loss or gain. Cognitive symptoms may occur, such as lack of concentration, confusion, and hallucinations. Emotional symptoms, such as anxiety, guilt, anger, fear, sadness, helplessness, or feelings of relief may occur. These symptoms of grief and loss can be manifested in many different ways and can vary from day to day. Manifestations of grief are unique to the individual and may be influenced by one’s age, culture, resources, and previous experiences with loss. Additionally, as patients cope with grief and loss, it is important for the nurse to recognize that support is often needed by their family members.[2] Any behavior that may endanger the patient or family should be reported to the health care provider, such as symptoms of depression, suicidal ideation, or symptoms lasting greater than six months. DiagnosesConsult a nursing care planning resource when selecting nursing diagnoses for patients and their family members experiencing grief. See Table 17.3 for definitions and selected defining characteristics of the NANDA-I diagnoses Grieving and Complicated Grieving while also keeping in mind the previous discussion in this chapter regarding stages and tasks of normal grief. Table 17.3 NANDA-I Nursing Diagnoses Related to Grieving[3]
ExamplesSee the following for examples of PES statements related to Grieving and Complicated Grieving:
Outcome IdentificationGoal setting and outcome identification for patients and family members experiencing grief are customized to the specific situation and focus on grief resolution. Grief resolution is evidenced by the following indicators:
For the nursing diagnosis of Grieving and Complicated Grieving, a sample goal is, “The patient will experience grief resolution.” A sample SMART outcome is, “The patient will discuss the meaning of the loss to their life in the next 2 weeks.”[5] Planning and Implementing InterventionsNurses are in the ideal position to assist patients with identifying and expressing their feelings related to loss. The most important intervention that nurses can provide is active listening and offering a supportive presence. Actively listening to the bereaved helps them express their feelings and relate the emotions and feelings related to the loss. Interventions to facilitate grief resolution focus on coping enhancement, anticipatory grieving interventions, and grief work facilitation. Coping EnhancementInterventions to enhance coping can be implemented for patients and families experiencing any type of actual, anticipated, or perceived loss. Sample interventions include the following:[6]
See Figure 17.18[7] for an image of a nurse enhancing a patient’s ability to cope with their illness through active listening and touch. Anticipatory Grieving InterventionsAnticipatory grieving refers to a grief reaction that occurs in anticipation of an impending loss. Recall that anticipatory grieving can be related to impending death of oneself or a loved one, but it can also occur in anticipation of other losses, such as the loss of a body part due to scheduled surgery or the loss of one’s home due to a move to a long-term care facility. Interventions to facilitate resolution of anticipatory grieving include the following:[8]
Grief Work FacilitationGrief work facilitation assists patients and family members in resolution of a significant loss. Sample interventions include the following:[9]
Community ResourcesBereavement follow-up with families is a component of hospice programs and includes formal activities and events to promote closure and acceptance. Many hospices have nondenominational memorial services to honor patients. Family members and staff are invited to participate, which can be effective at helping individuals find closure. Other formal types of support can include organized support groups to facilitate discussion and coping. Individual, group counseling, or psychotherapy are other methods that can assist the bereaved in coping with their loss. See additional resources for family members in the following box. Patients and family members experiencing depression or anxiety related to the grieving process may be prescribed antianxiety medications or antidepressants. See the “Central Nervous System” chapter in Open RN Nursing Pharmacology for additional information about these medications. EvaluationIt is always important to evaluate the effectiveness of interventions implemented. Nurses assess the effectiveness of interventions in helping individuals cope and work through the grief process based on the customized outcome criteria established for their situation. What are the five concepts of Swanson's caring theory that describe key elements in the nurse client relationship?Swanson's (1991) middle range theory of caring has traditionally been used to define the care of patients and family members. Swanson's caring theory outlines five caring processes: knowing, being with, doing for, enabling, and maintaining belief (p. 163).
What do you say to fetal demise?When you're talking to parents:. Be simple: “I'm sorry for your loss.”. Be honest: “I don't know what to say. I can't imagine what you're going through.”. Be comforting: “I care about you and your family. Please tell me what I can do to help.”. What options for saying goodbye would the nurse want to discuss with a woman who is diagnosed with having a stillborn girl?Which options for saying "good-bye" would the nurse want to discuss with a woman who is diagnosed with having a stillborn girl? a. The nurse should not discuss any options at this time; plenty of time will be available after the baby is born.
What is disenfranchised loss?Disenfranchised grief is when your grieving doesn't fit in with your larger society's attitude about dealing with death and loss. The lack of support you get during your grieving process can prolong emotional pain.
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