Nursing Care Plan (NCP) for NANDA Nursing Diagnosis Grieving
Nursing Care Plan (NCP) for NANDA Nursing Diagnosis Grieving

The NANDA nursing diagnosis Grieving is defined as a normal complex process that includes emotional, physical, spiritual, social, and intellectual responses and behaviors by which individuals, families, and communities incorporate an actual, anticipated, or perceived loss into their daily lives.

Grieving is an individual’s normal response to a loss. People experience grief as the effect of an intrapersonal loss of self and one’s bodily image such as a loss of a body part, and extrapersonal losses like the loss of a loved one including a child or a spouse, the loss of a personal friendship as the result of a dispute, or the loss of one’s life savings. Grief can also occur when a person learns of a terminal diagnosis, illness or disability, divorce, loss of employment, or loss of home or personal possessions.

All losses impact a person’s life, but how an individual or a family handle and response to such a situation varies widely depending on age, gender, culture, or strengths. Nurses encounter such condition from a day-to-day basis as patients experience suffering, despair, sleep impairments, pain, distress, anger, detachment, guilt, and even personal growth. These issues befall not just inside the hospital setting but in hospice and palliative care services provided in the community.

With appropriate knowledge about grief, loss, and the grieving process, nurses and healthcare providers can meet the needs of patients who are affected with normal grief and unresolved complicated grief.

Related Factors

Here are some factors that may be related to the nursing diagnosis Grieving:

  • Anticipatory loss of a significant other
  • Anticipatory loss of an important thing (e.g., home, possession, status, or job)
  • Loss of a loved one
  • Loss of something important (e.g., home, possession, status, or job)
  • Loss of a body part/s or processes of the body

Defining Characteristics

Grieving is characterized by the following signs and symptoms:

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  • Anger
  • Changes in activity level
  • Changes in neuroendocrine function
  • Changes in immune function
  • Depression
  • Detachment
  • Disorganization
  • Emotional distress
  • Giving meaning of the loss
  • Psychological distress
  • Sleep disturbance
  • Suffering

Goals and Outcomes of Grieving

The following are the common goals and expected outcomes for Grieving nursing diagnosis:

  • Patient of family verbalizes feelings and establishes and maintains functional support systems.

Nursing Assessment for Grieving

Assessment is necessary in order to identify potential problems that may have lead to grief and also name any event that may happen during nursing care. The following are the assessment cues for Grieving nursing diagnosis:

AssessmentRationale
Distinguish behaviors indicative of the grieving process.Crying, loud vocalizations or wide movements of the hands or body are behavioral indications of grief. These manifestations are greatly influenced by factors such as age, gender, and culture.
Mourning, Grief, and Bereavement
  • Mourning
This is an external expression of grief. It includes rituals that signify someone’s death, such as funerals, wakes or memorial services. Mourning is greatly influenced by a person’s religious, spiritual and cultural beliefs and practices.
  • Grief
This is a common reaction to the loss of a significant or loved one. It can further be a response to the loss of relationships, physical ability, opportunities or future hopes and dreams.
  • Bereavement
This is the state of having suffered the loss of a significant or loved one. It is the period after a loss during which grief is experienced and mourning occurs.
Assess the phase of grieving being experienced by the patient and significant others.The patient may need several months to adapt to the loss and go back to normal daily functioning. Patients and their families revisit the phases of the grief repeatedly.
The Five Stages of Grief by Elizabeth Kübler-Ross
  • Denial
Denial is the first of the five stages of grief. When a person first hears or discovers a loss, it’s typical to think, “This isn’t happening.” The person may feel upset or senseless. This is a temporary way to deal with the rush of overwhelming emotion. It’s a defense mechanism.
  • Anger
Anger is a necessary stage of the healing process. As reality sets in, the person is faced with the pain of the loss. He or she may feel frustrated and weak. These emotions later turn into anger. The person might point it toward other people, a higher power, or life in common. To be angry with a loved one who died and left is natural, also.
  • Bargaining
Before a loss, it seems like the person will do anything if only his or her loved one would be saved. During this stage, he or she dwells on what could’ve done to counteract the loss. General thoughts are “If only…” and “What if…” The person may also try to strike a bargain or compromise with a higher power.
  • Depression
Next to bargaining, the attention moves considerately into the present. Sadness sets in as the person begin to understand the loss and its effect in life. Indications of depression include crying, sleep issues, and a decreased appetite. He or she may feel defeated, frustrated, and empty.
  • Acceptance
Acceptance is frequently confused with the perception of being “all right” or “okay” with what has occurred. In this final stage of grief, the person accepts the reality of the loss. It can’t be reversed. Although he or she still feels sad, he or she is ready to start moving on in life.
Evaluate whether the patient and significant others vary in their stages of grieving.Conflicts and differences among patient and family members may transpire in the process of grieving. Some may become impatient if others do not reconcile their feelings as quickly as they do. Older adults may take longer to reintegrate the loss and reconcile their grief.
Determine the potential for a complicated grieving response.Grieving becomes more complicated in situations like multiple losses, lack of social support, unresolved family relationships and issues, or losses as a result of violence and injustice.
Assess the patient’s ability to make decisions.Grief may limit a person’s cognitive ability that is needed in decision-making and problem-solving.
Know the availability of support systems for the patient.If the patient’s main support is the object of perceived loss, the patient may need help in naming other sources of support.
Support sharing of common problems with others.There are people with the same experience that may be helpful in dealing with grief.
Evaluate the need for referral to social services, legal consultants, or support groups.It is necessary to engage with support systems as early as possible to analyze and estimate the possible financial considerations and other special needs before the anticipated loss occurs.

Nursing Interventions for Grieving

The following are the therapeutic nursing interventions for Grieving which you can use for your Nursing Care Plan (NCP):

Nursing InterventionsRationale
Anticipate increased or exaggerated affective behavior.During this time, all affective behavior may seem increased or exaggerated. Older adults may be preoccupied with thoughts of impending death and uncertainty. Displaced anger and resentment may transpire when the loss does not occur as anticipated by those grieving. Regression may transpire during this time.
Communicate therapeutically with patient and family members and allow them to verbalize feelings.Sharing feelings with a healthcare provider may help the patient find significance in the experience of loss.
Support patient and significant others share mutual fears, concerns, plans, and hopes for each other.Keeping secrets won’t do any help during this time. These time of stress can be used as an opportunity for growth and family development.
Review and point out strengths and progress to date.Reviewing patient’s progress is very helpful and provides perspective in the whole process.
Encourage significant others to manage their own self-care needs for rest, sleep, nutrition, leisure activities, and time away from the patient.Alteration in normal activities is evident during this time of stress. Care should be taken to treat these symptoms so that emotional reconstitution is not complicated by illness.
Initiate a process that provides additional support and resources.The patient and family may benefit from spiritual support resources.
Strengthen the patient’s efforts to go on with his or her life and normal routine.Allow the patient and family to feel that they are enabled to do this by supporting them.
Consider the patient’s or family’s denial about the loss for it is part of the grieving process.The nurse needs to recognize and understand these events as a time during which an individual or family member incorporates his or her strength to go on to the next stage of grief.
Acknowledge the patient’s need to review the loss experience.In this way, the patient and family members integrate the event into their experience.
Refer the patient and family to community resources.Support in the grieving process will come in many forms. Having the same experience from community groups is helpful in allowing the family to go through such a painful event and going on with life.

References

Additional references and further reading about Grieving nursing diagnosis:

  • Farrell, M. (1989). Dying and bereavement: the role of the critical care nurse. Intensive and Critical Care Nursing5(1), 39-45. [Link]
  • White, P., & Ferszt, G. (2009). Exploration of nurse practitioner practice with clients who are grieving. Journal of the American Academy of Nurse Practitioners21(4), 231-240. [Link]
Nursing Care Plan (NCP) for NANDA Nursing Diagnosis Grieving
Nursing Care Plan (NCP) for NANDA Nursing Diagnosis Grieving
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