Grieving & Loss Nursing Care Plan and Management

Utilize this comprehensive guide to assist you in developing a well-rounded nursing care plan tailored specifically for individuals experiencing grief. By following the outlined steps and recommendations, you can effectively address the unique needs and challenges associated with grieving.

What is grieving?

Grieving is a unique and personal emotional and psychological reaction to a perceived or real loss. It encompasses a range of manifestations, such as physical symptoms, emotional distress, and behavioral changes. Nurses hold a vital position in assisting individuals through their grieving process by offering empathetic support, counseling, and guidance on effective coping techniques. The nursing process encompasses developing a holistic care plan that attends to the patient’s physical, emotional, and spiritual requirements during their journey of grief. Use this guide to help you create a nursing care plan and nursing interventions for grieving.

Goals and outcomes

Here are the common goals and expected outcomes for Grieving nursing diagnosis that you can use in your nursing care plan:

• The patient will express feelings of grief.
• The patient will develop coping strategies and skills to help manage own emotions and cope with the loss.
• The patient will find meaning and purpose after a significant loss.
• The patient will achieve a sense of closure and acceptance by exploring feelings, beliefs, and values related to the loss.

Nursing Assessment and Rationales

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:

1. 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.

2. Mourning, Grief, and Bereavement

• 2.1. 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.

• 2.2. 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.

• 2.3. 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.

3. 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 grief repeatedly.

The Five Stages of Grief by Elizabeth Kübler-Ross

• 3.1. 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.

• 3.2. 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.

• 3.3. 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.

• 3.4. Depression
  Next to bargaining, the attention moves considerately into the present. Sadness sets in as the person begins to understand the loss and its effect on life. Indications of depression include crying, sleep issues, and a decreased appetite. He or she may feel defeated, frustrated, and empty.

• 3.5. 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.

4. Evaluate whether the patient and significant others vary in their stages of grieving.
Conflicts and differences among patients 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 from the loss and reconcile their grief.

5. 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.

6. Assess the patient’s ability to make decisions.
Grief may limit a person’s cognitive ability which is needed in decision-making and problem-solving.

Nursing Interventions and Rationales

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

1. 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.

2. Communicate therapeutically with patients 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.

3. Support patients and significant others who share mutual fears, concerns, plans, and hopes for each other.
Keeping secrets won’t help during this time. These times of stress can be used as an opportunity for growth and family development.

4. Review and point out strengths and progress to date.
Reviewing patients’ progress is very helpful and provides perspective in the whole process.

5. 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.

6. Initiate a process that provides additional support and resources.
The patient and family may benefit from spiritual support resources.

7. 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.

8. 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.

9. Acknowledge the patient’s need to review the loss experience.
In this way, the patient and family members integrate the event into their experience.

10. 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.

11. Support sharing of common problems with others.
There are people with the same experience that may be helpful in dealing with grief.

12. 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.

13. 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.

Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.

Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues, and on electrolytes and acid-base balance.

Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions and an alphabetized listing of nursing diagnoses covering more than 400 disorders.

Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care 
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!

All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health 
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.

See also

Other recommended site resources for this nursing care plan:

• Nursing Care Plans (NCP): Ultimate Guide and Database ^{MUST READ!}
  Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
• Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
  Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.

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 Nursing, 5(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 Practitioners, 21(4), 231-240. [Link]