17.3 Applying the Nursing Process to Grief
Open Resources for Nursing (Open RN)
Grieving a loss is a normal process that has implications for both client 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 clients 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 client 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 must be 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.
Assessment
Grief assessment includes the client, family members, and significant others. It begins when a client is diagnosed with an acute, chronic, or terminal illness and/or when the client is admitted to a hospital, nursing facility, or assisted living facility. It continues throughout the course of a terminal illness for the client, 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 clients 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 client or family should be reported to the health care provider, such as symptoms of depression, suicidal ideation, or symptoms lasting greater than six months.
Diagnoses
Consult a nursing care planning resource when selecting nursing diagnoses for clients and their family members experiencing grief. See Table 17.3 for the definition and selected defining characteristics of the NANDA-I diagnoses Maladaptiv