Grieving Nursing Diagnosis and Nursing Care Plan

Grieving Nursing Care Plans Diagnosis and Interventions

Grieving NCLEX Review and Nursing Care Plans

Grieving is a response of an individual to a perceived (anticipatory grieving) or actual loss. The loss may include having poor overall health or losing a body part, or may also be having a terminal illness that may cause an impending death.

Signs and Symptoms of Grieving

• feelings of sadness, emptiness, hopelessness
• Angry outbursts
• Irritability
• Withdrawn and avoids socializations
• Loss of interest in most normal activities such as hobbies
• Sleep disturbances
• Lack of energy
• Discrepancies in eating habits (either overeating or loss of appetite)
• Restlessness and anxiety
• Sluggish thinking, speaking
• Feelings of worthlessness, particularly from past failures

Stages of Grief

Understanding the stages of grief helps a nurse or any healthcare provider to establish rapport with the patient and his/her significant other, while providing a safe space, as well as physical and social support that they need.

Several theories have been made in relation to grieving, death, and dying. One of these theories is called the “Kubler-Ross Grief cycle.” Psychiatrist Elisabeth Kubler-Ross published her theory in 1969 describing the five stages of grief that patients and their family members may go through.

These stages are called “DABDA” which stands for Denial, Anger, Bargaining, Depression, and Acceptance.

1. Denial. Denial is the most common initial reaction to learning about having a long-term or grave illness, poor prognosis, or impending death. This shows the patient or significant other’s disbelief on the announcement of an unfortunate news. An example verbalization of denial is: “I feel healthy, so I think you are mistaken. I do not have cancer!” In the Denial stage, the nurse should exercise active listening skills and show empathy to the patient and significant other despite the possibility of them being argumentative.
2. Anger. This can result from fear of death and dying. The patient may say, “I hate myself!” or “I do not need your help! I am not a weakling.” The person may also be verbally or even physically aggressive due to impaired thinking and uncontrolled emotions. In the Anger stage, the nurse must be calm and not show anger towards the patient. Instead, the nurse should maintain being a patient advocate by listening to the patient but setting limits firmly. For instance, the nurse can say “I understand your anger and I am here for you, but please tone down your voice as other patients are resting and might feel uncomfortable with loud noises.”
3. Bargaining. In this stage, the patient is starting to calm down and attempt to accept his or her fate while trying to reduce the cruelty of the situation by saying that he/she will give or do anything. The patient may say, “I will go to church everyday just so God will heal me.” This is an opportunity for the nurse to advise the patient on how he/she can participate to treatment and daily care.
4. Depression. The patient may feel hopeless, helpless, fatigued, and unmotivated. He/she may say, “I don’t want visitors today. I don’t have energy to talk. Nothing is going my way.” The nurse should be supportive by saying that he/she is available to listen. The nurse should also watch out for any signs of major depression or impending suicide.
5. Acceptance. In this stage, the patient has accepted his/her fate and is willing to do activities that can improve the quality of his/her life such as comfort measures and relaxation techniques. The nurse should also encourage the patient to speak to family and friends and arrange last will of testament and other things that need to be settled.

Grieving Nursing Diagnosis

Grieving Nursing Care Plan 1

Nursing Diagnosis: Anticipatory Grieving related to anticipatory loss of body part secondary to mastectomy due to breast cancer, as evidenced by verbalization of anger about her disease, expression of fear of life after surgery, loss of appetite, and inability to sleep

Desired Outcome: The patient will be able to identify and express feelings in an appropriate manner without inflicting harm to oneself or others.

Grieving Nursing Care Plan 2

Terminal Illness

Nursing Diagnosis: Anticipatory Grieving related to perceived potential death of the patient, as evidenced by bargaining, expression of fear of death, low mood, loss of appetite, and inability to sleep

Desired Outcome: The patient will be able to identify and express feelings in an appropriate manner and continue activities of daily living as normal. He/she will also be able to verbalize understanding of the dying process and express feeling supported throughout the grieving process.

Grieving Nursing Care Plan 3

Loss of Body Part

Nursing Diagnosis: Dysfunctional Grieving related to the Depression stage of grief secondary to diabetes-related amputation of legs as evidenced by withdrawal from group gatherings or social events, anxiety, impaired perception, inability to meet basic needs and role expectations

Desired Outcome: The patient will demonstrate improved social interaction by increased participation in social events.

Grieving Nursing Care Plan 4

Death of a Family Member

Nursing Diagnosis: Dysfunctional Grieving related to losing the infant due to SIDS as evidenced by anger and crying outbursts, verbalization of being a worthless parent, increasing tension, decreased attention span, restlessness, shortness of breath, disorganized thought process, and verbalization of feeling hopeless

Desired Outcome: The patient will be able to proceed with the acceptance of losing the child.

Grieving Nursing Care Plan 5

Nursing Diagnosis: Dysfunctional Grieving related to situational crisis of metastasis of lung cancer as evidenced by anger outbursts, decreased attention span, restlessness, disorganized thought process, crying, and verbalization of feeling hopeless

Desired Outcome: The patient will be able to proceed with the acceptance of having poor prognosis of cancer.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

Anna Curran. RN-BC, BSN, PHN, CMSRN I am a Critical Care ER nurse. I have been in this field for over 30 years. I also began teaching BSN and LVN students and found that by writing additional study guides helped their knowledge base, especially when it was time to take the NCLEX examinations.