Psychiatric Mental Health Nursing by Videbeck

that the nurse can avoid imposing them on the client.
Attentive presenceis being with the client and
focusing intently on communicating with and under-
standing him or her (Skott, 2001). The nurse can
maintain attentive presence by using open body lan-
guage such as standing or sitting with arms down,
facing the client, and maintaining moderate eye con-
tact especially as the client speaks. Creating a psycho-
logically safe environment includes assuring the
client of confidentiality, refraining from judging or
giving specific advice, and allowing the client to share
thoughts and feelings freely.

Assessment

Effective assessment involves observing all dimen-

sions of human response: what the person is think-

ing (cognitive), how the person is feeling (emotional),

what the person’s values and beliefs are (spiritual),

how the person is acting (behavioral), and what is

happening in the person’s body (physiological). Effec-

tive communication skills during assessment can

lead the client toward understanding his or her ex-

perience. Thus assessment facilitates the client’s grief

process.

While observing for client responses in the di-

mensions of grieving, the nurse explores three criti-

cal components in assessment:

• Adequate perception regarding the loss


• Adequate support while grieving for the loss


• Adequate coping behaviors during the
  process

PERCEPTION OF THE LOSS

Assessment begins with exploration of the client’s

perception of the loss. What does the loss mean to the

client? For the woman who has spontaneously lost

12 GRIEF ANDLOSS 251

◗ DIMENSIONS(RESPONSES) ANDSYMPTOMS OF THEGRIEVINGCLIENT

Cognitive responses

Emotional responses

Spiritual responses

Behavioral responses

Physiologic responses

Disruption of assumptions and beliefs

Questioning and trying to make sense of the loss

Attempting to keep the lost one present

Believing in an afterlife and as though the lost one is a guide

Anger, sadness, anxiety

Resentment

Guilt

Feeling numb

Vacillating emotions

Profound sorrow, loneliness

Intense desire to restore bond with lost one or object

Depression, apathy, despair during phase of disorganization

Sense of independence and confidence as phase of reorganization evolves

Disillusioned and angry with God

Anguish of abandonment or perceived abandonment

Hopelessness; meaninglessness

Functioning “automatically”

Tearful sobbing; uncontrollable crying

Great restlessness; searching behaviors

Irritability and hostility

Seeking and avoiding places and activities shared with lost one

Keeping valuables of lost one while wanting to discard them

Possibly abusing drugs or alcohol

Possible suicidal or homicidal gestures or attempts

Seeking activity and personal reflection during phase of reorganization

Headaches, insomnia

Impaired appetite, weight loss

Lack of energy

Palpitations, indigestion

Changes in immune and endocrine systems