her first unborn child and the woman who has elected
to abort a pregnancy, this question could have simi-
lar or different answers. Nevertheless the question is
valuable for beginning to facilitate the grief process.
Other questions that assess perception as well
as encourage the client’s movement through the grief
process include the following:
- What does the client think and feel about
the loss? - How is the loss going to affect the client’s life?
- What information does the nurse need to
clarify or share with the client?
Assessing the client’s “need to know” in plain
and simple language invites the client to verbalize
perceptions that may need clarification. This is espe-
cially true for the person who is anticipating a loss
such as in a life-ending illness or the loss of a body
part. The nurse uses open-ended questions and helps
to clarify any misperceptions.
Consider the following. The doctor has just in-
formed Ms. Morrison that the lump on her breast is
cancerous and that she is scheduled for a mastectomy
in 2 days. The nurse visits the client after rounds and
finds her quietly watching television.
Nurse: “How are you?”(offering presence; giv-
ing a broad opening)
Client: “Oh, I’m fine. Really, I am.”
Nurse: “The doctor was just here. Tell me, what is
your understanding of what he said?”(using open-
ended questions for description of perception)
Client: “Well, I think he said that I will have to
have surgery on my breast.”
Nurse: “How do you feel about that news?”
(using open-ended question for what it means
to the client)
Exploring what the person believes about the
grieving process is another important assessment.
Does the client have preconceived ideas about when
or how grieving should happen? The nurse can help
the client realize that grieving is very personal and
unique: each person grieves in his or her own way.
The nurse finds Ms. Morrison hitting her pillow
and crying. This is her second postoperative day. She
has eaten little food and has refused visitors since
the surgery.
Nurse: “Ms. Morrison, I see that you are upset.
Tell me, what is happening right now?”(sharing
observation; encouraging description)
Client: “Oh, I’m so disgusted with myself. I’m
sorry you had to see me act this way. I should be snap-
ping out of this and getting on with my life.”
Nurse: “You’re pretty upset with yourself, think-
ing you should feel differently.”(using reflection)
Client: “Yes, exactly. Don’t you think so?”
Nurse: “You’ve had to deal with quite a shock these
past few days. Sounds to me like you are expecting quite
a bit of yourself. What do you think?”(using reflec-
tion; sharing perceptions; seeking validation)
Client: “I don’t know, maybe. How long is this
going to go on? I’m a wreck emotionally.”
Nurse: “You are grieving, and there is no fixed
timetable for what you are dealing with. Everyone
has a unique time and way of doing this work.”
(informing; validating experience)SUPPORT
Purposeful assessment of support systems provides
the grieving client with an awareness of those who
can meet his or her emotional and spiritual needs for
security and love. The nurse can help the client to
identify his or her support systems and reach out and
accept what they can offer.
Nurse: “Who in your life should or would really
want to know what you’ve just heard from the doctor?”
(seeking information about situational support)
Client: “Oh, I’m really alone. I’m not married
and don’t have any relatives in town.”
Nurse: “There’s no one who would care about this
news?”(voicing doubt)
Client: “Oh, maybe a friend I talk with on the
phone now and then.”COPING BEHAVIORS
The client’s behavior is likely to give the nurse the
easiest and most concrete information about coping252 Unit 3 CURRENTSOCIAL ANDEMOTIONALCONCERNS
Three major areas to explore to facilitate grieving client.