skills. The nurse must be careful to observe the
client’sbehavior throughout the grief process and
never assume that a client is at a particular phase.
The nurse must use effective communication skills to
assess how the client’s behavior reflects coping as
well as emotions and thoughts.
The nurse has heard in report that Ms. Morrison
received the news of her upcoming mastectomy. She
enters Ms. Morrison’s room and sees her crying with
a full tray of food untouched.
Nurse: “You must be quite upset about the news
you received from the doctor today.”(making an
observation, assuming client was crying as an
expected behavior of loss and grief)
Client: “I’m not having surgery. You have me
mistaken for someone else.”(using denial to cope)
The nurse also must consider several other ques-
tions when assessing the client’s coping. How has the
person dealt with loss previously? How is the person
currently impaired? How does the current experience
compare with previous experiences? What does the
client perceive as a problem? Is it related to unreal-
istic ideas about what he or she should feel or do?
(McBride, 2001).
The interaction of the dimensions of human re-
sponse is fluid and dynamic. What a person thinks
about during grieving affects his or her feelings, and
those feelings influence his or her behavior. The crit-
icalfactors of perception, support, and coping are
interrelated as well and provide a framework for
assessing and assisting the client.
Data Analysis and Planning
The nurse must base nursing diagnoses for the per-
son experiencing loss on subjective and objective as-
sessment data. Nursing diagnoses used for clients
experiencing grief include the following:- Grievingrelated to actual or perceived loss
such as a physiologic loss (e.g., loss of a limb).
Loss of security and sense of belonging
(e.g.,loss of a loved one) is defined as a nor-
mal process in the human experience of loss. - Anticipatory Grieving(NANDA), related
to the intellectual and emotional responses
and behaviors by which individuals, families,
and communities work through the process
of modifying self-concept based on the per-
ception of potential loss. - Dysfunctional Grieving(NANDA diagno-
sis for complicated grieving) related to the ex-
tended, unsuccessful use of intellectual and
emotional responses by which individuals,
families, and communities attempt to work
through the process of modifying self-concept
based upon the perception of loss.
Outcome Identification
Examples of outcomes for the three nursing diagnoses
are as follows:- Grieving: The client will
- Identify the effects of his or her loss.
- Seek adequate support.
- Apply effective coping strategies while ex-
pressing and assimilating all dimensions
of human response to loss in his or her life.
- Anticipatory Grieving: The client will
- Identify the meaning of the expected loss
in his or her life. - Seek adequate support while expressing
grief. - Develop a plan for coping with the loss as
it becomes a reality.
- Identify the meaning of the expected loss
- Dysfunctional Grieving: The client will
- Identify the meaning of his or her loss.
- Recognize the negative effects of the loss
on his or her life. - Seek or accept professional assistance to
promote the grieving process.
Interventions
The nurse’s guidance helps the client examine and
make changes. Changes imply movement as the client
progresses through the grief process. Sometimes
the client takes one painful step at a time. Some-
times he or she may seem to go over the same ground
repeatedly.INTERVENTIONS REGARDING THE
PERCEPTION OF LOSS
Cognitive responses are connected significantly with
the intense emotional turmoil that accompanies griev-
ing. For example in the vignette, Margaret’s disillu-
sionment with those friends unavailable after her hus-
band’s death added great pain to her loss. She had
counted on them to be there as she dealt with James’
death. A cognitive shift occurred when she realized
they would not be there, meaning she was alone and
they no longer cared. She felt abandoned. She then
had two immediate losses: James’ death and realizing
that people she had counted on were unavailable.
Exploring the client’s perception and meaning of
the loss is a first step that can help alleviate the pain
of what some would call the initial emotional over-
load in grieving. Using the example of Margaret, the
nurse could ask what being alone means to her and
explore the possibility of others being supportive.
Further exploration could focus on her perception
that those who had abandoned her no longer cared.
Perhaps Margaret would then discover that others
could meet her need to be cared for. She may begin to
think that it was fear or discomfort about death that12 GRIEF ANDLOSS 253