Nursing diagnosis: death anxiety related to anticipated loss of physiological well-being, change in body function perceived death of client
Possibly evidenced by
Changes in eating habits, sleep pattern, activity level, libido, and communication pattern
Denial of potential loss, choked feelings, anger
Fear of the process of dying, loss of physical and/or mental abilities
Negative death images or unpleasant thoughts about any event related to death or dying, anticipated pain related to dying
Powerlessness over issues related to dying, total loss of control over any aspect of one’s own death, inability to problem-solve
Worrying about impact of one’s own death on SO(s), being the cause of others’ grief and suffering, concerns of overworking
the caregiver as terminal illness incapacitates
Desired Outcomes/Evaluation Criteria—Client Will
Identify and express feelings appropriately.
Continue normal life activities, looking toward and planning for the future, one day at a time.
Verbalize understanding of the dying process and feelings of being supported in grief work.
Dignified Life Closure
Experience personal empowerment in spiritual strength and resources to find meaning and purpose in grief and loss.
Verbalize understanding of the stages of grief and loss.
Ventilate conflicts and feelings related to illness and death.
Nursing intervention with rationale:
1. Facilitate development of a trusting relationship with client and family.
Rationale: Trust is necessary before client and family can feel free to open personal lines of communication with the hospice team and address sensitive issues.
2. Assess client and SO for stage of grief currently being experienced. Explain process, as appropriate.
Rationale: Knowledge about the grieving process reinforces the normalcy of feelings and reactions being experienced and can help client deal more effectively with them.
3. Provide open, nonjudgmental environment. Use therapeutic communication skills of active-listening, acknowledgment, and so on.
Rationale: Promotes and encourages realistic dialogue about feelings and concerns.
4. Encourage verbalization of thoughts and concerns. Accept expressions of sadness, anger, and rejection. Acknowledge normalcy of these feelings.
Rationale: Client may feel supported in expression of feelings by the understanding that deep and often conflicting emotions are normal and experienced by others in this difficult situation (Otis-Green, 2008b).
5. Be aware of mood swings, hostility, and other acting-out behavior. Set limits on inappropriate behavior and redirect negative thinking.
Rationale: Indicators of ineffective coping and need for additional interventions. Preventing destructive actions enables client to maintain control and sense of self-esteem.
6. Monitor for signs of debilitating depression such as statements of hopelessness, desire to “end it now.” Ask client direct questions about state of mind.
Rationale: Client may be especially vulnerable when recently diagnosed with end-stage disease process and/or when discharged from hospital. Fear of loss of control or concerns about managing pain effectively may cause client to consider suicide.
7. Reinforce teaching regarding disease process and provide information as requested and appropriate about dying. Be honest; do not give false hope while providing emotional support.
Rationale: Client and SO benefit from factual information. Individuals may ask direct questions about death, and honest answers promote trust and provide reassurance that correct information will be given.
8. Review past life experiences, role changes, sexuality concerns, and coping skills. Promote an environment conducive to talking about things that interest client.
Rationale: This is an opportunity to identify skills that may help individuals cope with grief of current situation more effectively. Note: Issues of sexuality remain important at this stage, such as feelings of masculinity or femininity, giving up caretaker or provider role within family, and ability to maintain sexual activity or closeness, if desired.
9. Provide open environment for discussion with client and SO, when appropriate, about desires and plans pertaining to death including making a will, burial arrangements, tissue donation, death benefits, insurance, time for family gatherings, and how to spend remaining time.
Rationale: If client and SO are mutually aware of impending death, they may more easily deal with unfinished business or desired activities. Having a part in problem-solving and planning can provide a sense of control over anticipated events.
10. Refer to appropriate counselor, as needed, such as psychiatric clinical nurse specialist, social worker, psychologist, and pastoral support.
Rationale: Compassion and support can help alleviate distress or palliate feelings of grief to facilitate coping and foster growth.