Nursing diagnosis: Grieving related to anticipated loss of physiological well-being—loss of body part, change in body function; change in lifestyle; perceived potential death of client
Possibly evidenced by
Changes in eating habits, sleep patterns, activity level, libido, and communication patterns
Denial of potential loss, choked feelings, anger
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 reality and acceptance of situation.
Nursing intervention with rationale:
1. Expect initial shock and disbelief following diagnosis of cancer and/or traumatizing procedures such as disfiguring surgery, colostomy, and amputation.
Rationale: Few clients are fully prepared for the reality of the changes that can occur.
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, helping 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, accepting 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.
5. Be aware of mood swings, evidence of conflict, expressions of anger or hostility, and other acting-out behavior. Set limits on inappropriate behavior and redirect negative thinking.
Rationale: May be client’s way of expressing or dealing with feelings of despair and spiritual distress reflecting ineffective coping and need for additional interventions. Preventing destructive actions enables client to maintain control and sense of self-esteem.
6. Note signs of debilitating depression. Ask client direct questions about state of mind. Listen for statements of despair, guilt, and hopelessness, such as “There’s nothing to live for.”
Rationale: Studies show that many cancer clients are at higher risk for suicide (Miller et al, 2008; Misono et al, 2008). They are especially vulnerable when recently diagnosed and/or discharged from hospital.
7. Reinforce teaching regarding disease process and treatments. Be honest; do not give false hope while providing emotional support.
Rationale: Client and SO benefit from factual information. Honest answers promote trust and provide reassurance that correct information will be given.
8. Review past life experiences, role changes, and coping skills.
Rationale: Opportunity to identify skills that may help individuals cope with grief of current situation more effectively.
9. Refer to appropriate counselor as needed, such as psychiatric clinical nurse specialist, social worker, hospice counselor, psychologist, and clergy.
Rationale: Can help alleviate distress or palliate feelings of grief to facilitate coping and foster growth.
10. Refer to visiting nurse, home health agency as needed, or hospice program, if appropriate.
Rationale: Provides support in meeting physical and emotional needs of client and SO, and can supplement the care family and friends are able to give.