THE NURSING PROCESS

Assessment

Assessment of client in the grieving or mourning process includes an accurate perception of the loss from their viewpoint. You begin by identifying the loss, be it a person or a relationship or a change in health status, roles in life, or dreams and aspirations for the future. Seek to understand the nature of the attachment to the lost person, object, or expectation. Assess past experiences with loss and the impact those have on the present experience. Assess cultural rituals and rules about mourning to understand the unique experience of grieving individuals.

Diagnosis

Possible nursing diagnoses for survivors of a family member who has died include Anticipatory grieving, Dysfunctional grieving, Social isolation, Altered role performance, Risk for altered parenting, Ineffective family coping: compromised, and Family coping: potential for growth. Nursing diagnoses for children of divorce include Altered family processes, Risk for caregiver role strain, and Family coping: potential for growth. For adolescents who lack a peer group, nursing diagnoses might be Impaired social interaction and Self-esteem disturbance. Nursing diagnoses for middle adults experiencing loss might be Impaired adjustment, Self-esteem disturbance, and health-seeking behaviors. Nursing diagnoses in late adulthood include Spiritual distress, Social isolation, and Hopelessness. Nursing diagnoses for families experiencing loss through mental illness include Impaired social interaction, Social isolation, Caregiver role strain, Ineffective family coping: compromised, Family coping: potential for growth, and Ineffective community coping.

Nursing Interventions

Behavioral: Coping Assistance

Grief Work Facilitation

Assisting individuals and families to progress through the grief process is an important nursing intervention. Encourage people to express their feelings about the loss and help them identify their greatest fears concerning the loss. Help them recognize that all these feelings are a normal part of grieving. Discuss the active process of grieving as they meet new challenges in coping. Let them know that you understand grieving takes a great deal of time and energy.
As new skill are identified and implemented, support those which are most effective. If appropriate, suggest alternative ways of dealing with challenges while supporting them in following their own choices. An important aspect of grieving is establishing autonomy and direction in their own lives. (Attig, 1996; McCloskey and Bulechek, 1996)

Discuss potentially difficult times such as holiday seasons or anniversary dates. Role playing may be helpful as they anticipate these painful events. Assist survivors to identify goals that are unattainable because of the loss while encouraging realistic goal setting. Explore the ways in which social support system have changed as a result of the loss or death. Refer to appropriate self-help groups for survivors of death, families of mentally ill persons, and individuals who are psychiatrically disabled (Klebanoff and Smith, 1997)
Spiritual care includes helping grieving person to seek new meanings in both life and death. Encourage them to implement religious beliefs and rituals surrounding death. Guide them through the process of self-reflection as they think about what has happened to them. As grieving progresses, you can provide a listening ear while they recover old and discover new goals and purposes in life (Attig, 1996; McCloskey and Bulechek, 1996)

If children are involved in the grieving process, answer their questions associated with the loss. Use clear words, such as dead or died, rather than euphemisms, such as passing on or gone to sleep. Clear up any misunderstanding the children may have. Use play, art, or journal therapy to help children identify and work through their feelings. Refer to community resources designed to help children cope with the loss of a family member (McCloskey and Bulechek, 1996).
Families have specific needs as they address losses associated with having a member who is psychiatrically disabled. Assist them in redefining roles, responsibilities, and functions within the family. Teach them how to navigate the mental health system to obtain treatment and locate sources of emotional and financial support. If necessary, help them locate respite care to prevent caregiver burnout. Teach them locate respite care to cope with deficit behaviors and intrusive or acting out behaviors by their loved one. Discuss stigma and ways to respond to prejudice from individuals, from communities, and from state and federal legislative branches as health care resources are allocated. Act as an advocate in preventing family exclusion as a member of the team, all of whom work together to support the individual in living the fullest life possible.

Evaluation

Living with losses is a normal but very stressful part of life. When coping with loss through grieving or mourning, people may respond in adaptive or maladaptive ways. Some never lose their sense of despair. In the face of this overwhelming negativism, family and friends often avoid the despairing person. Others are able to move though the process and focus on positive achievement and celebrate the relationship that was or is now. Family and friends find delight in sharing this positive process.

Some nurses have difficulty dealing with loss and death since they view the essence of caring as supporting life process. To accept death as a process of life enables other nurses to support people through this final stage of growth. To be effective caregivers, nurses must be willing to talk openly about death as well as accept their own mortality. As Hoff (1989 p. 418) states: “A healthy attitude toward our own death is our powerful asset in assisting the dying through this final life passage and comforting their survivors.

References:
Barry, Patricia D. 1998. Mental Health and Mental Illness. New York, Philadelphia: Lippincott.
Clinton & Nelson. 1996. Mental Health Nursing Practice, Australia: Prentice Hall Pty Ltd.
H & CS. 1996. Mental Health Service Directory. Melbourne: Health and Community.
Hunsberg & Abderson. 1989. Psychiatric Mental Health Nursing. Philadelphia: W. B. Saunders Company.
http://helpguide.org/mental/grief_loss.htm