Responses to the death of a significant other, in which the experience of distress accompanying bereavement fails to follow sociocultural expectations

• Difficulty dealing with concurrent crises
• Excessive emotional disturbance
• Inadequate social support
• Unaddressed high attachment anxiety
• Unaddressed low attachment avoidance

• Anxiety disorders
• Depressive disorder

• History of loss
• Length of grief process
• Pattern of coping (grief delayed or avoided)
• Self-destructive behaviors
• Sleep assessment
• Nutritional assessment
• Changes in presentation of self
• Social or spiritual support
• Ability to maintain roles at occupation and within family

• Anger
• Anxiety
• Decreased life role performance
• Depressive symptoms
• Diminished intimacy levels
• Disbelief
• Distressed about the deceased person
• Excessive stress
• Experiencing symptoms the deceased experienced
• Fatigue
• Feeling of emptiness
• Feeling stunned
• Feels detached from others
• Gastrointestinal symptoms
• Grief avoidance
• Increased morbidity
• Longing for the deceased person
• Mistrust of others
• Nonacceptance of a death
• Overwhelm
• Persistent painful memories
• Preoccupation with thoughts about a deceased person
• Rumination about deceased person
• Searching for a deceased person
• Self-blame
• Shock

• Patient will express appropriate feelings of loss, guilt, fear, anger, or sadness.
• Patient will identify the loss and describe what it means to him or her.
• Patient will appropriately move through stages of grief.
• Patient will maintain healthy patterns of sleep, activity, and eating.
• Patient will verbalize understanding that grief is normal.
• Patient will use healthy coping mechanisms and social support systems.
• Patient will seek fulfillment through preferred spiritual practices.
• Patient will begin planning for future.

Suggested NOC Outcomes

• Encourage patient to express grief and feelings of anger, guilt, and sadness. Inability to express these feelings may result in maladaptive behaviors.
• Encourage journaling to express grief and loss. Writing and exploring feelings is an active process that may assist in grieving.
• Help patient identify an area of hope in life. Focusing on a life purpose may decrease anger and feelings of frustration.
• Refer patient to community support systems to help patient deal with bereavement and grief process.
• Contact patient's preferred spiritual leader if patient desires; this may provide relief from spiritual distress.
• Help patient focus realistically on changes the loss has brought about. This will assist patient in forming plans for the future and improving social relationships.
• Encourage patient and family to engage in reminiscing; this will give purpose and meaning to the loss and assist in maintenance of self-esteem.
• Help patient formulate goals for the future; this helps patient place loss in perspective and move on to new situations and relationships.
• Identify previous losses and assess for depression; in the elderly, losses frequently occur without adequate recovery time before the next loss.

Suggested NIC Interventions

• Patient expresses feelings, which may include grief, guilt, anger, or sadness.
• Patient verbalizes feelings and behaviors related to the grieving process and applies these behaviors and feelings to daily life.
• Patient appropriately moves through stages of grief.
• Patient maintains healthy patterns of sleep, activity, and eating.
• Patient communicates understanding that grieving is an appropriate response to loss and comes to terms with own grief response.
• Patient uses coping mechanisms and discusses loss with others, including support group and family.
• Patient experiences satisfaction and support from chosen religious practices.
• Patient begins planning for future.

• Patient's verbal expression of grief
• Observations of emotional responses, attempts at coping, and interactions with family and staff
• Interventions to assist coping with loss
• Patient's response to nursing interventions
• Evaluations for expected outcomes

• Fields, S. A., Johnson, W. M., Mears, J., & Johnson, W. M. (2018). How to treat complicated grief. Journal of Family Practice, 67(10), 637-640.
• Glickman, K., Shear, M. K., & Wall, M. M. (2018). Therapeutic alliance and outcome in complicated grief treatment. International Journal of Cognitive Therapy, 11(2), 222-233. doi:10.1007/s41811-018-0018-9
• Maccallum, F., & Bryant, R. A. (2019). Symptoms of prolonged grief and posttraumatic stress following loss: A latent class analysis. Australian and New Zealand Journal of Psychiatry, 53(1), 59-67. doi:10.1177/0004867418768429
• Tal, I., Mauro, C., Reynolds, C. F., III, Shear, M. K., Simon, N., Lebowitz, B., … Zisook, S. (2017). Complicated grief after suicide bereavement and other causes of death. Death Studies, 41(5), 267-275. doi:10.1080/07481187.2016.1265028