Susceptible to 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
• Behavioral status, understanding of health problem and treatment plan, past history with health care providers, participation in health care planning and decision-making; recognition and realization of potential growth, health, and autonomy

• Patient will express appropriate feelings of loss, guilt, fear, anger, or sadness.
• Patient will identify loss and describe meaning of loss.
• Patient will appropriately move through stages of grieving.
• Patient will maintain healthy patterns of sleep, activity, and eating.
• Patient will list personal strengths.
• 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

• Identify areas of hope in patient's life to help decrease anger and feelings of frustration.
• Identify previous losses and assess for depression to establish a baseline.
• Perform interventions to promote sleep such as giving snacks, pillows, backrubs, or showers to enhance rest.
• Teach patient relaxation techniques such as guided imagery, meditation, or progressive muscle relaxation to promote feelings of comfort.
• Encourage patient to express grief and feelings of anger, guilt, and sadness. Inability to express these feelings may result in maladaptive behaviors.
• Encourage patient to express feelings in a way the patient is most comfortable with, for example, crying, talking, writing, and/or drawing. Dysfunctional grieving may result from an inability to express feelings freely.
• Encourage patient to keep a journal to express feelings of grief and loss. The act of writing about feelings may aid in the grieving process. Help patient form goals for the future to place the loss in perspective and to move on to new situations and relationships.
• Refer patient to community support systems to assist with grieving process. Contact patient's preferred spiritual leader if patient desires. This may provide relief from spiritual distress.

Suggested NIC Interventions

• Patient expresses feelings of loss and grief.
• Patient describes the impact of the loss.
• Patient articulates movement through stages of grief.
• Patient's personal strengths are sufficient for normal functioning.
• Patient uses healthy coping strategies and social support systems.
• Patient states plan for future and uses spiritual practices satisfactorily.

• Patient's expressions of grief and loss
• Observations of physiologic and behavioral manifestations of grief
• Interventions performed to allay sleeping problems
• Patient's use of journal
• Patient's response to interventions
• Evaluations for expected outcomes

• McSpedden, M., Mullan, B., Sharpe, L., Breen, L. J., & Lobb, E. A. (2017). The presence and predictors of complicated grief symptoms in perinatally bereaved mothers from a bereavement support organization. Death Studies, 41(2), 112-117. doi:10.1080/07481187.2016.1210696
• Perng, A., & Renz, S. (2018). Identifying and treating complicated grief in older adults. Journal for Nurse Practitioners, 14(4), 289-295. doi:10.1016/j.nurpra.2017.12.001
• Thimm, J. C., & Holland, J. M. (2017). Early maladaptive schemas, meaning making, and complicated grief symptoms after bereavement. International Journal of Stress Management, 24(4), 347-367. doi:10.1037/str0000042
• Tofthagen, C. S., Kip, K., Witt, A., & McMillan, S. C. (2017). Complicated grief: Risk factors, interventions, and resources for oncology nurses. Clinical Journal of Oncology Nursing, 21(3), 331-337. doi:10.1188/17.CJON.331-337