Greiving

Greiving

(_)Actual (_) Potential

Related To:
[Check those that apply]
(_) Loss of function of body part:__________________________________
(_) Loss of s/o:________________________________________________
(_) Loss of independence/change in lifestyle.
(_) Diagnosis of a terminal illness.
(_) Loss of physical abilities:_____________________________________
(_) Other:____________________________________________________
____________________________________________________________
____________________________________________________________

As evidenced by:
[Check those that apply]
Major:
(
Must be present)
(_) Unsuccessful adaptation to loss (_) Expressed distress of actual or potential loss
(_) Prolonged denial (_) Depression (_) Delayed emotional reaction
Minor:
(
May be present)
(_) Social isolation or withdrawl (_) Failure to develop new relationships/interests
(_) Failure to restructure life after a loss (_) Denial (_) Guilt (_) Anger (_) Sorrow
(_) Change in eating habits (_) Change in sleep patterns (_) Decreased libido
(_) Change in communication patterns

Date &
Sign.
Plan and Outcome
[Check those that apply]
Target
Date:
Nursing Interventions
[Check those that apply]
Date
Achieved:
The patient will:

(_) Express his/her grief.

(_) Describe the meaning of the death or loss to him/her.

(_) Share his/her grief with s/o.

(_) Participate in ADL's as tolerated.

(_) Other:

(_) Assess for causative and contributing factors that may delay the grief process:
_________________________
_________________________
_________________________

(_) Reduce or eliminate causative or contributing factors if possible.

(_) Encourage to recognize grief situation.

(_) Give opportunity for questions.

(_) Encourage expressions of anger/concerns.

(_) Describe the stages of anticipatory grieving. (Include s.o).

(_) Have patient identify support systems.

(_) Assist with unfinished business.

(_) Encourage to share prognosis with s/o.

(_) Encourage s/o to participate in care.

(_) Encourage problem solving with help of others.

(_) Encourage planned, "one day at a time" living.

(_) Allow patient opportunity to identify own self care needs:____________
________________________
________________________

(_) Help to set realistic goals - give realistic hope:________________
_________________________
_________________________

(_) Encourage patient and s/o to accept individual responses to impending loss.

(_) Refer/order consult:

  • Pastoral care
  • Social services
  • Home health care
  • Psychiatry

(_) Other:________________
________________________
________________________
________________________

__________________________
Patient/Significant other signature

__________________________
RN signature

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