Nursing Diagnosis: Application to Clinical Practice
11th Edition

Dysfunctional Grieving
DEFINITION
Dysfunctional Grieving: State in which a person or group experiences prolonged unresolved grief and engages in detrimental activities
DEFINING CHARACTERISTICS
Major (Must Be Present, One or More)
  • Unsuccessful adaptation to loss
  • Delayed emotional reaction
  • Prolonged denial, depression
  • Inability to assume normal patterns of living
Minor (May Be Present)
  • Social isolation or withdrawal
  • Failure to restructure life after loss
  • Failure to develop new relationships/interests
RELATED FACTORS
See Grieving.
Focus Assessment Criteria
See Grieving.
Goal
The person will verbalize intent to seek professional assistance.
Indicators
  • Acknowledge the loss.
  • Acknowledge an unresolved grief process.
General Interventions
Assess for Causative and Contributing Factors
Unavailable (or lack of) support system
History of dependency on deceased
History of a difficult relationship with the lost person or object
Multiple past losses
Ineffective coping strategies
Unexpected death
Expectations to “be strong”
Promote a Trust Relationship
Implement the General Interventions under Grieving.
Support the Person and the Family’s Grief Reactions
Implement the General Interventions under Grieving.
Promote Family Cohesiveness
Implement the General Interventions under Grieving.
Slowly and carefully identify the reality of the situation (eg, “After your husband died, who helped you most?”).
Promote Grief Work with Each Response
Denial
Explain the use of denial by one family member to the other members.
Do not force client to move past denial without emotional readiness.
Isolation
Convey a feeling of acceptance by allowing grief.
Create open, honest communications to promote sharing.
Reinforce the person’s self-worth by allowing privacy.
Encourage client/family gradually to increase social activities (eg, support or church groups).
Depression
Implement the General Interventions under Grieving.
Anger
Understand that this feeling usually replaces denial.
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Explain to family that anger serves to try to control one’s environment more closely because of inability to control loss.
Encourage verbalization of the anger.
See Anxiety for additional information for anger.
Guilt/Ambivalence
Acknowledge client’s expressed self-view.
Role play to allow client to “express” to dead person what he or she wants to say or how he or she feels.
Encourage client to identify positive contributions/aspects of the relationship.
Avoid arguing and participating in the person’s system of shoulds and should nots.
Discuss the person’s preoccupation with him and attempt to move verbally beyond the present.
Fear
Focus on the present and maintain a safe and secure environment.
Help the person to explore reasons for a meaning of the behavior.
Consider alternative ways of expressing his or her feelings.
Provide Health Teaching and Referrals, as Indicated
Teach the Person and the Family Signs of Resolution
Grieving person no longer lives in past but is future oriented and establishing new goals.
Grieving person redefines relationship with the lost object/person.
Grieving person begins to resocialize; seeks new relationships, experiences.
Teach Individual/Family to Recognize Signs of Pathologic Grieving, Especially for People who are at Risk, and to Seek Professional Counseling
  • Continued searching for deceased
  • Living in past
  • Isolation
  • Prolonged depression
  • Prolonged hallucinations
  • Egocentricity
  • Denial
  • Delusions
  • Overhostility
Identify Agencies that May Be Helpful
  • Support groups
  • Psychotherapists
  • Mental health agencies
  • Grief specialists
  • Religious groups
Rationales
  • Risk of death is greater in men than in women during the first 6 months of conjugal bereavement. Changes in health behavior patterns, such as nutrition, alcohol use, smoking, and decreased physical activity levels, may contribute to this increased mortality rate (Kaprio & Koskenvuo, 1987).
  • The more dependent the person was on the deceased person, the more difficult the resolution (Varcarolis, 2002).
  • Unresolved conflicts disrupt successful grief work (Varcarolis, 2002).
  • People with few supportive relationships have more difficulty grieving (Varcarolis, 2002).