Maladaptive grieving

Domain 9. Coping-stress tolerance
Class 2. Coping responses
Diagnostic Code: 00301
Nanda label: Maladaptive grieving
Diagnostic focus: Grieving

Nursing Diagnosis: Maladaptive Grieving

Introduction
Nursing diagnosis is a nursing process which focuses on individual or group's responses to actual or potential health problems and life processes. It provides a basis for the development of appropriate interventions aimed at promoting clients' health and well-being. Any nurse can develop a nursing diagnosis from the clients' perspectives, assessment and data. Nursing diagnoses are classified into Risk, Actual, and Health Promotion/Well-Being diagnoses. Maladaptive grieving is an example of an Actual nursing diagnosis.

NANDA Nursing Diagnosis Definition

Maladaptive grieving is defined as “ineffective family coping related to difference in individual expectations of grieving resulting in prolonged mourning of the loss and difficulty adjusting to the situation.” The nursing diagnosis is based on a nursing assessment that identifies impaired family coping, grief reaction that is maladaptive but it must be well documented.

Defining Characteristics

Subjective symptoms of maladaptive grieving include:

• Excessive crying
• Anger
• Depression
• Hopelessness
• Anxiety
• Social isolation
• Preoccupation with the lost person
• Aversion to conversation about the deceased
• Poor decision making

Objective symptoms of maladaptive grieving include:

• Lack of interest in activities
• Inability to concentrate
• Weight change
• Increased need for sleep
• Reduced self-care
• Changes in behavior
• Neglecting responsibilities
• Heightened risk taking behavior

Related Factors

1. Prolonged suffering or death of the lost person. Long-term pain and suffering that the loved one experienced can lead to increased distress and difficulty in accepting their passing.
2. Unresolved issues regarding the lost person. If the relationship between the person and the deceased was strained, unresolved issues can make it very difficult to let go of the lost person and move forward.
3. Unrealistic expectations of the grieving process. Different people grieve differently and some could feel frustrated at not being able to cope as quickly as they want.

At Risk Population

Individuals who are at risk of maladaptive grieving include those who had a close, dependent relationship with the deceased. This includes children, spouses and other relatives of the deceased, as well as friends and colleagues. Moreover, individuals who have experienced significant losses in their lives in the past may be at greater risk due to the compounded effect of multiple losses.

Associated Conditions

Maladaptive grieving is often associated with several conditions such as depression or anxiety. Additionally, maladaptative grieving can lead to difficulty carrying out daily activities, substance abuse, and difficulty sleeping or eating. Therefore, it is important to recognize the signs and symptoms of maladaptive grieving to prevent further complications.

Suggestions for Use

Nurses can facilitate the grieving process by assessing the individual's level of pain and stress and understanding their expectations of the forthcoming events. Nurses should also assess the patient's physical and mental health to identify any underlying issues. Moreover, nurses should provide adequate support to the patient by offering reassurance and chances for expression.

Suggested Alternative NANDA Nursing Diagnoses

Alternative NANDA nursing diagnoses include:

• Ineffective Coping
• Risk for ineffective grief response
• Risk for dysfunctional grief response
• Ineffective Therapeutic Regimen Management
• Social Isolation
• Ineffective Denial
• Complicated Grief
• Unresolved Grief

Usage Tips

A nursing diagnosis should be developed with input from the patient and could be altered based on the specific needs of the patient. It is important to note that the diagnosis should take into consideration the patient’s readiness to change, abilities and values prior to the development of interventions.

NOC Outcomes

Nursing outcomes classification (NOC) outcomes associated with Maladaptive Grieving include:

• Coping
• Grief Resolution
• Hope
• Self-Esteem
• Social Interaction
• Spiritual Support

The NOC outcomes aim to achieve the end goal of reducing distress and improving the patient’s mental health and wellbeing.

Evaluation Objectives, Criteria and Data Sources

Evaluation objectives, criteria and data sources for this diagnosis include:

• Evaluation Objective: To identify the patient's adjustment to the loss.
  • Criteria: Patient expresses positive outlook of future
  • Data Source: Observations, patient responses
• Evaluation Objective: To reduce the patient's distress level
  • Criteria: Patient identifies healthy coping strategies
  • Data Source: Patient responses, observations, clinical tests

NIC Interventions

Intervention classification (NIC) interventions associated Maladaptive Grieving include:

• Grief Therapy
• Grief Support Group
• Relaxation Training
• Mental Imagery
• Therapeutic Presence
• Facilitate Self-Healing
• Biofeedback Training
• Teach Stress Reduction Techniques

Each of these interventions has the ultimate aim of providing psychological and medical therapy that can help the patient to cope with the changing environment and the challenges encountered.

Nursing Activities

Nursing activities associated with Maladaptive Grieving includes:

• Provide psychosocial support to patient by listening to patient's concerns, expressing empathy and giving feedback.
• Assess and document the patient’s mood and coping strategies to determine the effectiveness of interventions.
• Explain to the patient and family the difference between normal grief and behavior indicating maladaptive grieving.
• Discuss approaches to manage grief and encourage the patient to pursue them.
• Provide referrals to therapists and/or support groups when appropriate.
• Encourage patient to set realistic goals and focus on achievements rather than failures.

Nurses should ensure that interventions are implemented in a manner that best fits the client's culture and beliefs while respecting their autonomy and needs.

Conclusion

Maladaptive grieving is a common nursing diagnosis that can be identified and addressed by nursing staff. Its defining characteristics can vary greatly amongst individuals, so making sure to assess the patient's individual needs and expectations before implementation of interventions is key. Nurses can provide guidance and support throughout the healing process that can help restore the patient's mental health and wellbeing.

FAQs

Q1. What is maladaptive grieving?
A1. Maladaptive grieving is an Actual Nursing diagnosis defined as “ineffective family coping related to difference in individual expectations of grieving resulting in prolonged mourning of the loss and difficulty adjusting to the situation.”

Q2. Who is at risk for maladaptive grieving?
A2. Individuals who are at risk of maladaptive grieving include those who had a close, dependent relationship with the deceased, including children, spouses and other relatives, as well as friends and colleagues. Those who have experienced significant losses in the past may also be at a greater risk.

Q3. What are some possible interventions for maladaptive grieving?
A3. Possible interventions include grief therapy, a grief support group, relaxation training, mental imagery, therapeutic presence, biofeedback training, and teaching the patient stress reduction techniques. Nurses can also provide psychosocial support by listening to the patient's concerns and expressing empathy.

Q4. How can nurses evaluate the progress of patients?
A4. Nurses can evaluate the progress of patients by assessing the patient's mood and coping strategies. Additionally, assessing the patient’s physical and mental health to identify any underlying issues is another way to measure progress.

Q5. What are some associated conditions of maladaptive grieving?
A5. Maladaptive grieving is often associated with conditions such as depression or anxiety. Additionally, it can lead to difficulty carrying out day-to-day activities, substance abuse, and difficulty sleeping or eating.