Grief and Loss: Application of the Nursing Process

APPLICATION OF THE NURSING PROCESS

Because the strong emotional attachment created in a sig-nificant relationship is not released easily, the loss of that relationship is a major crisis with momentous conse-quences. Aquilera and Messick (1982) developed a broad approach to assessment and intervention in their work on crisis intervention. The state of disequilibrium that a crisis produces causes great consternation, compelling the per-son to return to homeostasis, a state of equilibrium or bal-ance. Factors that influence the grieving person’s return to homeostasis are adequate perception of the situation, ade-quate situational support, and adequate coping. These fac-tors help the person to regain balance and return to previ-ous functioning or even to use the crisis as an opportunity to grow. Because any loss may be perceived as a personal crisis, it seems appropriate for the nurse to link under-standing of crisis theory with the nursing process.

For the nurse to support and facilitate the grief process for clients, he or she must observe and listen for cognitive, emotional, spiritual, behavioral, and physiologic cues. Although the nurse must be familiar with the phases, tasks, and dimensions of human response to loss, he or she must realize that each client’s experience is unique. Skillful communication is key to performing assessment and providing interventions.

To meet clients’ needs effectively, the nurse must exam-ine his or her own personal attitudes, maintain an atten-tive presence, and provide a psychologically safe environ-ment for deeply intimate sharing. Awareness of one’s own beliefs and attitudes is essential so that the nurse can avoid imposing them on the client. Attentive presence is being with the client and focusing intently on communicating with and understanding him or her. The nurse can main-tain attentive presence by using open body language such as standing or sitting with arms down, facing the client, and maintaining moderate eye contact, especially as the client speaks. Creating a psychologically safe environment includes ensuring the client of confidentiality, refraining from judging or giving specific advice, and allowing the client to share thoughts and feelings freely.