related to:
  1. changes in body image and usual roles and lifestyle;
  2. diagnosis of cancer with potential for premature death.

*This diagnostic label includes anticipatory grieving and grieving following the actual losses.

Desired Outcome
The client will demonstrate beginning progression through the grieving process as evidenced by:
  1. verbalization of feelings about the diagnosis of cancer and chemotherapy
  2. usual sleep pattern
  3. participation in the treatment plan and self-care activities
  4. use of available support systems
  5. verbalization of a plan for integrating prescribed follow-up care into lifestyle.
Nursing Actions and Selected Purposes/Rationales
  1. Assess for signs and symptoms of grieving (e.g. expression of distress about having cancer, change in eating habits, inability to concentrate, insomnia, anger, sadness, withdrawal from significant others, denial of losses).
  2. Implement measures to facilitate the grieving process:
    1. assist client to acknowledge the losses so grief work can begin; assess for factors that may hinder and facilitate acknowledgment
    2. discuss the grieving process and assist client to accept the phases of grieving as an expected response to actual and/or anticipated losses
    3. allow time for client to progress through the phases of grieving (phases vary among theorists but progress from shock and alarm to acceptance); be aware that not every phase is expressed by all individuals, phases may overlap or recur, the amount of time needed to reach resolution of grief is very individual, and the grieving process may take months to years
    4. provide an atmosphere of care and concern (e.g. provide privacy, be available and nonjudgmental, display empathy and respect) so client will feel free to express feelings
    5. perform actions to promote trust (e.g. answer questions honestly, provide requested information)
    6. encourage the verbal expression of anger and sadness about the diagnosis and losses; recognize displacement of anger and assist client to see the actual cause of angry feelings and resentment
    7. encourage client to express feelings in whatever ways are comfortable (e.g. writing, drawing, conversation)
    8. assist client to identify and use techniques that have helped him/her cope in previous situations of loss
    9. support realistic hope about the prognosis and the temporary nature of most of the physical changes
    10. if acceptable to client, arrange for a visit with a person who has been successfully treated for cancer with cytotoxic drugs
    11. support behaviors suggesting successful grief work (e.g. verbalizing feelings about the diagnosis and losses, focusing on ways to adapt to losses)
    12. explain the phases of the grieving process to significant others; encourage their support and understanding
    13. facilitate communication between the client and significant others; be aware that they may be in different phases of the grieving process
    14. provide information regarding counseling services and support groups that might assist client in working through grief
    15. when appropriate, assist client to meet spiritual needs (e.g. arrange for visit from clergy)
    16. administer antidepressant agents if ordered
    17. assist client to identify and use available support systems; provide information about available community resources that can assist client and significant others in coping with the effects of chemotherapy and the diagnosis of cancer (e.g. American Cancer Society; support groups; individual, family, and financial counselors).
  3. Consult appropriate health care provider (e.g. psychiatric nurse clinician, physician) if signs of dysfunctional grieving (e.g. persistent denial of diagnosis or losses, excessive anger or sadness, emotional lability) occur.