Case study - Grief and loss: Nursing

Nurse Jamie works as a home health nurse, and is caring for Barbara, a 75-year-old female diagnosed with type 2 diabetes. This is her first home health care visit for a wound on her left lower extremity that developed from sitting in her recliner for long periods of time. Before performing a focused assessment and a dressing change, Nurse Jamie completes an assessment that includes questions about Barbara’s home life and support system.

Nurse Jamie will go through the steps of the Clinical Judgment Measurement Model to make clinical decisions about Barbara’s care by recognizing cues and analyzing cues, prioritizing hypotheses, generating solutions, taking action, and evaluating outcomes.

First, Nurse Jamie recognizes important cues. She notes that Barbara has lived alone since her husband died a year ago; so, Nurse Jamie performs a grief assessment and discovers that Barbara’s adult children live out of state, and she has few visitors.  

Barbara shares she often dwells on missing her husband, feels sad most days, and lacks energy or motivation to do things she used to enjoy. Additionally, she reveals she is not paying attention to her blood glucose levels like she used to.

Next, Nurse Jamie analyzes these cues. She recalls that after a loss of someone or something meaningful, a period of grief is normal and can present as sadness, anger, or regret, but varies for everyone. Nurse Jamie also understands dysfunctional grief can lead to suicidal thoughts, so she gathers additional information to rule out thoughts of self-harm.

Okay, so using the information gathered from Barbara’s grief assessment and medical history, Nurse Jamie identifies a priority hypothesis of dysfunctional grief. Then, she generates solutions to address Barbara’s grief, including promoting coping strategies and coordinating care with a multidisciplinary team. Next, she establishes the desired outcome that within three weeks of intervening, Barbara will demonstrate positive coping mechanisms to deal with her grief.

Nurse Jamie then takes action to implement these solutions. Nurse Jamie discusses Barbara’s grief symptoms with her using therapeutic communication techniques like active listening, empathy, and genuineness.  

Nurse Jamie: It seems that you’re having a difficult time dealing with the loss of your husband. Can you tell me more about that? 

Barbara: Well, I suppose I am. I just don’t know how to go on through life without him. 

Nurse Jamie: It’s difficult to adapt to life without a loved one. I'd like to help you come up with some coping strategies. Would that be okay? 

Barbara: Yes, that would be fine.