- Compromised Family Coping related to Impending death and Inadequate knowledge of end-of-life care as evidenced by Inquiries about the patient’s current health condition and complicated/anticipatory grieving of patient and family
- Death Anxiety related to Anticipation of death, life after death and leaving loved ones behind as evidenced by verbalizations about death and its effects on family and Expressions of fear of death and separation from loved ones
- Powerlessness related to Death anxiety and Insufficient knowledge about end-of-life care as evidenced by doubt about role performance and verbalization of a lack of purpose in life
| Assessment | Nursing Diagnosis | Planning/Outcomes | Intervention | Evaluation |
| Subjective data: Complaints about the patient’s response to treatment Objective data: -Limitation of communication between patient and support system -Inquiries about the patient’s current health condition -Withdrawal of patient’s family/caregiver -Uncooperative behaviours of the caregiver -Neglectful attitude towards the patient by the family or caregiver -Complicated/anticipatory grieving of patient and family | Compromised Family Coping related to Impending death and Inadequate knowledge of end-of-life care as evidenced by Inquiries about the patient’s current health condition and complicated/anticipatory grieving of patient and family | Patient and family will verbalize understanding of end-of-life care and acceptance of the patient’s condition. Patient and family will demonstrate effective coping strategies during the end-of-life phase. Patient and family will cooperate in care and decision-making related to the patient’s condition. Patient and family will express thoughts and feelings honestly. | 1. Establish rapport with the patient and family members. Established rapport between the nurse, patient, and family will lead to increased trust and a healthier dying process. 2. Evaluate the responses of the patient to end-of-life care. During this phase, end-of-life care can affect the patient’s and family’s coping ability. Not all family members may be accepting of the process. Ensure the patient is experiencing pain and symptom relief to their desired level. 3. Involve the patient and family in planning care. Proactive end-of-life care planning can reduce feelings of regret, depression, and helplessness. It will also help the patient and family accept the situation and plan out care appropriately. 4. Ensure that the patient and family understand advance directives. Instead of starting with a healthcare provider, discussions about patient preferences frequently take place within families. The nurse can inquire about the patient’s advance directive or expressed wishes for medical care. 5. Anticipate referral to social work or spiritual services. Social workers are essential to ease the burden of financial care at the end of life. They also offer bereavement services for 13 months after death. Chaplains or other religious leaders may be involved to ease the transition at the end of life. | Patient and family verbalized understanding of end-of-life care and acceptance of the patient’s condition. Patient and family demonstrated effective coping strategies during the end-of-life phase. Patient and family cooperated in care and decision-making related to the patient’s condition. Patient and family expressed thoughts and feelings honestly. |
| Subjective data: Verbalizations about death and its effects on family Objective data: -Depression -Loneliness -Fear of change in health status -Expressions of fear of death and separation from loved -ones -Fear of the unknown -Powerlessness -Reports of negative thoughts related to death and dying | Death Anxiety related to Anticipation of death, life after death and leaving loved ones behind as evidenced by Verbalizations about death and its effects on family and Expressions of fear of death and separation from loved ones | Patient and family will verbalize understanding of the dying process and its impact. Patient and family will express acceptance of impending death. Patient will move through the stages of grief. | 1. Set realistic goals with the patient and family. Setting realistic goals with the patient and family can reduce death anxiety during the end-of-life phase. 2. Assist the patient and family in decision-making. Letting the patient and family decide on end-of-life care practices offers a sense of control over the situation. 3. Explain signs and symptoms of impending death. Death and dying can be very stressful for the patient and family members. People often want to talk about what to expect. Remain open and honest about normal and expected signs and symptoms of the dying process. 4. Reminisce on life experiences. This can be a good time for family and friends to reminisce on memories and for the patient to discuss accomplishments. 5. Involve mental, spiritual, and social support. Feelings of guilt, grief, and spiritual distress need to be discussed and healed in order for the patient and family to move through the stages of grief and accept dying. 6. Anticipate hospice care. When patients no longer have curative alternatives or decide against further treatment, hospice care offers symptom management. The goal of hospice care is for patients to experience quality of life without pain and to die with dignity. | Patient and family verbalized understanding of the dying process and its impact. Patient and family expressed acceptance of impending death. Patient moved through the stages of grief. |
| Subjective data: Expresses emotional and restless about dying Objective data: Depression Anxiety Passivity Doubt about role performance Expression of regret and shame Verbalization of a lack of purpose in life Reports inadequate sense of control Fatigue Loss of independence Does not participate in decision-making | Powerlessness related to Death anxiety and Insufficient knowledge about end-of-life care as evidenced by doubt about role performance and verbalization of a lack of purpose in life | Patient and family will verbalize acceptance of the situation. Patient and family will express control of decision-making. Patient and family will participate in end-of-life care. | 1. Do not argue or provide false hope. The client who feels powerless will not believe in arguments of logic. Do not use empty phrases like, “It will all work out.” Sometimes listening and holding their hand is all that can be done. 2. Help the patient and family recognize what they can control. In the dying process, there is often little that can be controlled but helping the patient recognize they are still in charge of their healthcare decisions, pain control, and alertness offers some sense of power. 3. Encourage the patient to participate in routine activities. Simple self-care activities and participation in hobbies will help the patient feel more in control of their situation. 4. Advocate for the patient’s and family’s wishes. Collaborate with the interdisciplinary team regarding the patient’s preferences and wishes. The patient’s advance directives will help the healthcare team provide care tailored to the patient. | Patient and family verbalized acceptance of the situation. Patient and family expressed control of decision-making. Patient and family participated in end-of-life care. |