Assess for and report suicidal ideation, especially with intense or prolonged grief.
Before you read
Test yourself first: 4 questions
Question 1 of 4
An older adult who recently lost a spouse expresses sadness and withdraws from activities. Which finding would distinguish major depression from normal grief?
Answer: B. Persistent worthlessness and recurrent thoughts of suicide point to major depression rather than uncomplicated grief, in which self-esteem usually remains intact and waves of sadness ease over time. Occasional tearfulness, missing the spouse, and waves of sadness are normal grief responses.
Question 2 of 4
A client is in the bargaining stage of grief. Which statement reflects this stage?
Answer: B. Bargaining involves 'if-then' deals to postpone the loss ('If I do X, maybe...'). Denial, anger, and acceptance present differently.
Question 3 of 4
A client 3 weeks postpartum reports persistent sadness, loss of interest in the baby, difficulty sleeping even when the baby sleeps, and feelings of worthlessness. What does the nurse recognize?
Answer: A. Symptoms persisting beyond 2 weeks with loss of interest, sleep disturbance unrelated to the infant, and feelings of worthlessness indicate postpartum depression rather than transient baby blues. It requires referral and treatment. Baby blues resolve within about 2 weeks.
Question 4 of 4
Before electroconvulsive therapy (ECT), the nurse ensures the client:
Answer: B. ECT requires informed consent, NPO status before the procedure, and a pre-procedure assessment; a muscle relaxant and brief anesthesia are given. Confusion/short-term memory loss afterward is expected and temporary.
Keep the streak going with more questions like these, each with a full rationale.
What is grief and loss?
Kubler-Ross described five stages of dying and grief, but they are not fixed or sequential and people may move among them. The nurse's role is to provide presence, support healthy expression of feelings, and recognize when grief becomes complicated or dysfunctional.
Key points to remember
- Kubler-Ross stages: Denial, Anger, Bargaining, Depression, Acceptance (DABDA); they are not linear and may recur or be skipped.
- Normal (uncomplicated) grief gradually eases over time and allows the person to function and find meaning.
- Anticipatory grief begins before an expected loss; complicated/dysfunctional grief is prolonged, intense, and impairs functioning.
- Grief responses are strongly shaped by culture, spirituality, and prior losses, and all must be respected.
- Therapeutic presence, silence, and allowing expression of feelings are more helpful than offering solutions or false reassurance.
- Suicide risk can rise with profound or complicated grief and must be assessed.
- Typical statements by stage: denial ('Not me'), anger ('Why me?', often aimed at staff), bargaining ('If I…, then…'), depression (withdrawal, sadness), acceptance (coming to terms).
Nursing priorities
- Provide presence, active listening, and a safe space for the client to express feelings.
- Assess where the client is in the grieving process and respect cultural and spiritual practices.
- Encourage open expression of emotions without rushing or judging the process.
- Assess for complicated grief, depression, and suicidal ideation.
- Connect the client and family with support groups, spiritual care, and bereavement resources.
Patient teaching
- Grief has no fixed timeline or 'right' order; your feelings are a normal response to loss.
- Express your emotions and lean on support people, support groups, and spiritual resources.
- Seek help if grief feels overwhelming, lasts a very long time, or you have thoughts of harming yourself.
- Anger is often displaced onto staff; do not take it personally, and stay present.
Red flags: report now
- Assess for and report suicidal ideation, especially with intense or prolonged grief.
- Report grief that remains severe and disabling well beyond expected time (complicated grief or major depression).
- Never tell a grieving client how they 'should' feel or offer false reassurance ('They're in a better place').
References
Clinical references for this topic
