Dysfunctional Grieving

 

Instructions: Fill out this form, print it, and hand it in with your assessment to your instructor. When you click on Next at the bottom of the page, you see the data you submitted. Please follow the instructions on how to save the data on the next page.

AOL users: Read this instruction.

Definition: prolonged, unsuccessful use of intellectual and emotional responses in an attempt to work through the process of modifying self-concept based on the perception of loss. 

1. Your initials (required): 


2. Defining Characteristics- check those that apply to your client:

None- high risk diagnosis  prolonged interference with life functioning reliving past experiences with little or no reduction of intensity of the grief difficulty in expressing loss alteration in activity level alteration inalteration habits alteration in sleep patterns
crying  sadness  denial of loss  anger 

  3. Related Factors- check those that apply to your client:

loss of loved one loss of body part or function terminal illness chronic illness loss of possessions
loss of job loss of status changes in life style losses associated with aging
 



4. Goal (ultimate, long term) 

5. Outcome Criteria (short term) 


6. Evaluation: Was the outcome criteria met? 

Yes- Give Evidence: 

No- Explain how you would change the plan: 


7A. Interventions 

1. 

2.

3. 

4. 

5.

6. 

7B. Rationale for each intervention
1. 

2. 

3. 

4. 

5. 

6. 
 
 

 
 
Back to top
Return to Care Plan Homepage