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
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5.
6.
7B. Rationale for each intervention
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6.