NURSING HISTORY AND ASSESSMENT
Marissa, age 22, was born in a small town in Oklahoma. She lived there her whole life, even living at home while she attended a nearby college to earn a baccalaureate degree in education. She is an only child, and her parents were in their 40s when she was born. She was engaged throughout her college years to her high school sweetheart, Dave, who graduated 6 months ago from the state university with a degree in aeronautical engineering.
Upon his graduation, he accepted a position with NASA at Kennedy Space Center in Florida. Marissa and Dave were married 5 months ago and moved to a small apartment in Cape Canaveral, where Dave began his work with NASA. The plan was for Marissa to seek employment upon their arrival, but she has been unable to move ahead with those plans. She stays in the apartment most days, talking on the phone to her parents and crying about how much she misses them and her home in Oklahoma. She has met very few people and has no desire to do so. She sleeps a lot and has lost weight. She has been having severe headaches. Her husband has become very concerned about her and made an appointment for her with a private physician. Following a complete and unremarkable physical examination, the physician referred Marissa to the mental health clinic, where she was admitted to the day treatment center with a diagnosis of Adjustment Disorder with Depressed Mood.
NURSING DIAGNOSES AND OUTCOME
IDENTIFICATION
From the assessment data, the nurse develops the following nursing diagnoses for Marissa:
1. Complicated grieving related to feelings of loss associated with leaving her parents and her lifetime home.
a. Short-Term Goal: Within 1 week, Marissa will express anger about the loss associated with her move.
b. Long-Term Goal: Marissa will be able to verbalize behaviors associated with the normal stages of grief and identify her own position in the grief process, while progressing at her own pace toward resolution.
2. Relocation stress syndrome related to move away from parents and familiar environment in which she had spent her whole life.
a. Short-Term Goal: Within 1 week, Marissa will verbalize at least one positive aspect regarding relocation to her new environment.
b. Long-Term Goal: Within 1 month, Marissa will demonstrate positive adaptation to her new environment as evidenced by involvement in activities, expression of satisfaction with new acquaintances, and elimination of previously evident physical and psychological symptoms associated with the relocation.
PLANNING AND IMPLEMENTATION
COMPLICATED GRIEVING
The following nursing interventions have been identified for
Marissa:
1. Determine the stage of grief in which Marissa is fixed.
Identify behaviors associated with this stage.
2. Develop a trusting relationship with Marissa. Show empathy and caring. Be honest and keep all promises.
3. Convey an accepting attitude so that Marissa is not afraid to express her feelings openly.
4. Allow Marissa to express her anger. Do not become defensive if the initial expression of anger is displaced on nurse or therapist. Help Marissa explore angry feelings so that they may be directed toward the intended object or situation.
5. Help Marissa discharge pent-up anger through participation in large motor activities (e.g., brisk walks, jogging, physical exercises, or activity of her choice).
6. Explain to Marissa the normal stages of grief and the behaviors associated with each stage. Help her to understand that these feelings are normal and acceptable during a grief process.
7. Encourage Marissa to review her personal perception of the move. With support and sensitivity, point out the reality of the situation in areas where misrepresentations are expressed.
8. Help Marissa solve problems as she attempts to determine methods for more adaptive coping with the life change. Provide positive feedback for strategies identified and decisions made.
9. Encourage Marissa to reach out for spiritual support during this time in whatever form is desirable to her. Assess her spiritual needs and assist as necessary in the fulfillment of those needs.
RELOCATION STRESS SYNDROME
The following nursing interventions have been identified for
Marissa:
1. Encourage Marissa to discuss feelings (concerns, fears, anger) regarding this relocation.
2. Encourage Marissa to discuss how the change will affect her life. Ensure that Marissa is involved in decision-making and problem-solving regarding the move.
3. Help Marissa identify positive aspects about the move.
4. Help Marissa identify resources within the new community from which assistance with various types of services may be obtained.
5. Identify groups within the community that specialize in helping individuals adapt to relocation. Examples include Newcomers’ Club, Welcome Wagon International, and school and church organizations.
6. Refer Marissa to a support group (e.g., Depression and Bipolar Support Alliance [DBSA]).
EVALUATION
The outcome criteria for Marissa have been met. She is no longer having headaches and has regained some of her weight. She has joined a chapter of DBSA and has made some new acquaintances. She has applied to become a substitute teacher in the local school district, and she and Dave have joined the local Methodist church, where they have started to socialize with several couples their age. They have also adopted Molly, a 2-year-old mutt from the local shelter, who showers Marissa with love and keeps her company when no one else is around. They take daily walks together. Marissa still talks to her parents on the phone daily but no longer has feelings of despair about living so far away from them. Her parents provide encouragement and give her positive feedback for achieving a satisfactory adaptation to her new environment. They are planning a visit to see Marissa and Dave in the near future.
