00301 Inadapted Duel

Domain 9: coping/stress tolerance
Class 2: coping responses
Diagnostic Code: 00301
Nanda label: maple duel
Diagnostic focus: duel
approved 2020 • Evidence level 3.4

NANDA Nursing Diagnosis Definition

Nanda nursing diagnosis « maple duel ” is defined as: disorder that occurs after the death of a significant person, in which the experience of suffering that accompanies mourning does not follow sociocultural expectations .

Definite characteristics

  • Anxiety
  • Decrease in the realization of the role of life
  • Depressive symptoms
  • Decrease in intimacy levels
  • Incredulity
  • Excessive stress
  • Experience symptoms that the deceased had suffered
  • Express anger
  • Express being overwhelmed
  • Express discomfort in relation to the deceased person
  • Express feeling of feeling separate from others
  • Express feelings of vacuum
  • Express a feeling of stunning
  • Express shock
  • Fatigue
  • Gastrointestinal symptoms
  • Duel avoidance
  • Increase in morbidity
  • yearning for the deceased person
  • Distrust of others
  • No acceptance of a death
  • Persistent painful memories
  • Concern with thoughts about the deceased person
  • Cavilation on the deceased person
  • Search for the deceased person
  • Autoculpabilization

Related factors

  • Difficulty dealing with recurring crises
  • Excessive emotional alteration
  • Anxious linking
  • Inadequate social support
  • Avitative linking

Risk population

  • People at economic disadvantage
  • People who experience unacceptable losses
  • People who experience sudden death of significant people
  • People who experience violent death of significant people
  • Unsatisfied people with the notification of death
  • People who have witnessed uncontrolled symptoms of the deceased
  • People with a history of child abuse
  • People with an unresolved mourning history
  • People with significant dependence on the deceased before death
  • People with strong emotional proximity to the deceased
  • People with unresolved conflicts with the deceased
  • People without paid employment
  • Women

Associated problems

  • Anxiety disorders
  • Depression

Suggestions of use

  • Most defining characteristics may also be present in the normal grieving process. The duel is only dysfunctional if prolonged (perhaps for more than a year after the loss, although no absolute period can be specified) or if the symptoms are too numerous or serious. Chronic affliction describes the patient’s feelings, while the duel describes the behaviors used to try to face the loss. See the suggestions of use for duel.

Suggested alternative diagnostics

  • Ineffective coping
  • Duel
  • Health risk behavior, a tendency to adopt
  • Chronic affliction
  • Spiritual suffering

NOC Results

  • coping: personal actions aimed at handling the stressful factors that test the resources of an individual
  • Role performance: congruence of an individual’s role behaviors with the expectations of the role
  • Affliction resolution: adjustment to a real or imminent loss

Evaluation objectives and criteria

Examples with the use of noc> terms

  • • The patient and the family satisfactorily resolve complicated duel, as evidenced by successful grieving and resolution of grief and adequate role performance
  • • See the evaluation objectives/criteria, as well as other examples for the duel and resolution of the affliction
  • • Demonstrates the performance of the role, as stated by the following indicators (specify from 1 to 5: at all, slightly, moderately, substantially or totally adequate):
    • Performance of role expectations
    • Family role behavior performance
    • Community role behavior performance
    • Expression of comfort with the expectations of the role

Other examples

The patient and family will be able to:

  • • Communicate an adequate intake of food and liquids
  • • Communicate adequate social support
  • • Verbally express the duel
  • • Verbally express suffering
  • • Express the meaning of loss
  • • Demonstrate ability to make mutual decisions regarding a possible loss
  • • Express spiritual thoughts, feelings and beliefs about loss
  • • Verbally express your fears and concerns regarding a possible loss
  • • Work to overcome suffering
  • • Do not suffer somatic disorders
  • • Express feelings of productivity, utility, power and optimism

NIC Interventions

  • Emotional support: provide comfort, approval and encouragement during moments of stress
  • Increased self -awareness: helping a patient to explore and understand their thoughts, feelings, motivations and behaviors
  • Facilitate the expression of duel: Help with the resolution of a significant loss
  • Facilitate the expression of duel: perinatal death: Help with the resolution of a perinatal loss
  • Promotion of family integrity: promotion of cohesion and family unit
  • Promotion of resilience: help people, families and communities to develop, use and strengthen protective factors that must be used to face environmental and social stressors
  • Improvement of coping: help the patient adapt to stressful factors, changes or perceived threats that interfere with the satisfaction of the demands and the roles of life
  • Improvement of the role: helping a patient, their family and/or people relative to improving relationships by clarifying and complementing specific role behaviors

Nursing Activities

  • See also nursing activities for duel.


  • • Evaluate and record the presence and source of suffering of the patient
  • • (NIC) Promotion of family integrity.
    • Determine typical family relationships
    • Monitor habitual family relationships
    • Identify the usual coping mechanisms of the family
    • Identify conflict priorities between family members

Patient and family education

  • • Provide the patient and family information about existing hospital and community resources, as is the case of self -help groups

Collaboration activities

  • • Organize a meeting to review the needs of a patient and their family related to the stage of the grieving process in which they are and to establish a care plan
  • • Look for support from colleagues and other people for patient care, as required
  • • (NIC) Facilitation of the expression of grief: perinatal death: notify the laboratory or funeral home, as appropriate, so that they have the body


  • • Recognize the patient and family’s grieving reactions while the necessary care activities continue
  • • Comment with the patient and his family the impact of loss on family unit and its operation
  • • Avoid confrontation of denial, without reinforcing it
  • • Balance any erroneous ideas with reality
  • • Promote independence in self -care, helping the patient only when necessary
  • • Establish a contact program with the patient
  • • Establish a relationship of trust with the patient and family
  • • Help the patient and his family actively participate in the decision -making process
  • • Offer a safe and private environment to facilitate the patient and family’s grieving process
  • • Recognize and reinforce the strength of each family member

Babies and Children

  • • See the interventions for the duel
  • • (NIC) Facilitation of grieving expression: perinatal death ’.
    • Help keep the baby alive until parents arrive
    • Baptize the baby, if applicable
    • Talk about the plans made (for example, the burial, the funeral and the name of the baby)
    • Describe the memories that will be kept, such as foot and feet traces, photographs, hats, clothing, blankets, diapers and blood pressure sleeves, if it is considered necessary
    • Prepare the baby to see it, bathing and dressing it, including parents in the activities, according to proceed
    • Encourage family members to see and load the baby for the time they want
    • Focus on the normal characteristics of the baby and speak with tact of its abnormalities
    • Transfer to the baby to the bodies deposit, or prepare the body so that your family transports it to the funeral home

Older people

  • • Use individual or group memories therapy
  • • Evaluate the patient’s support system, remember your family that your support is necessary