# Situation: A 70-year-old man whose wife died 14 months ago is admitted to the psychiatric ward. He lives alone. He says he longs for his wife every day, and his children report that he has stopped seeing his friends. His physical examination and laboratory tests are normal. The nurse writes the nursing diagnosis Maladaptive grieving. Which of his data belongs in the "as evidenced by" part of the statement?

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> subject: Nursing Practice V — Care of Clients with Maladaptive Patterns of Behavior; Care of Clients with Life-Threatening Conditions, Acute Multi-Organ Problems, High Acuity and Emergency Situations

## 문제

Situation: A 70-year-old man whose wife died 14 months ago is admitted to the psychiatric ward. He lives alone. He says he longs for his wife every day, and his children report that he has stopped seeing his friends. His physical examination and laboratory tests are normal.

The nurse writes the nursing diagnosis Maladaptive grieving. Which of his data belongs in the "as evidenced by" part of the statement?

## 보기

1. His wife died suddenly 14 months ago
2. He is a 70-year-old man living alone
3. He says he longs for his wife every day **✔ 정답**
4. He relied on his wife for all household tasks

**정답: 3**

## 해설

The "as evidenced by" part lists defining characteristics, the signs and symptoms that show the response is present, such as daily yearning for the deceased. The death itself, his age and living situation, and his past dependence are factors that explain or add to risk; they are not evidence of the response.

## 심화 해설

A nursing diagnosis is a clinical judgment with a specific structure. The full statement follows a format: the diagnostic label, a related factor or etiology, and the defining characteristics that are the observable cues. In the diagnosis Maladaptive grieving, the phrase “as evidenced by” must be followed by the signs and symptoms the nurse directly observes or the client reports—not by background facts, demographic details, or risk factors.

The client’s statement that he longs for his wife every day is a subjective defining characteristic. It is a direct expression of the grief response itself. In the framework of complicated or maladaptive grief, persistent yearning and preoccupation with the deceased are core symptoms that distinguish a stalled or dysfunctional grief process from normal bereavement. The Inventory of Complicated Grief identifies this kind of intense, chronic longing as a primary marker of grief that has become maladaptive rather than resolving over time [3]. Because the wife died 14 months ago and the yearning remains daily, this is not simply acute grief; it reflects a failure to move through the expected trajectory of mourning toward adaptation [2].

The other options describe context or vulnerability, not evidence of the response. The wife’s sudden death 14 months ago is the precipitating event—the loss itself. It belongs in the etiology or related-to portion of the diagnosis, because it explains why the grieving process began, but it does not show that grieving has become maladaptive. Similarly, being a 70-year-old man living alone is a demographic and situational factor that may increase risk, especially because older adults often face reduced social resources and cumulative losses that can hinder adjustment [4]. However, living alone is not a symptom of maladaptive grieving. Finally, having relied on his wife for household tasks describes a past dependency that may intensify the impact of the loss, but it is a contributing factor, not an observable sign of the current grief response.

The children’s report that he has stopped seeing his friends is also a defining characteristic—social withdrawal is a behavioral cue of dysfunctional grieving [2]. Yet among the choices given, only the daily yearning is a direct, client-reported symptom that belongs after “as evidenced by.” Key point! In writing nursing diagnoses, the “as evidenced by” section must contain only the defining characteristics: the subjective complaints and objective findings that demonstrate the problem is present. Risk factors, causes, and background information belong in the “related to” section or in the assessment data, not in the evidence clause.

| Component of diagnosis | Example from this case | Why it fits there |
| --- | --- | --- |
| Diagnostic label | Maladaptive grieving | Names the human response to the loss |
| Related to (etiology) | Sudden death of wife 14 months ago; past dependence on wife | Explains the cause or contributing context, not the current signs |
| As evidenced by (defining characteristics) | Daily yearning for wife; social withdrawal from friends | Directly observable or reported signs and symptoms of the grief response |

Nurses in primary care and psychiatric settings assess maladaptive grief by looking for exactly these defining characteristics—persistent longing, avoidance of social contact, and functional decline—rather than relying on how long ago the loss occurred or the client’s living arrangement . The correct data for the “as evidenced by” portion is therefore the client’s own report of daily yearning, because it is the clearest symptom that the grief response is present and has become maladaptive.References (research sources)

- [2]Dysfunctional grieving.Research articleBateman A, Broderick D, Gleason L, Kardon R, Flaherty C, Anderson S (1992) · DOI: 10.3928/0279-3695-19921201-04

- [3]Inventory of Complicated Grief: a scale to measure maladaptive symptoms of loss.Research articlePrigerson HG, Maciejewski PK, Reynolds CF, Bierhals AJ, Newsom JT, Fasiczka A (1995) · DOI: 10.1016/0165-1781(95)02757-2

- [4]Responding to grief-related needs in older adults: protocol for a community-based matched-care trial (GriefDiff).Research articleNeto DD, Coelho A, Barbosa M, Albuquerque S. (2026) · DOI: 10.1186/s40359-026-04491-9

## 임상 시나리오

Maladaptive Grieving: Writing the DiagnosisSelecting Defining Characteristics for "As Evidenced By"
The PES format guides diagnosis structure: Problem, Etiology (related to), and Signs/Symptoms (as evidenced by). The "as evidenced by" section must contain defining characteristics—observable cues or client-reported symptoms that demonstrate the response is occurring.

For Maladaptive Grieving, persistent yearning for the deceased is a core defining characteristic. The client's statement of daily longing 14 months after the loss is subjective data that directly evidences a stalled grief process.

CautionDo not place risk factors (age, living alone), precipitating events (the death itself), or past dependence in the "as evidenced by" section. These belong in the etiology or background portion of the diagnosis.

## 핵심 개념

- **Maladaptive Grieving** — A dysfunctional grief response characterized by prolonged, intense yearning and failure to adapt to the loss over time.
- **Defining Characteristics** — Observable signs and symptoms or client-reported cues that demonstrate a specific nursing diagnosis is present.
- **PES Format** — A structure for nursing diagnosis statements: Problem, Etiology (related to), and Signs/Symptoms (as evidenced by).
- **Subjective Data** — Information reported by the client, such as feelings, perceptions, and symptoms, that cannot be directly measured by the nurse.
- **Precipitating Event** — The triggering incident or loss that initiates a response, belonging in the etiology portion of a diagnosis.

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