The family caregivers of an older patient have not left the bedside for 36 hours. Which finding best indicates potential for an abnormal grief reaction?

• A. Dying patient is becoming more restless and agitated
• B. A family member is going through a difficult divorce
• C. Family talks with and reassures the patient at frequent intervals
• D. Family cannot express their feelings to one another

Answer: (D)

Open expression of emotions within the family shapes how grief develops. When family members cannot express their feelings to one another, emotions remain bottled up, support is limited, and grief can become unresolved or prolonged—an abnormal or complicated grief reaction. This lack of communication deprives the group of shared processing and communal coping, which are protective against intense, persistent distress.

The other scenarios don’t point to an abnormal grief pattern. The patient’s increasing restlessness signals the patient’s deterioration, not the family’s grieving process. A family member undergoing a difficult divorce is an external stressor but doesn’t directly indicate how the family members are processing their own grief together. Reading the patient and reassuring them at frequent intervals reflects healthy engagement and coping, not maladaptive grief.