| Course | NUR-7643 Advanced Assessment, Differential Diagnosis, and Management of Psychiatric Disorders Geriatric Populations Part B |
|---|---|
| Module | Module 4 |
| Paper type | Case analysis: prolonged grief disorder in later life |
| Length | About 1,106 words, 7 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | M.S. in Nursing, Psychiatric Mental Health Nurse Practitioner |
| Updated | October 2026 |
Free sample paper for NUR 7643 Module 4
A Place Still Set at the Table: Recognizing and Treating Prolonged Grief Disorder in a 73-Year-Old Father
Student Name
M.S. in Nursing, Psychiatric Mental Health Nurse Practitioner, Thomas Edison State University
NUR-7643: Advanced Assessment, Differential Diagnosis, and Management of Psychiatric Disorders: Geriatric Populations Part B
Mentor Name
Month Day, Year
A Place Still Set at the Table: Recognizing and Treating Prolonged Grief Disorder in a 73-Year-Old Father
Two Years Later
Victor, an invented patient, is 73 and served thirty years with the Union City fire department. His son, Daniel, a 41-year-old firefighter in the same department, died two years ago from a heart attack at a training exercise. Victor's wife says he has not been the same since. He visits the cemetery every morning, keeps Daniel's turnout gear in the hallway, sets a place for him at Sunday dinner and talks to his photograph at night. He cannot accept that his son is gone and feels that part of himself died too. He avoids the firehouse, the training ground and Daniel's children because they remind him too much of his son.
He has stopped going to the veterans' breakfast he attended for decades and has lost interest in fishing, though he still eats regularly, sleeps about six hours and takes pleasure in brief moments, such as when his granddaughter calls. He has said he wishes he could be with Daniel, but he has no plan to end his life and says his wife needs him. He takes medicine for blood pressure and cholesterol and drinks two beers a night, more than before.
Firefighting is part of the story. Victor was on duty the night his own father, also a firefighter, was injured, and he raised his son in the same tradition. He says he encouraged Daniel to join the department and wonders whether the job's strain caused the heart attack. That thought, which he has told no one, carries a guilt that keeps his grief raw, and the paper names it as a target for therapy.
Normal Grief, Depression or Prolonged Grief?
Prigerson et al. (2009) tested proposed criteria for prolonged grief disorder in 291 bereaved people interviewed three times over two years after their loss. The most informative criteria required intense yearning for the person who died, plus at least five of nine symptoms experienced daily or to a disabling degree, such as feeling stunned or that life is meaningless, difficulty accepting the death, avoiding reminders, bitterness, feeling that part of oneself has died, and trouble moving on. Symptoms had to last at least six months and cause significant impairment. The criteria identified a group distinct from depression and anxiety whose symptoms predicted later problems.
Victor meets these criteria: daily yearning, inability to accept the death, avoidance of reminders, a feeling that part of him died, loss of meaning and withdrawal from friends, for two years with clear impairment. His depression screen is mildly raised, but he still feels pleasure at moments, and his sense of loss is focused on his son rather than a general sense of worthlessness, which points to prolonged grief rather than major depression. His grief has lasted well beyond the usual softening seen over the first year.
Safety and Drinking
His wish to be with Daniel is explored directly. He has no plan and gives strong reasons to live. A safety plan is written, and he agrees to keep his old service handgun stored at his brother's house for now. His increased drinking is discussed, since alcohol worsens grief and sleep, and he agrees to limit himself to one beer a night.
Choosing a Therapy
Shear et al. (2014) randomly assigned 151 adults aged 50 and older with complicated grief to sixteen sessions of complicated grief treatment or interpersonal psychotherapy. Response, judged by an independent evaluator, was 70.5 percent with complicated grief treatment compared with 32.0 percent with interpersonal therapy, and grief symptoms and impairment improved faster. About three people needed to receive the grief-focused therapy for one more to respond.
Complicated grief treatment combines work on accepting the reality of the loss with work on restoring a life with purpose. For Victor, it includes retelling the story of the day Daniel died and reflecting on it, gradually visiting the places he avoids, beginning with the firehouse, an imagined conversation with his son, and setting personal goals that matter to him, such as teaching his grandson to fish as he once taught Daniel.
The imagined conversation is prepared carefully over several sessions. Victor is asked what he would want to tell Daniel and what he imagines Daniel would say back. In the session, he speaks of his pride, his regret about encouraging the career and his anger that his son was taken so young, and then answers in Daniel's voice. Many people find this the most painful and most freeing part of the treatment, and the therapist plans the session so he does not leave alone.
The Question of Medicine
Shear et al. (2016) then tested whether an antidepressant improves grief treatment. In 395 adults with complicated grief, participants received citalopram or placebo, with or without complicated grief treatment. Response was 82.5 percent with grief treatment and placebo compared with 54.8 percent with placebo alone, confirming the therapy's benefit. Adding citalopram to grief treatment did not improve grief outcomes, at 83.7 percent, but it did reduce depressive symptoms more. Citalopram without the therapy was less effective than citalopram with it.
For Victor, the therapy is the main treatment. Because his depressive symptoms are mild, no antidepressant is started now. If they worsen during therapy, an antidepressant could be added for the depression, with the understanding that it is not expected to treat the grief itself. Citalopram itself would be used carefully at his age, given its dose limit for older adults.
| Option | Evidence | Fit for Victor |
|---|---|---|
| Complicated grief treatment | 70.5 versus 32.0 percent response | Chosen |
| Interpersonal therapy | Less effective for grief | Not chosen |
| Citalopram added | No added grief benefit; eases depression | Held unless depression rises |
| Support group | Helpful companionship | Added alongside therapy |
His Family and Community
His wife is invited to a session to talk about how they each grieve differently. A firefighters' family support group, run by the department's chaplain, is suggested once he has taken his first step back into the firehouse. Daniel's children are part of his goals, so that the reminders he has avoided become connections again.
Conclusion
Victor has prolonged grief disorder two years after his son's sudden death, with daily yearning, avoidance and loss of meaning, separated from depression by the focus of his distress. His safety and drinking are addressed. Complicated grief treatment, supported by a trial in older adults where it more than doubled the response to interpersonal therapy, is the main treatment. Citalopram is held back, since a large trial showed it eased mood without improving grief. His grief and depression scores, drinking and goals will be reviewed every four weeks.
References
Prigerson, H. G., Horowitz, M. J., Jacobs, S. C., Parkes, C. M., Aslan, M., Goodkin, K., Raphael, B., Marwit, S. J., Wortman, C., Neimeyer, R. A., Bonanno, G., Block, S. D., Kissane, D., Boelen, P., Maercker, A., Litz, B. T., Johnson, J. G., First, M. B., & Maciejewski, P. K. (2009). Prolonged grief disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11. PLoS Medicine, 6(8), Article e1000121. https://doi.org/10.1371/journal.pmed.1000121
Shear, M. K., Reynolds, C. F., Simon, N. M., Zisook, S., Wang, Y., Mauro, C., Duan, N., Lebowitz, B., & Skritskaya, N. (2016). Optimizing treatment of complicated grief: A randomized clinical trial. JAMA Psychiatry, 73(7), 685-694. https://doi.org/10.1001/jamapsychiatry.2016.0892
Shear, M. K., Wang, Y., Skritskaya, N., Duan, N., Mauro, C., & Ghesquiere, A. (2014). Treatment of complicated grief in elderly persons: A randomized clinical trial. JAMA Psychiatry, 71(11), 1287-1295. https://doi.org/10.1001/jamapsychiatry.2014.1242
What the NUR 7643 Module 4 instructions ask for
Loss is a constant of later life, and grief that does not soften is one of the current geriatric concerns that TESU's NUR-7643 catalog paragraph points to, so, lacking a public syllabus, module four centers on grief that has not eased. Expect an analysis that applies validated criteria for prolonged grief disorder, separates it from normal grief and from major depression, assesses suicide risk and alcohol use, selects a grief-specific therapy backed by trials and walks through its steps, weighs whether an antidepressant adds anything and involves family and community. Some sections assign grief after a spouse's death with caregiving guilt, or grief complicated by trauma. Check whether your directions name a grief measure, ask for cultural or spiritual considerations or require a safety plan in the appendix.
How this NUR 7643 Module 4 example is built
Victor's daily cemetery visits, the place he still sets for his son and his avoidance of the firehouse open the paper. The validated criteria for prolonged grief are described from their development study, and his symptoms are matched to them, with the reasons his distress is grief rather than depression. Safety and drinking are addressed. The trial of complicated grief treatment in older adults is reported with its response rates, and the therapy's parts are applied to Victor. The 395-person citalopram trial follows, and the options table shows why medicine is held. Family and community steps close the case before a conclusion with review dates. Margin notes explain the differential and the accurate reading of the drug trial.
Reading the NUR 7643 Module 4 grading rubric
Prolonged grief cases are graded on applying validated criteria, separating prolonged grief from normal grief and depression, assessing suicide risk and alcohol use, choosing a grief-focused therapy from trial evidence and describing its parts, an accurate account of what medicine adds and involvement of family and community. Mentors credit papers that use the focus of distress, yearning for the person who died, to separate grief from depression. Respecting cultural and occupational meaning, such as a firefighting family, shows individualized care. Treating firearm access in an older man as part of grief care is often noted. Shear's two trials carry different years, and APA citations should keep them distinct; every response rate must be exact.
Common NUR 7643 Module 4 mistakes, and how to avoid them
Students often call prolonged grief depression and prescribe an antidepressant; separate the two and explain why. Another frequent miss is describing grief therapy as "supportive counseling"; name the grief-focused therapy and its parts. Do not forget suicide risk and firearms, especially in older men after a loss. Ask about alcohol. Read the drug trial carefully: an antidepressant helped mood, not grief. Bring family and community into the plan. A bereavement paper for your course can begin from the assignment sheet; draft one is free. Write the imagined conversation step with care, and plan the session so the patient does not leave alone afterward.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Thomas Edison State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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NUR 7643 Module 4 questions, answered
Where can I find a free NUR 7643 Module 4 sample paper?
Victor's prolonged grief case, from the place he still sets for his son to complicated grief treatment, is printed in full above.
What is prolonged grief disorder?
Intense yearning for the person who died, with symptoms such as disbelief, avoidance and loss of meaning, lasting well beyond the usual time and causing impairment.
How is prolonged grief different from depression?
Grief distress centers on the person who died and the loss, while depression involves a broader low mood and loss of pleasure.
Does complicated grief treatment work in older adults?
In a trial of 151 adults 50 and older, 70.5 percent responded compared with 32.0 percent with interpersonal therapy.
Do antidepressants help prolonged grief?
In a 395-person trial, citalopram did not improve grief outcomes when added to grief therapy, though it reduced depressive symptoms.