NURS 519 Week 5 Case Study 2 on a Widower's Grief After Reading Golden Example

Case Study 2: A Widower Building a Cedar Bench, Masculine Grieving and Bereavement Risk Three Months After a Hospice Death

The Case

A 69-year-old retired electrical lineman lost his wife of 44 years to pancreatic cancer three months ago after six weeks of home hospice care. Since the funeral, he has spent most days in his garage building a cedar bench for the rose garden she planted, and he has refused offers from his church to bring meals. His daughter called the hospice bereavement coordinator because her father "hasn't shed a tear" in front of anyone, has gone from one beer at supper to three, sleeps about five hours a night, and has missed four Sunday services. At the bereavement visit he said little until asked about the bench, then explained every joint and said, "She always wanted somewhere to sit out there." At the door he asked the nurse whether God "took her early because I didn't pray hard enough."

How Would Golden Interpret the Widower's Behavior?

Golden would most likely see the widower as grieving, not avoiding grief. In Swallowed by a Snake, Golden (2010) describes a way of healing often seen in men, though not limited to them, that moves through action and solitude and through doing something that honors the person who died, rather than through talking about feelings with others. Building a bench for his wife's garden fits that pattern closely: it is private, it uses his hands and skill, and it links him to her. Golden also notes that this way of grieving is often judged as denial by people who expect tears, which may explain why the daughter is frightened. Doka and Martin (2010) describe a similar pattern as instrumental grieving, in which a person experiences grief more as thought and energy for activity than as visible emotion. The nurse's first task, then, is to recognize the bench as grief work and say so, not to treat the absence of tears as the problem. In my own hospice practice, I have seen widowers open up more while working beside someone than when seated across a table, so an offer to look at the bench may do more than an invitation to talk.

Is This Normal Grief, Prolonged Grief or Depression?

At three months the widower cannot meet the criteria for prolonged grief disorder, and most of what he shows is consistent with acute grief, but two features need watching. Under the DSM-5-TR, a diagnosis of prolonged grief disorder in an adult requires at least 12 months since the death, a persistent longing for the person who died or a preoccupation with thoughts of them, and symptoms such as identity disruption, marked emotional pain or difficulty reintegrating into life, causing significant impairment (Prigerson et al., 2021). Prigerson et al. (2021) validated the PG-13-R against these criteria in three samples and found its symptom score distinct from depression and post-traumatic stress, with high internal consistency and stable results months later. The nurse can record a PG-13-R score now as a baseline and repeat it after the first anniversary, when the time criterion can be met. In the meantime, the questions to track are whether his yearning keeps him from eating, sleeping or seeing people, and whether he begins to feel that part of himself died with her. Golden (2010) would add that the finished bench may be a turning point, so the team should ask what he plans to do once it is done. Depression, however, has no waiting period. The nurse should screen now for persistent low mood, loss of interest beyond the bench, hopelessness, guilt that is pervasive rather than tied to the loss, and any thoughts of death or suicide, asking directly. Matzo and Sherman (2018) note that grief and depression overlap and that a person can be grieving and depressed at once, so a screening tool such as the PHQ-9 gives the team a baseline.

What Risk Factors Does He Carry?

The widower carries several risk factors for a poor bereavement outcome: he is an older man, he lives alone, his drinking and sleep have changed, and he is withdrawing from church. In a cohort of more than 25,000 Japanese adults aged 65 and older, Kawaguchi et al. (2026) found that spousal loss was linked to higher mortality and dementia risk among men, that widowed men had more depressive symptoms and hopelessness in the first year, and that only men lost social support and drank more after the loss. Among more than 9,000 bereaved family members of patients who died of cancer, Aoyama et al. (2020) found that insomnia and both increases and decreases in drinking were associated with possible complicated grief or major depression, and they suggested that asking about sleep and alcohol could identify people at risk. The widower's new nightly drinking and five-hour nights are therefore not side notes. His guilt about prayer is a further concern, because self-blame can deepen grief. His protective factors include a close daughter, a church that keeps reaching out, and a meaningful project.

What Should the Hospice Bereavement Team Do?

The team should move him from routine follow-up to a higher-risk bereavement plan, built around activity and his own pace. Hospices offer bereavement support to families for up to a year after a death, and Matzo and Sherman (2018) describe matching its intensity to the level of risk. For this widower, the plan would include a home visit from the bereavement counselor in the next two weeks, scheduled at the bench rather than the kitchen table; a PHQ-9 and a brief alcohol screen at that visit; a call to his primary care provider about sleep and drinking, with the widower's permission; and an invitation to a men's grief group that meets over breakfast or a shared task, which Golden (2010) would expect to suit him better than a talking circle. The daughter needs help as well. The counselor can explain that her father's way of mourning is real and suggest she join him in the garden instead of urging him to cry. The team should call at the six-month point and again before the first anniversary, holiday season and wedding date, when risk rises. If screening reveals hopelessness or any thought of suicide, he should be referred to a mental health professional the same day.

How Should the Nurse Respond to His Question About God?

The nurse should answer his question with presence and a gentle question in return before offering any reassurance. A useful response is, "That sounds like a heavy thing to carry. What makes you think it was your prayers?" His answer will show whether he is voicing guilt, anger at God or a belief from his upbringing. The nurse can then share, if he is open, that Scripture does not teach that a loved one's death is a punishment for weak prayer. When Jesus' disciples asked whose sin caused a man's blindness, Jesus answered that neither the man nor his parents had sinned (English Standard Version Bible, 2001/2016, John 9:2-3). The nurse can also offer a visit from the hospice chaplain or his own pastor, whom he has avoided for a month, since a pastor who knew his wife may reach him in a way the nurse cannot. Matzo and Sherman (2018) describe spiritual distress as part of the suffering hospice care addresses, and this man's question deserves the same follow-up as his sleep.

References

Aoyama, M., Sakaguchi, Y., Fujisawa, D., Morita, T., Ogawa, A., Kizawa, Y., Tsuneto, S., Shima, Y., & Miyashita, M. (2020). Insomnia and changes in alcohol consumption: Relation between possible complicated grief and depression among bereaved family caregivers. Journal of Affective Disorders, 275, 1-6. https://doi.org/10.1016/j.jad.2020.06.023

Doka, K. J., & Martin, T. L. (2010). Grieving beyond gender: Understanding the ways men and women mourn (Rev. ed.). Routledge.

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Golden, T. R. (2010). Swallowed by a snake: The gift of the masculine side of healing (2nd ed.). Golden Healing Publishing.

Kawaguchi, K., Nakagomi, A., Ide, K., Shirai, K., Koga, C., Chen, Y. R., Kondo, K., & Shiba, K. (2026). Health and well-being after spousal loss among older men and women. Journal of Affective Disorders, 403, Article 121391. https://doi.org/10.1016/j.jad.2026.121391

Matzo, M., & Sherman, D. W. (Eds.). (2018). Palliative care nursing: Quality care to the end of life (5th ed.). Springer Publishing Company.

Prigerson, H. G., Boelen, P. A., Xu, J., Smith, K. V., & Maciejewski, P. K. (2021). Validation of the new DSM-5-TR criteria for prolonged grief disorder and the PG-13-Revised (PG-13-R) scale. World Psychiatry, 20(1), 96-106. https://doi.org/10.1002/wps.20823