Fundamental of Nursing, mental health nursing, psychology

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Kubler-Ross Stages of Dying / Grief
Precipitating Factors of Grief
Death in family
Separation
Divorce
Physical Illness
Work failure disappointments
1. Denial
Initial response to protect the self from anxiety.
“No not me”, “Its not true”, “Its not impossible”
May continue to make impractical/unrealistic plans
May comment that a mistake has been made about
the diagnosis of terminal illness
May appear normal and can continued ADL as if
nothing is wrong
May not conform with the advised treatment
regimen
Adaptive response – crying, verbal denial
Maladptive response – absence or reaction such as
crying.
2. Anger
Individual feel that they are victims of incompetence or a vengeful God (they did
something wrong so they are being punished), fate (karma), circumstances (wrong place
and wrong time).
“Why me”, “What did I do to deserve this?”
They seek for reasons, answers and explanations
May express anger overtly – being irritable, impatient, critical verbally abusive.
May express anger covertly by neglecting self, not eating, nor going to check ups,
committing suicide, drinking alcohol.
Adaptive response – verbal expression
Maladaptive – persistent guilt or low self esteem, aggression, self destructive ideation or
behavior.
3. Bargaining

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The person try to inhibit good behavior, make up for perceived wrong doings or other
engage in behaviors that would please GOD so he will be given more time-an extension
of life or granted recovery.
“Yes, me but”
“If I live until Christmas or until my child’s graduation ( So many if’s), I will do this…”
Adaptive response – bargains for treatment control, express wish to be alive for specific
events in the near future.
Maladaptive response – bargains for unrealistic activities or events in the distant future.
4. Depression
Occurs when the reality of loss or impending loss cannot be ignored anymore and the
person grieves for himself and those he will leave behind, for the things that he can no
longer accomplish or experience.
“Yes, I’m dying”
Withdrawn, has no energy and interest to interact.
Cries
Makes few demands
Adaptive response – crying, withdrawing from interaction
Maladaptive response – self destructive actions, despair.
5. Acceptance
Occurs when the person has come to peace with himself and others
“Yes, I am ready”
Stage of affective void – not happy nor sad
Only persons who are highly significant to him stimulates a reaction. Others are merely
tolerated.
Makes realistic preparation
Adaptive response – may wish to be alone, limit conversation, complete personal and
family business.
Nursing Interventions:
Assess; specific loss, meaning of loss, coping skills, support persons.
Accept the client; do not respond personally to the client.
Support adaptive responses; allow to express feelings
Support defense mechanism – reassure client that denial and wanting to be alone is
normal.
Help find constructive outlets of anger. Do not take clients hostility personally. Do no
retaliate.
Monitor for self destructive behaviors
Help express feelings: Ask how they feel
Meet needs
Allow as much decision making as possible to maintain dignity by giving choices and
alternatives.

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