Kubler ross stages of dying -grief

Download Kubler ross stages of dying -grief

Post on 16-Apr-2017




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    Kubler-Ross Stages of Dying / Grief

    Precipitating Factors of Grief

    Death in family



    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


    Adaptive response crying, verbal denial

    Maladptive response absence or reaction such as


    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


    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 childs graduation ( So many ifs), 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, Im dying

    Withdrawn, has no energy and interest to interact.


    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


    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


    Help find constructive outlets of anger. Do not take clients hostility personally. Do no


    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


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