Stages of grief

Grief is a normal response to physical or emotional loss, and it’s defined as a state of mental anguish. In a medical setting, grief can be encountered as a response to the loss of a loved one; when a terminally ill client comes to know that their own life may end; or when a client receives a diagnosis of a chronic disease, such as heart failure.

There are five stages of grief, also called the five stages of dying. These are denial, anger, bargaining, depression, and acceptance.So let’s imagine a scenario and walk through these stages one by one.

Suppose you are caring for a client with final stage lung cancer, and they have been through surgery and several rounds of chemotherapy to manage the disease.

However, their last computed tomography, or CT, scan shows the cancer has spread so much that there are no more medical or surgical options to prolong their life.

So, the only recommendation is palliative care, which is when measures are taken to make the patient as comfortable as possible until they die.

Death may occur within the next couple of weeks, months, or a year; however, it suddenly becomes a near-future certainty.

When told the news, a grieving client can first react with denial. So, they may reject the news altogether or think that the doctors have made a mistake.

In this stage, the most important thing is to remain neutral but understanding and compassionate. Refrain from trying to convince the person about the reality of their situation or illness.

So, if the client says, “These can’t be my scans! I was supposed to get better after chemotherapy!

This is a mistake!” You can respond along the lines of, “I am sorry. I understand the news must come as a shock.

I know this is not an easy time for you.” Denial can last anywhere from a couple of minutes, to a few days or hours, and in some cases, the person never moves past this stage.

If they do progress past denial, they enter the second stage of grief, which is anger. Anger results from realizing the certainty of death, and it may be directed at people, at the healthcare system, or at themselves.

The person might start calling the hospital staff incompetent or blame themselves for not having quit bad habits, like smoking, that have contributed to the disease.

When caring for an angry client, remember not to take it personally or engage in their anger. Instead, be empathetic and acknowledge their feelings.

You can respond by saying, “I can see that you’re angry, and it’s okay to feel this way right now,” and offer to leave them alone to process their feelings.

After anger, comes the third stage of grief, which is bargaining. This stage involves making deals to prolong their life, typically with a higher power.

For example, they might say to themselves that they’ll donate all their possessions to charity if they can live long enough for a momentous occasion, like their children getting married or seeing their grandchild be born.

The person may also bargain with their caregivers. So, a terminally ill client might tell you, “I’ll do anything to stay alive just so I can see my children once more.” The best way to respond is in a realistically hopeful manner.

So, you might reply with, “We are doing our very best to help you make it until your children arrive.” It’s important not to blunt their hope during this stage.The fourth stage of grief is depression.

During this stage, they feel the full impact of their disease, and in response, they might refuse food, be unable to sleep, and become reclusive and quiet.

They also might want to openly talk about their feelings. As a nursing assistant, it’s important to respect the person’s wishes; so, if they don’t want to talk, you can be compassionate by telling them, “It’s okay if you don’t want to talk.

Would you like me to just sit here with you?” Every person has a different way of mourning, so the most important thing is to not force them to talk, eat, or sleep if they don’t want to.

Still, you should inform the nurse if the person is refusing all of their meals, crying continuously, or not sleeping. The fifth and final stage is acceptance.

That’s when the person is at peace with the reality of their situation. This might happen days, months, or even years before death.

During this stage, the person might make plans for when they’re no longer around, like wrapping up unfinished business or drafting a will, or they might make plans to travel while they still can.It’s important to remember that grief is a very individualized process, and people will experience grief differently because the process is heavily influenced by their personal experience and cultural and spiritual beliefs.

Not everyone will go through all 5 steps nor will they go through them all in the same order. Some people may bounce back and forth between anger and depression; some may skip anger altogether; and some might reach acceptance only to go back to denial in a week or two.

Remember that their family members can go through the stages of grief as well as the client; you should do your best to be considerate and understanding with them as well.

As a nursing assistant, you should let the nurse know if the client or family members request support from a counselor or a faith leader or if they need help with an advanced directive.Alright, as a quick recap… The five stages of grief are denial, anger, bargaining, depression, and acceptance.

During denial, the person may reject the reality of their situation.During anger, they might become angry with themselves, a caregiver, or the healthcare system.

Bargaining is when the person tries to make a deal, usually with a higher power or a caregiver, to prolong their life. Depression is when the person realizes the full impact of their illness, and that might make them cry, refuse meals, become withdrawn, or stop sleeping.

Finally, acceptance is when the person has made peace with