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.