Home News Journals and Essays A revisit to Elisabeth Kübler Ross -Nursing Implications on Loss

A revisit to Elisabeth Kübler Ross -Nursing Implications on Loss

Loss is a short word but the depth of impact in a person’s life is too deep to grasp. Dealing with it is just like dealing with uncertainty. As if you are walking in a winding road that would never end.

Dealing with things or persons that were lost before and now found can be likened to a miracle but on the contrary, dealing with loss can be very upsetting and sometimes a winding road into something that you wouldn’t want to in your life.

Man’s ultimate goal in life is happiness. Being care-free and to be with the person they love and loves them in return– no prejudices, no pretensions. At any point in a person’s life, there will be a situation that you have to experience loss at any cost in a person, earthly things, memory and specially relationship. Nonetheless, it is important to deal with those feelings rather than packing it up every day of your life.

Whether it is your fault or not, the feeling loss can be very uncomfortable and coping is actually unique to every individual. It was only observed that people do have something in common in dealing with the loss. A theory was proposed by Elisabeth Kübler-Ross in the 1960s about how we deal with loss. In her book, On Death and Dying she was able to point out five distinct yet overlapping stages: Denial, Anger, Bargaining, Depression and Acceptance. It is important to note that the proponent of this theory claimed that it is not necessarily that these stages will come in order but certain reactions of people are commonly grouped into such categories.

As nurses, we may see loss every day, not just in our patients but also in our lives too. It is important to deal with those feelings of loss in order to prevent feelings such as counter transference – wherein you as a nurse may transfer your feelings towards your clients that may resemble someone you have lost before. It is therefore important to be self-aware first before having a successful nurse-patient therapeutic relationship.

These the following basic ways in dealing with patients under the 5 stages recognized above.

a) Denial – A stage wherein disbelief and sometimes not acknowledging the real scenario since it is a sad event or a poor prognosis.

Nursing Implication:

  1. Give the patient and the family time to be aware of their feelings.
  2. Assist them to voice out whatever is bothering them.
  3. Provide short and concise answers about questions and let the physician know about such feeling of denial in terms of the outcome of the disease or prognosis.
  4. Listen and be empathetic – put yourselves on their situation and think of how would you react rather than giving sympathy.
  5. In collaboration with the doctor you can observe the behavior of your patients, if the patient is visiting a lot of doctors time after time – it can be a mal-adaptive form of coping with the present situation. Recognize that there are patients that are compliant to the treatment but still in denial of their present health condition.

b) Anger – It is feeling that most of the patients feel when things are not under their control anymore. Anger can be vented towards others which can either be physically destructive or not.
Common questions that may be encountered: “Why me?” “Why my daughter who was innocent?” “Why did God gave me this disease?”

Nursing Implication:

  1. Being empathetic is the key in this stage.
  2. Anger can be delivered in many forms such as verbal assaults, erratic mood, blaming others, the family members, the hospital staff and the doctors.
  3. Take in mind that it is not you that he or she is angry about but the situation he or she is in.
  4. Assist the patient or family members to address the feelings that resulted them to be angry which can either be feelings of fear, loneliness and sadness.
  5. Answer in a non-defensive manner when talking to the patient.

c) Bargaining – In this stage, patients may think that they can change the real situation when they change their attitude in return for a healthier outcome. They may ask their doctor or family members or even God about taking the present ailment away in exchange for being good to the community, to others, to reconcile with broken relationships.

Nursing Implications:

  1. Always reassure the patient that the health care team is doing their best in assisting him or her in making his or her journey as comfortable as possible.
  2. Acknowledge the fact that patients’ need the sense of being under control – they may equate it into being a good patient in exchange for a better outcome.
  3. Encourage the patient to be honest with their feelings and try to get their attention to cooperate well on treatment.
  4. Be observant of manipulative behaviors too.

d) Depression – It is in this stage that patients would feel that they have gone into the downward spiral feeling of loss and symptoms such difficulty in concentrating, sleep deprivation and mood disturbances appear.

Nursing Implications:

  1. Be mindful about symptoms of depression.
      1. – Change in eating patterns/ lack of appetite/ more appetite
      2. – sudden outbursts of crying
      3. – sleeplessness
      4. – mood swings
  2. Watch out for suicidal ideations and self-destructive behaviors.
  3. Protect the patient properly by padding the head board, side rails.
  4. Administer antidepressant medications as ordered by the physician.

e) Acceptance – In this stage, patients would usually manifest the feelings of acknowledging that there would always be an end at everything. Patient’s feelings is geared towards spending their time with the loved ones and not regretting or being angry about what is about to happen.

  1. Nursing according to Virginia Henderson means it is a way of making the dying process as comfortable as possible. So take steps to accomplish such comforting actions.
  2. Always listen to what the patient tells you about his or her requests.
  3. Provide privacy and confidentiality at all times in doing beside care.

Thus, no matter how life may pick on us it will always go through a cycle but what we need to give emphasis on what is going through within the cycle. We are created with unique differences implying on how we cope on things. Some may arrive at the finish line earlier or will be last but then it never defines the person who you become. If a friend or a family needs a helping hand be sure to embed good ingredients in soothing the situation.


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