NCLEX · Crisis and Grief

What are the five stages of grief described by Elisabeth Kübler-Ross?

Correct answer

Denial, Anger, Bargaining, Depression, Acceptance — not a linear progression; stages may be revisited, skipped, or occur in different order

  1. A Hope, fear, peace
  2. B Denial, Anger, Bargaining, Depression, Acceptance — not a linear progression; stages may be revisited, skipped, or occur in different order
  3. C Sad, mad, glad
  4. D Three stages only

Why this is the answer

Kübler-Ross's five stages of grief (developed from observing dying patients in 'On Death and Dying,' 1969): (1) Denial — 'This can't be happening' — protects from initial shock; (2) Anger — 'Why me? It's not fair' — directed at self, others, healthcare team, God; (3) Bargaining — 'If only...' — attempts to negotiate, often with higher power; (4) Depression — 'What's the point?' — sadness, withdrawal, mourning the losses; (5) Acceptance — 'I'm ready for what comes' — peace, not necessarily happiness. Important points: (1) NOT linear — grieving people move between stages, revisit stages, or skip stages; (2) Individual experience — no 'right' way to grieve; (3) Cultural variation — different cultures express and process grief differently; (4) Time variable — there is no fixed timeline; complicated grief lasting >12 months is recognized as a clinical concern. Other grief models: (1) Bowlby's attachment-based grief stages; (2) Worden's tasks of mourning — accept reality, work through pain, adjust to environment without deceased, find ongoing connection while moving forward; (3) Dual process model — alternating between loss-oriented and restoration-oriented coping. Nursing interventions: (1) Therapeutic presence — be there, don't always fill silence; (2) Allow expression of all emotions — anger, fear, sadness are normal; (3) Avoid platitudes ('They're in a better place'); (4) Active listening; (5) Educate family about normal grief; (6) Refer to grief counseling, support groups, palliative care, chaplaincy as appropriate; (7) Recognize complicated grief — prolonged, intense, functional impairment. Anticipatory grief — grieving before the death — is common in terminal illness.
Source: NCLEX-RN, Psychosocial — Grief