Nurses Notes on Stages of Grief accdng. to Kobler Ross

I. Denial
Behavioral Responses:

1. refuses to believe that loss is happening, "This is not happening to me"
   
2. non ready to deal with practical problems
3. may assume artificial cheerfulness to prolong denial

Nursing Implication:

1. verbally support client but do not reinforce denial
2. examine your own behavior to ensure that you do not share client's denial

II. Anger
Behavioral Responses:

1. client may direct anger to anybody may be the nurse/staff/object about something that normally wouldn't bother them

Nursing Implication:

1. help client understand that anger is a normal response to a feeling of loss and powerlessness
2. avoid withdrawal or retaliation , don't take anger personally
3. deal with needs underlying angry reaction
4. provide structure and continuity to promote feeling over their lives

III. Bargaining
Behavioral Responses:

1. seeks to bargain to avoid loss
2. may express feelings of guilt or fear of punishment for just real imagine

Nursing Implication:

1. listen attentively and encourage client to talk to relieve guilt or irrational fear
2. offer spiritual support
   

IV. Depression
Behavioral Response:

1. grieves over to what happened and what can't be
2. may talk freely ( reviewing past losses) or may withdraw

Nursing Implication:

1. allow client to express sadness
2. communicates non-verbally by sitting quietly without expecting conversation
3. convey caring for touch

V. Acceptance
Behavioral Response:

1. comes to term with loss, may wish to begin making plans
   
2. may have decreased interest in surroundings and support people
   

Nursing Implication:

1. help family and friends understand clients decrease need to socialize
2. encourage client to participate as much as possible
   

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