Grief in the Light of the Theory of Kubler Ross - Essay Example

Nursing Grief: Sharing with a Patients Humanity               The foremost objective of the paper is to present grief in the light of the theory of Kubler Ross. An analysis of the theory will be provided in the beginning of the paper. Applications of the said theory will then be provided in the next sections of the paper. Finally, coping mechanisms will be presented in the last part of the paper as part of nursing implications of the concepts presented.               Grief is one of the most ambiguous emotions that a human being can experience. The ability of nurses to gain an increased understanding of grief depends on the clarification of this concept (Jacob,1993). The understanding of the very concept of the term will give an objective perspective to the nurse as to the nature of the emotion. Through the years, much effort has een exerted in order to fully understand the concept of grief. Studies assessing how nurses view the emotion have been done (Jacob, 1993). However, an analysis of how nurses view the emotion is just an initial step to solving the dilemma of dealing with grief.               Grief is defined as a multi-faceted emotion in response to loss (Germain, 1990; Wikipedia.com). It not only involves emotional response. It also involves physical, behavioral, social and philosophical aspects. In her book entitled , On Death and Dying, Dr. Elizabeth Kubler-Ross (1969) identified five stages in the grief cycle. The stages are denial, anger, bargaining, depression, and acceptance. Dr. Kubler-Ross maintained that people dealing with grief go through most if not all of these stages in some fashion. Further research found that people could get stuck in a stage and never make it to acceptance and they could regress to earlier stages (Changing Minds, 2005). While the Kubler-Ross is the most well known of theories addressing grief, it does have its critics. Some psychologists believe that people can aid grief recovery by avoiding grief entirely. Further, there is research to indicate that men and women grieve differently which is not accounted for by Kubler-Ross (Greenburg, 2003).Another criticism of Kubler-Ross is that grief is much too complicated to be neatly summarized in five stages. In fact, Kubler-Ross has been misidentified. Instead of the five stages of grief, the Kubler-Ross theory should be called the five stages of receiving catastrophic news. Once the person has made it through the five stages, then the grieving process can begin (Counseling for Loss, 2001).               The author will begin the discussion with a walk through the different stages of grief as stipulaed by Kubler Ross. The first stage is Denial. It is a conscious or unconscious refusal to accept facts, information, reality, etc., relating to the situation concerned. Its a defense mechanism and perfectly natural. Some people can become locked in this stage when dealing with a traumatic change that can be ignored (Kubler-Ross, 1969). The second stage is Anger and can manifest in different ways. People dealing with emotional upset can be angry with themselves, and/or with others, especially those close to them. Knowing this helps keep detached and non-judgemental when experiencing the anger of someone who is very upset (Businessballs.com, 2007). Bargaining follows anger. Traditionally the bargaining stage for people facing death can involve attempting to bargain with whatever God the person believes in. People facing less serious trauma can bargain or seek to negotiate a compromise. Bargaining rarely provides a sustainable solution, especially if its a matter of life or death (Germain, 1990). Depression then ensues. It is preparatory grieving. It is acceptance with emotional attachment. Its natural to feel sadness and regret, fear, uncertainty, etc. It shows that the person has at least begun to accept the reality (Kubler_ross, 1969). After all the stages comes Acceptance and the process of moving on. An important note to make on the stages is that the stages may not occur in the same sequence in all people. It is also a cycle, and a patient may go through the stages in one direction or may frequently regress in previus stages, or may be forever fixed in a particular stage. A particular patient may also be halfway through two distinct stages. The identification of whether a patient is experiencing simple or complicated grief is vital in the planning for the treatment of a patient. One recognizes that in complicated grief, a greater amount of time is required. A stepwise approach is also commonly applied in complicated grief. It is a process of slowly untangling the many facets involved in the grief experienced by the person. The knowledge of the type of grief will also impact on the attitude of the nurse towards the patient. The nurse will recognize the complexity of the feelings of the patient. As such, it will be easier to muster patience and empathy on the patient.               In the final portions of the paper, with a background of a thorough analysis of the theory of Kubler Ross, the author will examine the applicability of the theory of grief at the present time. This will determine, if the concept, after several years, will indeed hold through, for all types of patients. The theory was formulated in 1969. As such, its applicability to the present time must be reassessed. To provide a more sold evidence, a recent study, published in the Journal of American Medical Association will be presented. In a study entitled, The Stage Theory of Grief (Silver and Wortman, 2007), a reassessment of the presence of all the five stages of grief in human experience was done. At first, investigators thought that it was a difficult, if not, an impossible study. On the background of extensive criticisms on the Five Stage Theory by Ross, it was tough to prove that the five stages indeed existed. A lot of adjustments had to be made to present a very objective study. All the bereaved subjects must agree ahead of time to the questioning and follow up. Cases where the death of the loved one was caused by violence such as suicide or trauma must be separated out, since the staged theory of grief was formed on the basis of observations of family of persons dying of natural causes. Then the study must attempt to quantify emotions that are themselves inherently qualitative. All these problems were overcome, and 233 persons were studied in New England. The participants in the study were part of a larger Yale Bereavement Study. The research team included faculty from Yale Medical School, Harvard Medical School, Dana-Farber Cancer Institute in Boston and Brigham and Womens Hospital in Boston. One great challenge is to be able to follow through the different stages of grief as the patients go through with them. Participants in the study agreed to take surveys at intervals of six, eleven and 20 months during a two year period after the death of someone close, or a loved one. Participants filled out grief indicator scores that measured the frequency and degree they were experiencing a specific emotion, specifically the sense of disbelief or denial of the death, the sense of yearning for the person and/or experiencing the sense of loss of the deceased, anger over the loss, depression, or acceptance of the loss. The exact manner of asking for this information drew upon well respected test instruments and methods. The analysts found that the frequency with which the participants experienced the feelings was a more useful measure (in this study) of their pattern of grieving than were attempts to tell us just how strongly they felt. So the studys conclusions were based upon the frequency with which participants felt the symptoms of grief, and of course, the sequence in which the symptoms of grief appeared. The studys researchers believe that their findings can help healthcare professionals - and families - decide if a persons pattern of grief adjustment is normal or not. If not, of course special therapy should be offered. Conversely, the results should help a health worker or family member more confidently tell a patient that the emotions he or she are experiencing after a loss are quite normal -- if perhaps even universally shared (Silver and Worthman, 2007).             The study, as a whole, affirmed that most participants did experience the five stages of grieving as was stated by Ross in her theory. Since the emotion is a dynamic one, patients differ in experiencing the sequence of events of the stages of grief. The authors of the study pointed out that persons surveyed tended to deal better with grief when a loved one was diagnosed with a terminal illness more than six months before death. They had longer to prepare for the loss. The other four stages (disbelief, anger, yearning and depression) peak and then receded gradually within the first six months in most patients. Acceptance starts forming even in the first month and steadily strengthens. Another observation is that disbelief reached a peak one month after a loss and then, declined. Acceptance was present even soon after a loss but it became more dominant as time progressed The process of yearning, or missing a loved one, was a significantly more dominant emotion than depression. The important part, with much impact for nurses, is the statement of one of the authors, who expressed that the understanding that yearning and not sadness is what bereavement is really about.               The study present affirmed that the stage theory of grief can be applied to different types of patients, even today. This proves the universality of the concept. A thorough knowledge of the five stage theory will be most helpful in dealing with grieving patients. As a starting point, having the thought of the five stage theory at the back of every nurses mind will provide, at least, with much effort, objective ground for the nurse in dealing with the grieving patient. The frequent thought of the five stage theory will be a constant reminder for the nurse to have some form of unattachment to the patient in order to provide the best quality of nursing care. A very strict definition and subsequent identification of the stage that the patient undergoes is not mandatory. At times, a patient may be in a limbo- a stage in between two stages. A rough estimate of the stage the patient is currently experiencing will give a nurse a guide on how to deal with the patient. The nurse can also tailor-fit his or her approach to a particular patient according to the stage of grief that the patient is undergoing. The application of the conclusion generated in the recently published article on grief in the Journal of American Medical Association will be a constant reminder for a nurse to shift the focus of treatment from fixation to the permanent and relative long-term experience of depression, towards efforts of alleviating the feelings of loss of the patient. It is somewhat a way of demonstrating a stepwise approach of solving a more comprehensive expanse of grief through small efforts. The study affirms the value of additive concept of solving a complicated problem by first, untangling the roots of grief.               The author, as a conclusion, would like to affirm the uniqueness of the nursing profession. It is one of the professions where one can share with emotions of another human being. The participation of a nurse in caring for a patient makes him go through an unimplied contract or relationship with the patient. As such, he agrees to go through the experiences of the patient, too. The understanding of the concept of grief gave the author an important insight on the call of exerting a nurses effort to reach out to his patient.                            References   Germain, P. (1990). Nursing the Dying: Implications of Kubler-Ross Staging Theory Annals of the American Academy of Political and Social Science, Vol. 447, The Social Meaning of Death , 46-58.   Greenburg, M. (2003). Good Grief: The Different Ways to Cope After Loss. Psychology Today, 36, 44. Jacob ,S. (1993) An analysis of the concept of grief Journal of Advanced Nursing 18 (11), 1787–1794.   Kubler-Ross, E. (1969). On Death and Dying, New York: Macmillan Publishing Co., Inc.   Kubler-Ross Grief Cycle. (2005). Changing Minds.Org, Retrieved July 18, 2005, from http://changingminds.org/disciplines/change_management/kubler_ross/kubler_ross.htm   Silver and Wortman. (2007). The Stage Theory of Grief. Journal of American Medcal Association. 297:2692. Beware the 5 Stages of Grief. (2001, February, 1). The TLC Group, Retrieved July 18, 2005 from http://www.counselingforloss.com/article8.html. Businessballs.com. (2007). Retrieved on October 14, 2007 from www.businessballs.com Sea-of-flowers.ca. (2007). Retrieved on October 14, 2007 from www.sea-of-flowers.ca Wikipedia.com. (2007). Retrieved on October 14, 2007 from www. wikipedia.com Read More