Five Stages of Dying
By Barbara Gould Preparing for approaching death can be terrifying if you have no idea what to expect both physically and emotionally. As the dying process enters its final stages there are two different dynamics at work. The physical aspect concerns the body as it begins its final process of shutting down; this ends the physical systems' functioning. The other dynamic is the emotional/mental and spiritual area which is a different process. This is where the spirit of the dying individual begins to slip away from its immediate environment and attachments. This release tends to follow its own priorities when it comes to letting go; of family members, unfinished business of a personal nature and/or unreconciled problems. You have all heard people tell how someone on their death bed refused to let go until a certain member of the family was able to get there. Even when the body is trying to shut down the spirit hangs on until a resolution is reached. It is as though the dying person needs permission to go; needs to feel that he has achieved the support and acceptance of his fate by those he leaves behind. This way he can slip into the next dimension of life with grace and dignity. There are FIVE stages of dying. There is in all of us a curiosity about dying. Regardless of your religious beliefs there have to be some doubts or shadows of uncertainty. There are five stages involved, some have time to proceed into each stage and come to a peaceful resolve. DENIAL: I'm too young to die. I'm not ready to die (is anyone ever really ready?). You don't just get up some morning and say, "Well, I'm ready to die today". Even when a physician informs one that nothing can be done for them the feeling that some mistake must have been made is in the dying person's mind. The prediction from ones physician of imminent death can do several things. It can give you time to prepare, take care of business, close doors, make amends. The shock begins to ebb as you come to grips with approaching death. ANGER: Suddenly you are not in control of your life, or death. You have no choice......you are going to die. You have always known this, no one has come out and stated it as a fact before. It makes you angry, you feel so helpless especially at first, then guilt climbs upon your back Anger is directed at everyone and no one in particular. It is a sense of loss of control which is likely not a new feeling if you have endured a long illness. It is normal. Anger is in its own, a sense of strength. It can also be debilitating. BARGAINING: You are willing now to compromise. No use denying it, anger comes and goes so perhaps you can make a deal with God! You are willing to promise to do or not to do specific things if only you can be given more time. It can be based on an upcoming event that is important to you. You can be suffering from insecurities regarding a member of your family or a loved one who you feel is yet dependent on you. There can be a rift that has never been eliminated that needs to be further addressed. You are not free to go until these reasons can be alleviated once and for all.
You are hoping yet and eager to deal! DEPRESSION: This is such a normal part of the process of preparing to die. You are already depressed about your incapability's in dealing with responsibility, projects and the situation of every day life. Symptoms of terminal illness are impossible to ignore. You are fully aware that death is inevitable. Aware, angry and filled with sorrow and here again the culprit of guilt sneaks in as you mourn for yourself and the pain that this is causing you family and loved ones. Another totally NORMAL phase. ACCEPTANCE: This comes after you work though the numerous conflicts and feelings that death brings. You can succumb to the inevitable as you become more tired and weakness hangs on. You become less emotional, calmness arrives and banishes fear along with joy or sadness. You realize the battle is almost over and now it's really alright for you to die. Hospice defines acceptance... Acceptance is NOT doing nothing, defeat, resignation or submission. Acceptance IS coming to terms with reality. It is accepting that the world will still go on without you. Death is after all, just a part of LIFE. @2001gould About the Author Barbara Gould
STAGES OF DEATH & DYING
How to Understand the Stages of Death and Dying By an eHow Contributor Death and dying is a process we all must go through, whether we are the person dying or the one who is left behind. Understanding this process can help you cope with your feelings surrounding the stages of death and dying. Read more: How to Understand the Stages of Death and Dying | eHow.com http://www.ehow.com/how_2065654_understand-stages-deathdying.html#ixzz27jHuDMTR 1. Understand that denial is the first of several steps or stages a person goes through when told he is dying. Denying the diagnosis and refusing to believe anything is wrong is the initial reaction of shock. 2
Allow the person to feel anger. The anger and frustration and "Why me?" stage sets in soon after denial, and the patient blames friends, physicians and even God for his illness. 3 Realize that bargaining and attempting to negotiate with physicians, friends and God for a cure is a normal stage in the process of death and dying. 4 Recognize signs of clinical depression and know this is a normal stage of death and dying. Withdrawal, sleep disturbances, feelings of hopelessness and suicidal thoughts are all part of the depression phase. 5 Accept death. Realizing it is inevitable is the last stage of the death and dying process.
Kubler-Ross Stages of Dying or Grief http://nursingcrib.com/nursing-notes-reviewer/kubler-ross-stages-of-dying-or-grief/ Precipitating Factors of Grief • • • • •
Death in family Separation Divorce Physical Illness Work failure disappointments
1. Denial • • • • • • • •
Initial response to protect the self from anxiety. “No not me”, “Its not true”, “Its not impossible” May continue to make impractical/unrealistic plans May comment that a mistake has been made about the diagnosis of terminal illness May appear normal and can continued ADL as if nothing is wrong May not conform with the advised treatment regimen Adaptive response – crying, verbal denial Maladptive response – absence or reaction such as crying.
2. Anger
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• • • • • •
Individual feel that they are victims of incompetence or a vengeful God (they did something wrong so they are being punished), fate (karma), circumstances (wrong place and wrong time). “Why me”, “What did I do to deserve this?” They seek for reasons, answers and explanations May express anger overtly – being irritable, impatient, critical verbally abusive. May express anger covertly by neglecting self, not eating, nor going to check ups, committing suicide, drinking alcohol. Adaptive response – verbal expression Maladaptive – persistent guilt or low self esteem, aggression, self destructive ideation or behavior.
3. Bargaining •
• • • •
The person try to inhibit good behavior, make up for perceived wrong doings or other engage in behaviors that would please GOD so he will be given more timean extension of life or granted recovery. “Yes, me but” “If I live until Christmas or until my child’s graduation ( So many if’s), I will do this…” Adaptive response – bargains for treatment control, express wish to be alive for specific events in the near future. Maladaptive response – bargains for unrealistic activities or events in the distant future.
4. Depression •
• • • • • •
Occurs when the reality of loss or impending loss cannot be ignored anymore and the person grieves for himself and those he will leave behind, for the things that he can no longer accomplish or experience. “Yes, I’m dying” Withdrawn, has no energy and interest to interact. Cries Makes few demands Adaptive response – crying, withdrawing from interaction Maladaptive response – self destructive actions, despair.
5. Acceptance • • • • •
Occurs when the person has come to peace with himself and others “Yes, I am ready” Stage of affective void – not happy nor sad Only persons who are highly significant to him stimulates a reaction. Others are merely tolerated. Makes realistic preparation
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Adaptive response – may wish to be alone, limit conversation, complete personal and family business.
Nursing Interventions: • • • • • • • • •
Assess; specific loss, meaning of loss, coping skills, support persons. Accept the client; do not respond personally to the client. Support adaptive responses; allow to express feelings Support defense mechanism – reassure client that denial and wanting to be alone is normal. Help find constructive outlets of anger. Do not take clients hostility personally. Do no retaliate. Monitor for self destructive behaviors Help express feelings: Ask how they feel Meet needs Allow as much decision making as possible to maintain dignity by giving choices and alternatives.
