Key Takeaways
- Grief is the emotional response to loss, which may include death, health, independence, or relationships
- Kubler-Ross identified five stages: denial, anger, bargaining, depression, and acceptance (not always sequential)
- Anticipatory grief occurs before an expected loss and can help with adaptation
- Complicated grief is prolonged, intense grief that interferes with daily functioning
- The LPN/LVN supports patients and families through the grief process with presence, listening, and appropriate referrals
Last updated: January 2026
Grief and Loss
Grief is the emotional response to loss. Patients experience many types of losses during illness, and the LPN/LVN must be prepared to provide compassionate support.
Types of Loss
| Type | Examples |
|---|---|
| Death | Loss of loved one, impending own death |
| Health | Diagnosis of chronic or terminal illness |
| Body part or function | Amputation, paralysis, mastectomy |
| Independence | Inability to drive, need for assistance |
| Role | Job loss, change in family role |
| Relationship | Divorce, separation, estrangement |
| Security | Financial loss, housing loss |
| Dreams/hopes | Infertility, career loss |
Kubler-Ross Stages of Grief
Five Stages (Not Always Sequential):
| Stage | Description | Example Statement |
|---|---|---|
| Denial | Refusing to believe reality | "This can't be happening." |
| Anger | Frustration at the unfairness | "Why me? This isn't fair!" |
| Bargaining | Trying to negotiate | "If I do everything right, maybe..." |
| Depression | Sadness at the reality | "What's the point of anything?" |
| Acceptance | Coming to terms | "I'm going to make the most of my time." |
Important Notes:
- Not everyone experiences all stages
- Stages may occur in any order
- People may move back and forth
- No "right" way to grieve
- The model is a framework, not a prescription
Types of Grief
| Type | Description |
|---|---|
| Normal grief | Expected emotional response to loss |
| Anticipatory grief | Grief before expected loss (terminal illness) |
| Disenfranchised grief | Loss not openly acknowledged (miscarriage, pet death) |
| Complicated grief | Prolonged, intense grief interfering with function |
| Delayed grief | Grief that emerges much later |
Manifestations of Grief
Physical:
- Fatigue
- Sleep disturbances
- Appetite changes
- Somatic symptoms
- Weakened immune system
Emotional:
- Sadness
- Anxiety
- Guilt
- Anger
- Loneliness
- Numbness
Cognitive:
- Confusion
- Difficulty concentrating
- Preoccupation with loss
- Dreams of deceased
Behavioral:
- Crying
- Social withdrawal
- Searching for deceased
- Avoidance of reminders
- Changed routines
Complicated Grief
Signs of Complicated Grief:
- Intense grief lasting more than 12 months
- Inability to accept the death
- Persistent difficulty functioning
- Constant yearning for deceased
- Feeling life is meaningless
- Inability to engage in activities
- Social withdrawal
Risk Factors:
- Sudden or traumatic loss
- Multiple losses
- Ambivalent relationship with deceased
- Limited support system
- History of mental health issues
- Dependent relationship
Nursing Support for Grieving Patients
Do:
| Action | Purpose |
|---|---|
| Be present | Shows you care |
| Listen actively | Allows expression of feelings |
| Use silence | Gives space to process |
| Validate feelings | Normalizes the experience |
| Offer practical support | Helps with immediate needs |
| Follow patient's lead | Respects their process |
| Acknowledge the loss | Shows recognition of their pain |
Say:
- "I'm so sorry for your loss."
- "I'm here if you want to talk."
- "It's okay to cry."
- "How can I support you right now?"
- "There's no right way to grieve."
Avoid:
| Action | Why |
|---|---|
| "I know how you feel" | You can't fully know their experience |
| "They're in a better place" | May not match their beliefs |
| "At least they're not suffering" | Minimizes their grief |
| "Time heals all wounds" | Feels dismissive |
| "You need to be strong" | Invalidates feelings |
| Changing the subject | Avoids their needs |
Supporting Families
Family Needs:
- Information about what to expect
- Presence and support
- Privacy for grieving
- Assistance with practical matters
- Connection with resources (chaplain, social work)
- Follow-up support
Cultural Considerations in Grief
| Culture | Potential Practices |
|---|---|
| Many Latino cultures | Extended mourning period, large family involvement |
| Some Asian cultures | Restraint of emotions in public |
| Jewish tradition | Shiva period of mourning, specific rituals |
| Islamic tradition | Specific burial practices, mourning periods |
| Some African cultures | Celebration of life, communal grieving |
Nursing Approach:
- Ask about cultural practices
- Facilitate family/religious rituals
- Respect varying emotional expressions
- Don't impose your own expectations
End-of-Life Care
LPN/LVN Role:
- Provide comfort measures
- Support dignity and respect
- Communicate with patient and family
- Report changes to RN
- Assist with family presence
- Provide post-mortem care
On the NCLEX-PN
Expect questions about:
- Stages of grief and normal manifestations
- Appropriate nursing responses to grief
- Recognizing complicated grief
- Cultural considerations in grief support
Test Your Knowledge
A patient whose spouse recently died says, "If only I had insisted they see the doctor sooner." This statement most likely reflects which stage of grief?
A
B
C
D
Test Your Knowledge
A patient who lost their husband 14 months ago is still unable to work, refuses to leave the house, and says life has no meaning without him. This most likely represents:
A
B
C
D
Test Your Knowledge
A family member of a dying patient is crying and asks the LPN, "Why is this happening to us?" The most therapeutic response is:
A
B
C
D