Choices: Engel, Parkes, Demi, Kubler-Ross

1. Denial
2. Anger
3. Barganing
4. Depression
5. Acceptance

Choices: Engel, Parkes, Demi, Kubler-Ross

1. Numbness
2. Yearning
3. Disorganization
4. Reorganization

Choices: Engel, Parkes, Demi, Kubler-Ross

1. shock and disbelief
2. developing awareness
3. restitution
4. resolving the loss
5. idealization
6. outcome

Choices: Engel, Parkes, Demi, Kubler-Ross

1. shock
2. protest
3. disorganization
4. reorganization

Choices: Shock, Protest, Disorganization, Reorganization

• slow and disorganized thinking
• blocking of thoughts
• wish to join deceased
• thoughts of suicide
• denial of the loss and its significance 

Choices: Shock, Protest, Disorganization, Reorganization

• Blocking of emotions
• emotional outbursts
• may appear unaffected
• emotionally numb
• feeling of unreality

Choices: Shock, Protest, Disorganization, Reorganization

• feels physically numb
• hyperactive/underactive, immobile
• passive
• unaware of others

Choices: Shock, Protest, Disorganization, Reorganization

• Preoccupation with thoughts of deceased
• searching for deceased
• dreams/nightmares
• hallucinations
• concerns about others' health and safety
• continued death wishes

Choices: Shock, Protest, Disorganization, Reorganization

• sadness
• anger
• guilt
• relief
• anxiety
• yearning for deceased
• feel deceased's presence

Choices: Shock, Protest, Disorganization, Reorganization

• Pain in heart
• sleep or appetite problems
• weight loss
• neglect of appearance
• fatigue
• lethargy
• poor hygiene
• depends on others
• seeks help and advice of others

Choices: Shock, Protest, Disorganization, Reorganization

• difficulty making decisions
• aimlessness
• loss of interest in people, work, usual activities
• perception of life as meaningless
• focus on memories and reminders of deceased

Choices: Shock, Protest, Disorganization, Reorganization

• Depression
• loneliness
• meaninglessness
• decreased self-esteem
• apathy

Choices: Shock, Protest, Disorganization, Reorganization

• continued sleep and appetite problems
• restlessness
• decreased sexual interest/satisfaction
• aimless activity
• decreased resistance to illness
• accident prone
• increased drug/alcohol intake
• loss of interest in people and work

Choices: Shock, Protest, Disorganization, Reorganization

• Realistic memory of deceased
• comfortable when remembering deceased
• return to previous level of ability
• feels life has meaning
• able to experience pleasure

Choices: Shock, Protest, Disorganization, Reorganization

• renewed vigor
• restoration to previous level of health
• improved health habits
• sexual drive renewed
• new or renewed social relationships
• development of close relationship w/at least 1 person

May be Normal at 1 Year After Bereavement

• excessive or persistent expression of affect
• inability to experience joy
• clinical symptoms of depression
• inability to form new relationships
• inability to speak of the deceased w/out intense emotion
• hearing or seeing the deceased
• feelings of emptiness or meaninglessness

• Leaving the deceased's room and belongings intact
• reporting physical symptoms similar to those the deceased had before death
• talking about the loss as if it had just happened
• inability to remember or talk about the deceased
• being preoccupied with thoughts of the deceased
• talking or acting as if the deceased were still alive
• experiencing physical illness that seems to be related to the loss

Appropriate interventions for which phase of grief: Shock, Protest, Disorganization, or Reorganization

• help patient mobilize support system
• protect patient from p hysical harm
• have a family member present when notifying patient of a loss
• have someone drive patient home
• help patient establish comping behaviors used in past
• encourage patient to participate in mourning rituals

Appropriate interventions for which phase of grief: Shock, Protest, Disorganization, or Reorganization

• encourage expression of diverse feelings
• encourage remembering and talking about that which was lost
• provide anticipatory guidance regarding the normal grief process
• provide role models who have successfully coped with similar loss
• encourage patient to use existing support systems and identify new ones
• promote appropriate sleep habits
• promote good nutrition
• encourage participation in religious rituals
• encourage use of previous healthy coping behaviors
• introduce new coping behaviors

Appropriate interventions for which phase of grief: Shock, Protest, Disorganization, or Reorganization

• continue interventions begun in shock phase
• refer patient to self-help groups
• refer patient for individual or group counseling

Appropriate interventions for which phase of grief: Shock, Protest, Disorganization, or Reorganization

• refer patient for career counseling
• refer patient to educational programs
• refer patient to social activity programs