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5.7 Grief and End-of-Life Care

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NCLEX-RN Registered Nurse

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1 Introduction

About the NCLEX-RN Exam Next Generation NCLEX (NGN) Clinical Judgment Measurement Model (NCJMM) How to Use This Course

2 Chapter 2: Management of Care

2.1 Legal Rights and Responsibilities 2.2 Advance Directives and Self-Determination 2.3 Informed Consent Protocols 2.4 Client Advocacy and Rights (HIPAA) 2.5 Assignment, Delegation, and Supervision 2.6 Five Rights of Delegation 2.7 Scope of Practice (RN vs LPN vs UAP) 2.8 Ethical Practice Principles

3 Chapter 3: Safety and Infection Prevention and Control

3.1 Standard Precautions and Hand Hygiene 3.2 Transmission-Based Precautions (Contact, Droplet, Airborne) 3.3 PPE Donning and Doffing Sequences 3.4 Fall Prevention and Restraints 3.5 Fire Safety (RACE/PASS) 3.6 Disaster Triage and Emergency Response

4 Chapter 4: Health Promotion and Maintenance

4.1 Growth and Development (Erikson/Piaget) 4.2 Developmental Stages: Infancy through Older Adult 4.3 Maternal and Newborn Care (Antepartum) 4.4 Intrapartum Care and Fetal Monitoring 4.5 Postpartum Care (BUBBLE-HE) 4.6 Health Screening Guidelines 4.7 Immunization Schedules

5 Chapter 5: Psychosocial Integrity

5.1 Therapeutic Communication Techniques 5.2 Non-Therapeutic Communication (What to Avoid) 5.3 Anxiety Disorders and Mental Health Concepts 5.4 Schizophrenia: Hallucinations and Delusions 5.5 Depression and Suicide Assessment 5.6 Substance Misuse and Withdrawal 5.7 Grief and End-of-Life Care

6 Chapter 6: Basic Care and Comfort

6.1 Mobility and Hazards of Immobility 6.2 Assistive Devices (Crutches, Canes, Walkers) 6.3 Nutrition and Diet Therapy 6.4 Enteral Nutrition (Tube Feeding) 6.5 Bowel Elimination and Ostomy Care 6.6 Urinary Elimination and Catheter Care

7 Chapter 7: Pharmacological and Parenteral Therapies

7.1 Medication Administration Rights 7.2 Medication Calculations 7.3 High-Alert Medications: Insulins 7.4 High-Alert Medications: Anticoagulants 7.5 High-Alert Medications: Opioids 7.6 High-Alert Medications: Digoxin and Electrolytes 7.7 IV Therapy and Complications 7.8 Blood Product Administration 7.9 Total Parenteral Nutrition (TPN)

8 Chapter 8: Reduction of Risk Potential

8.1 Laboratory Values: Hematology (CBC) 8.2 Laboratory Values: Metabolic Panel (BMP) 8.3 Laboratory Values: Coagulation Studies 8.4 Vital Signs and Trend Recognition 8.5 Perioperative Care (Pre-Op and Post-Op) 8.6 Nasogastric Tubes and Therapeutic Procedures

9 Chapter 9: Physiological Adaptation

9.1 Fluid Imbalances (Hypovolemia and Hypervolemia) 9.2 Arterial Blood Gases (ABGs) and Acid-Base Balance 9.3 Medical Emergencies: Stroke (CVA) 9.4 Medical Emergencies: Myocardial Infarction (MONA) 9.5 Diabetic Emergencies (Hypoglycemia and DKA) 9.6 Respiratory Conditions (COPD, Pneumonia) 9.7 Cardiac Conditions (Heart Failure) 9.8 Neurological Conditions (Seizures)

5.7 Grief and End-of-Life Care

Key Takeaways Explain This Topic AI

Kubler-Ross identified five stages of grief: Denial, Anger, Bargaining, Depression, and Acceptance (not linear, may not experience all)

Palliative care focuses on symptom management and quality of life alongside curative treatment for serious illness

Hospice care is for clients with prognosis of 6 months or less when curative treatment has stopped; focus is entirely on comfort

Anticipatory grief occurs before an expected loss and can help with adjustment but may also cause premature emotional detachment

  • Cultural and spiritual beliefs significantly influence how individuals and families experience grief and death
  • Last updated: October 2026

Death and loss are inevitable parts of life. Nurses encounter grieving clients and families regularly, whether in hospice settings, hospitals, or clinics. Understanding the grief process and providing compassionate end-of-life care are essential nursing competencies tested on the NCLEX.

Understanding Grief

Grief is the internal experience of loss. It affects every dimension of human functioning.

Types of Grief

  • Type Description
  • Normal/Uncomplicated Expected response; painful but resolves over time
  • Anticipatory Grief that occurs before an expected loss
  • Complicated/Prolonged Grief that is intense, prolonged, or impairs functioning beyond expected timeframes
  • Disenfranchised Grief that is not socially acknowledged (e.g., loss of a pet, ex-partner, miscarriage)
  • Manifestations of Grief

Grief affects the whole person:

  • Domain Manifestations
  • Physical Fatigue, changes in appetite/sleep, somatic complaints, weakened immunity
  • Emotional Sadness, anger, guilt, anxiety, numbness, yearning
  • Cognitive Difficulty concentrating, confusion, preoccupation with the deceased, questioning meaning
  • Behavioral Crying, social withdrawal, restlessness, searching behaviors
  • Spiritual Questioning faith, searching for meaning, spiritual distress or growth
  • Kubler-Ross Stages of Grief

Dr. Elisabeth Kubler-Ross identified five stages of grief based on her work with dying patients. These stages are now applied to many types of loss.

The Five Stages

  • Stage Description Client Behaviors/Statements
  • Denial Defense mechanism; shock and disbelief "This can't be happening." "There must be a mistake."

Anger Frustration directed at self, others, God, situation "Why me?" "It's not fair!" May lash out at staff or family

  • Bargaining Attempting to negotiate or make deals "If I could just live until my daughter's wedding..."
  • Depression Deep sadness as reality sets in Crying, withdrawal, "What's the point?"
  • Acceptance Coming to terms with the loss Making final arrangements, saying goodbyes, finding peace
  • Important Points About the Stages
  • Not linear - People do not progress neatly through stages; they may move back and forth
  • Not universal - Some people may not experience all stages
  • No timeline - Each person grieves at their own pace
  • Individual experience - Grief is unique; there is no "right" way to grieve
  • Applied broadly - Originally about dying, now used for any significant loss
  • Types of End-of-Life Care
  • Palliative Care

Palliative care focuses on improving quality of life for clients with serious illness. It can be provided alongside curative treatment .

Key features:

  • Symptom management (pain, nausea, dyspnea)
  • Emotional and spiritual support
  • Help with decision-making
  • Care coordination
  • Available at any stage of illness
  • Does NOT mean giving up on treatment
  • Hospice Care

Hospice care is for clients with a terminal prognosis of 6 months or less when curative treatment has stopped.

Key features:

  • Focus entirely on comfort
  • No curative intent
  • Usually provided at home or in hospice facilities
  • Includes family support
  • Bereavement support for family after death
  • Covered by Medicare, Medicaid, most insurance
  • Comparison
  • Feature Palliative Care Hospice Care
  • Prognosis Any serious illness Less than 6 months
  • Curative treatment May continue Discontinued
  • Setting Hospital, clinic, home Usually home or hospice facility
  • Goals Improve quality of life Comfort, dignity at end of life
  • When starts At diagnosis of serious illness When death is expected
  • Nursing Care at End of Life
  • Physical Comfort
  • Symptom Interventions
  • Pain Opioids (morphine common); schedule medications
  • Dyspnea Low-dose opioids, positioning, fan near face, oxygen if helpful
  • Nausea Antiemetics, small frequent meals, avoid strong odors
  • Secretions Positioning, gentle suctioning if distressing, scopolamine
  • Constipation Bowel regimen with opioids (scheduled stimulant laxative such as senna)
  • Restlessness Assess for pain, benzodiazepines if agitated
  • Signs of Approaching Death
  • Sign Explanation
  • Decreased food/fluid intake Body slowing down; do not force feed
  • Increased sleep Conservation of energy
  • Withdrawal Detachment from environment
  • Confusion/disorientation Decreased oxygenation, metabolic changes
  • Mottled skin Decreased circulation
  • Changes in breathing Cheyne-Stokes pattern, death rattle
  • Cool extremities Blood shunting to vital organs
  • Decreased urine output Kidney shutdown
  • Supporting Grieving Clients and Families
  • Therapeutic Interventions
  • Intervention Example
  • Presence Sitting with the client/family without need for words
  • Active listening Giving full attention without trying to fix
  • Normalizing grief "Grief can feel overwhelming. What you're experiencing is normal."
  • Avoiding cliches Do NOT say "They're in a better place" or "Everything happens for a reason"
  • Encouraging expression "Tell me about your father."
  • Providing resources Chaplain, social worker, support groups
  • What NOT to Say
  • Non-Therapeutic Why It's Harmful
  • "I know how you feel." You can't; each person's grief is unique
  • "It was God's will." May not match their beliefs; feels dismissive
  • "At least they lived a long life." Minimizes the pain of loss
  • "You need to be strong." Gives permission to suppress grief
  • "They're in a better place." May not be comforting; assumes beliefs
  • "Call me if you need anything." Too vague; offer specific help
  • Therapeutic Responses
  • Situation Therapeutic Response
  • Family member crying "I can see how much pain you're in. I'm here with you."
  • "Why did this happen?" "I wish I had an answer. This must feel so unfair."
  • Anger at healthcare team "You're angry about what happened. Tell me more."
  • Guilt about decision "You made the best decision you could with the information you had."
  • Cultural Considerations

Grief and death practices vary significantly across cultures. Nurses must:

  • Ask about preferences rather than assume
  • Respect religious and cultural rituals
  • Accommodate family involvement in care
  • Recognize diverse expressions of grief
  • Provide culturally sensitive foods and practices when possible
  • Examples of Cultural Variations
  • Culture Practices (Generalizations)
  • Some Asian cultures White is color of mourning; family prepares body
  • Some Latino cultures Extended family vigil; open expression of grief
  • Some Jewish traditions Prompt burial; week-long shiva period
  • Some Muslim traditions Body washed/wrapped by same-sex family; burial within 24 hours
  • Some Native American traditions Rituals vary by tribe; may involve extended ceremonies

Remember: Never assume practices based on culture. Always ask the individual and family.

Anticipatory Grief

Anticipatory grief occurs before an expected loss.

Benefits:

  • Time to prepare emotionally
  • Opportunity to say goodbye
  • Chance to complete unfinished business
  • May ease adjustment after death

Challenges:

  • Prolonged period of distress
  • May cause premature detachment
  • Others may not understand ("They're not even dead yet")
  • On the Exam

NCLEX focus areas:

  • Kubler-Ross stages are NOT linear
  • Palliative = comfort WITH curative treatment
  • Hospice = comfort INSTEAD of curative treatment; <6 months prognosis
  • Therapeutic presence > saying the "right" thing
  • Avoid cliches and false reassurance
  • Respect cultural differences in grief