Elisabeth Kübler-Ross and the 5 Stages Model in a Sampling of Recent North American Nursing Textbooks

Abstract

Nursing education programs and nursing textbooks often present accounts of the work of Dr Elisabeth Kübler-Ross and her “5 stages” model. In this article, we examine a sampling of recent North American nursing textbooks to illustrate the different ways those subjects are discussed. Unfortunately, the information provided is not always accurate or helpful in guiding readers. We describe why that is so and suggest some ways in which better guidance could be delivered. It is particularly timely to undertake this examination since 2019 is the 50th anniversary of the publication of On Death and Dying, the well-known book in which Dr Kübler-Ross first published her theory and descriptions of the work that led to it.

Propaganda and Education Can Improve the Quality of Life of Patients With Urologic Cancer Before Surgery

“…After patients were diagnosed with cancer, they may undergo drastic psychological changes in the time interval from diagnosis to operation. They may experience the same "5 stages" as patients with a terminal illness do based on our observation: denial, anger, bargaining, depression, and acceptance in sequence (5). Stress often comes from the unknown and the description of disease from relatives or the Internet is full of contradictions and inconsistencies, which together aggravates patients' psychological stress.…”

An End-of-Life Communication Performance Rubric

“…According to Dugan, 1 the Kübler-Ross stages allow health care providers to work through insecurities and improve competency and comfort level during EOL discussions with patients, families, and peers. The grief stages are not linear and therefore may be experienced in any order 37 . The bereaved may go back and forth between stages or may skip stages altogether.…”

“…34 This teaching strategy is meant to increase insight and empathy during EOL conversations. 35 Using role-play in the classroom, students practiced responding to different grief reactions framed around Dr Elisabeth Kübler-Ross' 36,37 stages of grief. Creating an empathic nurse is both challenging and vital for quality care.…”

“…The grief stages are not linear and therefore may be experienced in any order. 37 The bereaved may go back and forth between stages or may skip stages altogether. Although our health care and life trajectory have changed drastically since 1969, Kübler-Ross's grief reaction model still serves to facilitate empathy and EOL communication skills in nursing education.…”

“…Although our health care and life trajectory have changed drastically since 1969, Kübler-Ross's grief reaction model still serves to facilitate empathy and EOL communication skills in nursing education. 37 The simulation scenarios and rubric were framed around students responding to Kübler-Ross's grief reactions. Each student participated in 1 of 2 scenarios.…”