Table of Contents
The philosophy of nursing, which underlies all nursing and non-nursing theories, describes a system of views on the relationship between a nurse, a patient, society, and the environment. The philosophy of nursing is a theoretical foundation of the nursing profession, revealing the main provisions that determine its meaning, direction, and role in society.
For example, many people know the theory according to which grief goes through several stages when a person receives unbearable information. Its scope is wide: from hospices to company boards of directors (da Maia et al., 2017). When the Swiss psychiatrist Elisabeth Kubler-Ross began working in American hospitals in 1958, she was struck by the lack of methods of psychological assistance to the dying patient. Kubler-Ross graduated from the Faculty of Medicine at the University of Zurich, after which she left for the United States in 1958. She has worked extensively in hospitals in New York, Chicago, and Colorado, deeply resenting the treatment of dying patients by doctors. Unlike her colleagues, she communicated with the dying, listened to their stories about the emotions they felt. This is how her course of lectures on near-death experiences came about. She began teaching workshops with medical students at Colorado State University based on her conversations with cancer patients about how they thought and felt (Alligood, 2018). Later, based on the results of her observations and conversations, in 1969, she published a book On Death and Dying, in which she cited typical statements of her patients, and then moved on to a discussion of how to help doomed people leave life without fear and torment.
Kübler-Ross described in detail the five emotional states that a person goes through after knowing a fatal diagnosis: denial, anger, bargaining, depression, acceptance. She considered all five stages to be protective mechanisms of the psyche, which are triggered in an extremely difficult situation (Newman, 2004). A separate chapter of her book is devoted to each of the stages. In addition to the five main ones, the author singled out intermediate states – the first shock, preliminary grief, hope – in total, from 10 to 13 types. Below, there is a detailed description of each of the five main stages (Alligood, 2018):
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The first stage is denial and isolation. Usually, shock and denial arise in patients who were told a fatal diagnosis at the very beginning of the development of the disease, or in those who guessed it themselves. Too strong shock is present in patients to whom this news was prematurely and unexpectedly reported by a person who does not know the patient well or who was not prepared. Denial and shock are common in almost all patients and not only in the early stages of the disease. Shock, according to Kübler-Ross, acts as a form of protection; it softens unexpected strikes and allows the patient to arrange his/her thoughts, and later use other, less radical forms of protection. After the shock comes the stage of denial, which later transforms into the stage of partial denial.
The second stage is anger. When the patient is unable to deny the obvious, he is overwhelmed with rage, irritation, envy, and resentment. He asks the question: “Why me?” In this case, it is difficult for the patient’s family and hospital staff to communicate with the patient. The patient suddenly throws out his indignation on others; he scolds the doctors for keeping him in the hospital for too long, the nurses for being either too annoying or indifferent, and visiting relatives cause only irritation and anger in the patient, which leads relatives to a state of grief.
The third stage is bargaining. This stage is rather short; during it, the patient is trying to “negotiate” with the disease. He/she knows that good behavior is rewarded; at first, the patient desires to prolong life, and later they are replaced by hope for at least a few days without pain and inconvenience, or hope for the fulfillment of a cherished desire. In essence, the deal is an attempt to delay the inevitable. It not only defines the award for “good behavior,” but also establishes a certain “final line”. If the dream comes true, the patient promises not to ask for anything else. At the same time, usually, no one keeps his words.
The fourth stage is depression. Numbness, irritability, and res
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