The Grief Wheel

The Grief Wheel 150 150 Tony Guo

The Grief Wheel


Numbness, denial, disbelief, hysteria, inability to think straight


Strong, powerful feelings of anger, guilt, sadness, fear, yearning, and searching


Overwhelming bleakness, despair, apathy, anxiety, and confusion


Gradual return to normal functioning, but feelings are different

Grief Support

Bereavement programs assist survivors transition to life without the deceased person

Should be integrated into the plan of care before as well as after the death

Spiritual Needs

At the end of life, many patients question their beliefs about a higher power, their own journey through life, religion, and an afterlife

Spirituality is associated with decreased despair at EOL

Spiritual distress may occur

Many turn to religion because it may provide order to the world even in the presence of physical decline, social losses, suffering, and impending death.

Religion may offer an existential meaning that offers a sense of peace and recognition of one’s place in the broader cosmic context

Culturally Competent Care: End of Life

Cultural beliefs affect

Understanding of and reaction to death or loss

Treatment decisions

Cultural differences in relation to death and dying varies

Rituals associated with dying are part of all cultures

Ensure adequate information for those who don’t speak English

Pay attention to nonverbal cues

Make nursing assessment of beliefs and preferences on an individual basis

Use open-ended questions to guide planning and evaluation of care

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