Nursing the dying: implications of Kübler-Ross' staging theory.

Society's failure to value the work of nurses, the professionals most frequently involved in the care of the dying, is attributed to a cultural definition of nursing as a second-class occupation and the public's need to deny the realities of the suffering and indignities often associated with the process of dying. Efforts within the field of nursing to improve the care of the dying, by shifting emphasis from a narrow physical focus to a more holistic patient and family focus, preceded the past decade's contributions of Elisabeth Kübler-Ross. Although her staging theory has been cited as having limitations in development and in interpretation, Kübler-Ross' influence towards increasing awareness of the needs of the dying and others experiencing major losses has been substantial as evidenced by many references to staging theory in nursing literature, by a marked increase in attention to holistic care of the dying in the basic and continuing education programs of nursing, and by specialty role development in nursing care of the dying. This decade has also witnessed the major growth of professionalism in nursing, including strides towards professional autonomy. Conflict with the traditional pattern of medical dominance and bureacratic constraints in institutions is inevitable, especially when the medical goal of cure is not attainable. Change to an interdisciplinary model of care is viewed as essential for optimal care of the dying and their families.