Patients can experience these stages in
random order for varying lengths of time
and often revisit them, which poses
difficulties for nurses as one day a patient
may appear to be accepting his or her
situation, but the next day the same patient
may be back to being tearful and angry.16
Nurses therefore need to be astute in order
to establish which stage their patients are at
on each occasion they care for them.
Another interesting element of the two
models is that they suggest that denial is a
normal reaction. This may come as a
surprise to some nurses, as it is often
believed that the patient in denial is failing
to cope and adjust. In fact, denial is a
defense mechanism used by patients to
protect themselves from overwhelming
situations and give themselves time to
assimilate the impact of the illness.17
The use of denial by most patients will
gradually diminish as they come to
terms with the threats imposed by their
illness.