Guest Contributor: Cheryl J. Bostelman MSN, RN

Nursing programs across the United States teach students using the latest research and evidence-based practices. The entire human lifespan, from conception to death, is brought into the nursing classroom. Death can unfortunately occur at any time during the lifespan. When administering palliative and hospice care, the topic of anticipatory grief is present. Patients are trying to come to terms with the end of their lives, and families are dealing with the impending loss of their loved ones.

How should nursing educators teach undergraduate nursing students about this natural human occurrence that is anticipatory grief? A suggested nursing curriculum by the author for anticipatory grief includes learning the definition of anticipatory grief, discussing individual experiences with grief, using the Peaceful End-of-Life theory, keeping a reflection journal, and participating in nursing simulation case studies. The purpose of this blog is to discuss the subject of anticipatory grief and how to incorporate the subject into the undergraduate nursing curriculum.

Anticipatory grief is defined as a type of grief that an individual experiences when faced with an impending loss. “Anticipatory grief is a state of deep, painful sorrow that occurs before an impending loss; it can affect people facing the impending death of a loved one or their own death” (Eldridge, 2026). Anticipatory grief is not a mental disorder, yet it can affect mental health, leading to intense distress, exhaustion, and burnout. Mental health disorders associated with anticipatory grief include anxiety, clinical depression, and prolonged grief (Fowler et al., 2013). Archuletta (2025), “When considering grief, we typically think first of painful emotions resulting from a loss or transition. In fact, we also experience anticipatory grief about upcoming events or situations we realize will bring disappointment, even expectations that we learn or sense will result in a different, unexpected outcome at some point in our lives”.

Nurses and the interdisciplinary healthcare team are essential to understanding and navigating anticipatory grief. Nurses use their knowledge and therapeutic communication skills to introduce patients and their families to resources that support end-of-life decision-making and advance care planning during this challenging time. Patients may choose to transition at home in more familiar surroundings or choose to spend their final days in a hospice facility. Palliative and hospice care planning will hopefully be implemented with the patient’s final wishes in mind. Sometimes, families unfortunately get caught up in their own feelings and do not consider what their loved ones would have wanted. This tug of war in anticipatory grief is a “state in which the family surrogates struggle to navigate between two instincts: ‘hold on and letting go,’ longing for the dying patient and seeking to protect them while also readying themselves for the patient’s death (Bouchal et al., 2015; Cholbi, 2019).

The application of Ruland and Moore’s Peaceful End-of-Life (PELT) is a useful tool for nurses to support their patients in navigating anticipatory grief. PELT can be used to facilitate therapeutic communication with patients and family members while providing nursing care. The Peaceful End of Life Theory was developed in 1998 by nurse theorists Cornelia Ruland and Shirley Moore. PELT is a middle-range theory intended for research, nursing practice, and education (Khan, 2023). The theory focuses on providing purposeful and dignified care in the time that remains for terminally ill patients, their families, and friends (Ruland & Moore, 1998). To achieve a peaceful end of life, the theory outlines five outcome criteria: (1) not being in pain, (2) experiencing comfort, (3) experiencing dignity and respect, (4) being at peace, and (5) closeness to significant others / and persons who care (Ruland & Moore, 1998). Under each of the five outcome criteria, there are examples of nursing interventions and how those interventions relate to a patient’s peaceful death. The PELT is currently relevant to nursing practice because it guides nurses in selecting interventions that alleviate suffering and help patients make the last stage of their lives a meaningful experience (Ruland & Moore, 1998). Using PELT can support individuals experiencing anticipatory grief by addressing anxiety and emotional distress, while promoting coping and preparedness in response to an impending loss. https://nursology.net/nurse-theories/peaceful-end-of-life/

Therapeutic communication and empathetic nursing care are essential tools for providing palliative and end-of-life care. Curriculum Ideas Course Assignments Nurse educators can introduce the concept of anticipatory grief to nursing students as a natural human occurrence. The following ideas for course assignments are suggestions on how to incorporate the concept of anticipatory grief into the nursing curriculum:

• Keep a Reflection Journal: Nursing students can keep a reflection journal during their clinical rotations in critical care areas, where palliative and hospice care planning may occur during observations of interdisciplinary care team meetings. Ask the students to discuss what role, if any, anticipatory grief plays in the decision-making process, based on the wishes of patients and their families.
• Write a Medical Power of Attorney: The nursing students are assigned to write a medical power of attorney and then discuss these plans as a debriefing exercise.
• Discussion topic: Discuss how anticipatory grief may affect a nurse’s clinical performance when providing care to seriously ill patients. Use of Nursing Simulation Nursing simulation labs have been proven to be most effective in nursing programs. Nursing students can practice their clinical skills in a designated and safe area. Just as Elisabeth Kübler-Ross introduced the five stages of death in her book Death and Dying, she also proposed that there are actual stages to grieving.

The five stages of grieving are denial, anger, bargaining, depression, and acceptance (Kübler-Ross & Kessler, 2005). In the simulation labs, students would be able to practice their communication skills discussing grief, palliative, and hospice care with dying patients and families, as well as performing physical nursing skills (Smothers, 2019). End-of-life simulation case studies can help enhance nursing students’ confidence in administering palliative and hospice care to patients. Student anxiety levels can be decreased with more palliative and hospice simulation practice time (Gurdogan et al., 2019).

Anticipatory grief is a type of grief that is experienced when faced with an impending loss, such as the death of a loved one. By incorporating anticipatory grief into the undergraduate nursing curriculum, nursing students gain working knowledge and understanding of the subject. Nursing educators can prepare prelicensure nursing students with this knowledge by defining the anticipatory grief phenomenon, incorporating Peaceful End-of-Life | Nursology, and including palliative and hospice care nursing assignments. These are just a few interventions that can be utilized in an undergraduate nursing curriculum to introduce the concept of anticipatory grief. More research is needed on anticipatory grief to enhance an existing palliative and hospice care nursing curriculum.

References:

Archuletta, C. (2025). Before the loss: Understanding anticipatory grief. NBCC | Before the Loss: Understanding Anticipatory Grief Bostelman, C. (2025).

The Peaceful End-of-Life Theory. Peaceful End-of-Life | Nursology. Cholbi, M. (2019). Holding on and letting go: Anticipatory grief and surrogate choices at the end of life. The American Journal of Bioethics: AJOB, 19(12), 42-43. doi: 10.4314/rjmhs.v4i3.11

Eldridge, L. (2026). What is Anticipatory Grief? Retrieved on May 7, 2026, from Very Well Health. https://www.verywellhealth.com/understanding-anticipatory-grief-and-symptoms-2248855

Fowler, N. R., Hansen, A. S., Barnato, A. E., & Garand, L. (2013). Association between anticipatory grief and problem solving among family caregivers of persons with cognitive impairment. Journal of Aging and Health, 25(3), 493-509. https://doi.org/10.1177/0898264313477133

Gurdogan, E.P., Kinici, E., & Aksoy, B. (2019). The relationship between death anxiety and attitudes toward the care of dying patient in nursing students. Psychology, Health, & Medicine, 24(7), 843-852. https://doi.org/10.1080/13548506.2019.1576914

Khan, K. (2023). Comparison of two nursing theories: Virginia Henderson’s “Need Theory” and “Peaceful End-of-Life theory”. I-Manager’s Journal of Nursing, 13(1), 1-6. https://doi.org/10.26634/jnur.13.1.19297

Kübler-Ross, E., & Kessler, D. (2014). On grief and grieving. Simon & Schuster. Smothers, A., Young, S., & Dai, Z. (2019). Prelicensure nursing students’ attitudes and perceptions of end-of-life care. Nurse Educator, 44(4), 222-225. https://doi.org/10.1097/NNE.0000000000000606

About Cheryl J. Bostelman

I’ve been a registered nurse since 2006, and I’m currently enrolled as a PhD student in the Nelda C. Stark College of Nursing at Texas Woman’s University. My research interest is in End-of-Life care education and its inclusion in BSN nursing curricula. In nursing programs, students are taught to administer nursing care across the human lifespan. The human population is aging, and population health is also declining. Death is a natural phenomenon that can occur at any time during the human lifespan. Undergraduate nursing students must receive clinical training to administer palliative and hospice care before graduating from baccalaureate nursing programs. According to the AACN guideline, one of the four core “Spheres of Nursing Care” of the BSN curriculum should be devoted to Palliative, Hospice, and Supportive Care. My dissertation research focuses on “How Baccalaureate Nurse Educators form their opinions on the AACN Guideline for one of the four core ‘Spheres of Nursing Care’ of the BSN curriculum be devoted to Palliative, Hospice, and Supportive Care: A Qualitative Analysis”.