Outside-the-Box Ideas for Nurses to Manage Grief
By Debra Wood, RN, contributor
During the COVID-19 pandemic, nurses and others are experiencing personal grief and a collective grief associated with not only the massive loss of life but also the less-tangible losses associated with everyone’s former and more predictable lives.
However, there are ways to manage grief as a nurse.
“When people are swimming and often drowning in a sea of loss, there must be so few opportunities to process that and support each other,” said Robert Neimeyer, PhD, director of the Portland Institute for Loss and Transition in Portland, Oregon, and professor emeritus of psychology at the University of Memphis.
“In some ways, nursing staff, more than other healthcare professionals, represent the unrecognized grievers and mourners,” Neimeyer added.
Nurses have so much contact with patients, which contributes to the feelings of loss and grief when a patient dies.
Grief extends beyond death. Nurses and others can experience grief for other losses, social groups who cannot get together, income and economic issues, and core beliefs, such as life is predictable and we have a sense of control, Neimeyer explained. Now those assumptions have been invalidated.
“Whenever we lose someone or something that we really cherish and rely on that provides a secure base for us in life, then we grieve the loss,” he said. “There are no rituals for those nondeath losses.”
Personal and collective grief
There are two types of loss: personal and collective. Personal grief relates to what the nurse feels as he or she cares for patients who are dying, often without family members present.
“The level of personal grief depends on your own history with loss,” said Sherry Cormier, PhD, in Annapolis, Maryland, author of Sweet Sorrow: Finding Enduring Wholeness after Loss and Grief.
The loss of patients can retrigger feelings about prior personal losses, she explained.
The pandemic has created a shared collective grief, as the world experiences COVID-19 deaths and changes to routines and connections with others.
“We are all losing something together,” Cormier said. “We are all losing loss of routines.”
Additionally, people, including nurses, may be losing the traditional ways of celebrating holidays, children may be learning at home rather than at school, and many people have lost their jobs.
In prior episodes of shared grief, such as after September 11, 2001, people could come together and support each other and take part in community rituals to process the grief.
Now, people must process grief in different ways, perhaps through virtual meetings. But if a nurse does not process the grief as it occurs, it gets suppressed rather than healed, Cornier explained.
“Finding ways to process grief collectively is important, because it leads to collective growth,” she said, adding that processing grief can help develop coping skills and resilience.
Ideas to manage grief
There are ways to manage grief as a nurse.
“A starting point is to recognize and acknowledge it,” Neimeyer said.
Experiencing grief is not the same as stress or depression.
“Grief is not a pathological condition, like high levels of stress,” he added. “Grief is a natural human response to the disruption of an attachment bond with someone, even with our patients.”
Neimeyer said if nurses are given the time, they can think through the losses and what can be restored and support one another.
In an elder care facility that had experienced a lot of death, Neimeyer reported that the nurses brainstormed and came up with several ideas, including allowing a moment of silence during weekly staff meetings or reading the names of the people who died that week.
The nurses also came up with an idea of putting a table with cards in the break room. That way they could write on the cards about their memories of each person lost and then send those cards to the patients’ family members.
“As they began to take these steps, these nurses began to feel less disempowered,” Neimeyer said. “There was a place for their grief and a place for their professional contribution to the welfare of the family.”
Sometimes, clinicians can create a ritual, such as to bless one another’s hands.
“There are many ways people can invent to create a way to ritualize their losses,” said Neimeyer, adding, “the act of acknowledging someone we cared about and lost, the act of honoring that person, helps in small ways.”
Cormier recommended scheduling a time to talk or cry or share feelings with fellow nurses about the losses. That connection limits feelings of isolation. Set a limit on that time, such as 30 minutes, to avoid wallowing in the grief.
Writing about feelings in a journal can help express emotions. Regular journal writing, three times a week, without editing, can improve mood, decrease emotions, relieve stress, and improve immune system functioning, Cormier said.
“It’s like live-streaming our thoughts but writing them down,” she explained. “It helps us find meaning in the work we are doing.”
For additional ideas to manage grief, Cormier advised limiting exposure to the news and social media, exercising, getting enough sleep, eating nourishing foods, walking in nature and practicing gratitude.
“This is an important time to utilize self-care,” Cormier added. “We get so busy taking care of other people and their illness and distress, we forget to put self-care into place.”
When bereavement and grief are adversely affecting work and professional life, Cormier said that is time to reach out for professional help. Counseling can help people overcome problematic or prolonged grief. Not all nurses will require professional help.
“Sadness is appropriate here,” Neimeyer said. “It’s not a pathology.”
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