Apreviously occupied room is now empty because the resident has passed away. Pictures still hang on the walls, clothes fill the closet, personal items are in the dresser drawers; the bed has been carefully made. The nursing staff must continue to go about their business in the halls and in other resident rooms, although some carry grief locked in their hearts, trying to be professional but finding it difficult to cope.
Even now, in the new millennium, many of us have not learned how, or taught others how, to grieve or how to cope with the mortality of patients and residents. It is assumed that we know how to grieve. Often in our culture, we are expected to go on as if nothing has happened, so as not to burden others with our pain. But pain and loss are part of life. We can learn to grieve well, to seek healing and growth, or we can choose to deny our emotions and suffer even more pain.
“Acknowledging loss is important when coping with death and dying in any environment. When we experience several deaths of people we have known without acknowledging our feelings or the actual loss, grief seems to build up and can contribute to a profound sense of loss without the benefit of an outlet,” says Carol Luecke, chaplain for Northwood Deaconess Health Center (NDHC) in Northwood, North Dakota. “Staff should be encouraged to discuss their feelings with each other or another person they feel comfortable with. Staff members must be able to come to terms with death in their own lives so that they can be more effective caregivers. Those who cannot do this will undoubtedly avoid end-of-life situations and residents who are in the process of dying. They feel guilty because of what they should or should not have done to contribute to the resident's life or death experience, must confront their feelings, and let them go. They must learn to forgive themselves and others,” advises Luecke, who is the founder of the NDHC's End of Life Program.
Implemented not only for relatives but to help NDHC staff to deal with issues of grief and grieving, as well, the End of Life Program is initiated when a resident is near death. A dedicated cart laden with items intended to show reverence and respect is taken to the resident's room. A vase of silk roses is prominently displayed on the cart along with inspirational items. Refreshments are provided for visiting family and friends, who are encouraged to visit often and are invited to stay over if desired. NDHC is a small facility, but often room can be found for a family member to stay near his or her loved one.
Nursing staff are encouraged to visit with the family and the resident whenever possible. After the resident passes and his or her body is removed, a short devotional service is held for those employees who wish to attend. Finally, the room is placed in order, the door is closed, and a card is placed on it to acknowledge the resident's passing. The card, in keeping with the tradition, is adorned with a single rose. To assist employees in the grieving process, entry to the room is encouraged for several days.
Beneficial Traditions and Programs
Cultures around the world have their own end-of-life rituals and traditions. In some cultures, grief can take on several physical and verbal forms. For example, there may be a seven-day mourning period in which the bereaved show no excessive emotion. In other cultures candles are lit for a specified time (seven days, for example) to honor the dead and give mourners a focal point for their grief. A mourning ritual can occur during a meaningful time—an anniversary, wake, or holiday—or at a distinct location, such as a church, synagogue, or home. In North American cultures, for example, Catholics attend an anniversary Mass, Jews recite Kaddish, and people of Hispanic origins remember Día de los Muertos.
There are secular memorials, too. Many ceremonies have spontaneously grown up around the Vietnam Veterans Memorial in Washington, D.C., and a special mourning project—the AIDS Memorial Quilt—travels throughout the nation to allow the public to participate in this expression of grief. Grief rituals and ceremonies acknowledge the pain of loss while offering social support and a reaffirmation of life. Shrines may also be erected. Whether the shrine is large, such as the memorials for losses in various wars, or as small as a grouping of photographs on a mantle in a grieving family's home, it can provide a place of solace and reflection.
Funerals, memorials, wakes, and public burials are held to put our loved ones to rest and so that we can experience closure. Once these public rituals are over, we begin a time of personal mourning.
Beginning New Traditions
Sometimes it is not enough just to attend a funeral, a memorial, or even a wake. Often, we are confused by our feelings and we may need to begin new, creative traditions at home so that we can grieve privately. Don't let the word “creative” throw you. A personal memorial can be created from anything that reminds us of the deceased, such as photographs, a memento from a shared experience. Sometimes writing poetry or simply keeping a journal of one's feelings can be a source of personal healing. Listening to favorite music to help soothe heartache may also facilitate the healing process.
Talking with a trusted friend can be helpful, as well. Many of us do not easily share our feelings with others for a variety of reasons; however, it is a very potent way of coping and even of discovery of what our feelings really are.