Coping with mortality
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.
Help at Work
If your facility has access to an Employee Assistance Program (EAP), use this confidential service. An EAP is an excellent source for employees to find someone to listen to their feelings of frustration, fear, grief, and guilt when other options seem unavailable. The person on the other end of the phone is caring, helpful, and ready to simply listen or, if desired, give suggestions for self-help.
People in Real Time
When interviewed on the subject of coping with resident mortality, nurses readily shared their thoughts and some were surprised at their contributions when asked, “How do you cope with the death of patients and residents?” Some of their responses follow:
“The older one gets, the harder it is. One’s own mortality, one’s own parents come to mind. I’m going to have to think about a nursing home for my mother.”
“A person can’t work with staff and residents for years and not get to know them. When does one not personalize? I guess it’s when you don’t know the people because they may be new and they die within a couple of weeks or, maybe, when patients are difficult and you don’t really care for their personality. Of course, we do our best for them anyway. Then the question is, did I do enough? Did I treat them well enough, did I make the best difference that I could for them? Sometimes a person has to deal with guilt over feelings about a difficult patient/resident. That’s when you have to forgive yourself for any real or imagined inequities in the care you gave. You have to always keep it in mind. You can’t go back and do it again for that person.”
“Sometimes it’s frustrating when family members don’t want to participate in the life/death of a resident. You sit with the dying resident, trying to make up for the family that isn’t there.”
“How does a person explain to a family that their loved one won’t be there forever? He or she will eventually die. People, whole families walk around in denial, always thinking they have tomorrow and, finally, the tomorrow comes and their loved one has passed on.”
“There are times when, at the death of a loved one, anger comes out in the form of blame and usually the blame is leveled on the people standing there, the nursing staff.”
“Sometimes I am happy that a person has died. He or she is not suffering anymore.”
“I am certain that faith is essential when facing the death of a loved one or when facing your own mortality.”
When reading these comments from people who have made careers of caring, people who should have the answers regarding loss and its effects if only because of experience, “how do you cope?” is still a difficult question to answer. It is a question that most of us don’t think about until we come face-to-face with the experience. Then we may find that we are empty handed when we most need the skills with which to cope and help others cope, as well.
Skills to Give Hope
How do you give hope to someone who is in the grief process?
Just be there.
Just listen. You don’t have to say anything.
Let them know that you are available, that you care, and that you are a worthy confidant. Communicate this in your daily attitude and your unwillingness to gossip. People will know who you are and, if you are willing to allow them access to your heart, they will come.
The Dos and Don’ts of Grieving
Here are some suggested positive skills to cope with grief.
For a more detailed discussion on the subject, check out “How to Grieve When You Need to Work, Caregive, and Live” by Beth Erickson, PhD, at https://www.strengthforcaring.com.
The Nursing Assistant’s Survival Guide by Karl Pillemer, PhD (Frontline Publishing, 1999). This 87-page, easy-to-read manual, illustrated with cartoon drawings, provides practical strategies for coping with stress; dealing with the deaths of residents/patients; overcoming communication difficulties with supervisors, family members, and angry or aggressive residents; and family demands.
https://www.inspirationalnursing.com/nursing. This site is a repository for nurses and other medical staff, such as CNAs, to leave encouraging and inspirational stories, poems, and thoughts.
https://www.4nursing.blogspot.com. This site offers a list of nurse- and CNA-friendly blogs and a place to begin blogging. (A blog [short for Weblog] is simply a place on the Internet to put down thoughts and feelings, as in a journal, or to contribute to others’ blogs with your own inspirational writing.)
https://www.caringinfo.org. This site offers several articles on the subject of grieving, such as “Sudden Loss,” “Anticipatory Grief,” “Helping Grieving Employees,” and “Complicated Grief.”
https://www.metanoia.org/suicide/grief.htm. This site has an article on grief and suicide. However, the article is not just about suicide, it presents more information that we can all use.
How will the nursing staff of any facility cope with the mortality of their patients and residents? Each staff member will cope according to his or her gifts and knowledge. Let us be facilitators of coping skills. Let us do our best to train and encourage each other so that we may become stronger and be able to give—and receive—hope.
Carol Weshenfelder is a wife and mother of four. She works in the dietary department of Northwood Deaconess Health Center in Northwood, North Dakota.
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Do be patient with yourself.
Do find a listening post.
Do remember that grieving is not completed in a day, a month, or a year.
Do talk about it, cry about it, and sit with it.
Do understand that nobody else can feel exactly as you do; they can only empathize.
Don’t be too strong for your own good.
Don’t push yourself when you are tired.
Don’t expect to feel just one emotion.
Don’t blame yourself for what happened.
Don’t isolate yourself.
Topics: Articles , Staffing