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Handling Loss and Working Through Grief in Nursing Homes

The loss nursing home staff members have experienced over the last two years has been unprecedented. Many have lost well-loved friends, family members, and residents—and nearly all have had their sense of normalcy upended. Healthcare professionals have been so busy battling the virus daily that most haven’t had time to process the emotional effects the fight has inflicted. This article examines grief and ways to help facility leadership manage that grief, for both themselves and staff.

What is Grief?

To manage grief, it’s important to first understand what it is. According to Merriam-Webster’s (n.d.), grief is a deep distress caused especially by someone’s death. Things other than death can cause grief, too; it can be due to the loss of anything special to a person, such as a way of life, or even a family heirloom. Grief is both universal, because everyone experiences it at some point, and personal, because how they experience it is unique (Mayo Clinic, 2016). No two experiences are alike. Grief can pass after a relatively short period of time or last months or even years.

Elizabeth Kübler-Ross described the widely-known five stages of grief that include (Gregory, 2021):

Denial – This first stage helps one get through the initial loss. The individual may be overwhelmed and cannot make sense of what is going on. He or she may be in a state of shock because life as they knew it no longer exists. In the denial stage, the individual is living the ‘preferred’ reality rather than actual reality. The denial stage helps the individual to cope and survive the loss by staggering the full impact of the loss over time so the circumstances seem less overwhelming.

Anger – This step begins when the individual starts to live in the ‘actual’ reality again and feelings of frustration and anger set in. He or she may have thoughts of “why me” or “this isn’t fair” and blame others for their loss. Many mental health professionals feel this stage is crucial for healing and encourage the individual’s anger at their loss.

Bargaining – In this stage, the individual may seek to change the circumstances that are causing the grief. Often, people in this stage will bargain with God. Bargaining can help the individual cope with the loss by giving them a sense of control instead of a feeling of helplessness.

Depression – This is the stage is most often associated with grief. It represents the emptiness the individual feels when the loss becomes real. Often, individuals in this stage may break down and cry or ask what the point of going on is. He or she may even have suicidal thoughts (Gregory, 2021). Some may experience prolonged or profound feelings of depression that can lead to clinical depression. It is important to be aware that clinical depression differs from grief and should be treated by a mental health professional.

Acceptance – In this last stage of grief, individuals’ emotions stabilize. Although they are still not reconciled to the loss, they know they are going to be okay. They come to terms with their new reality. At this stage, they start to re-enter the world and engage with friends again (Gregory, 2022).

Don’t Miss the Signs

Facility leaders are not expected to know the daily happenings of each staff member’s life. However, they have a responsibility to create a work environment in which staff can function at their best to provide the quality care that residents deserve. To do this, facility leaders need to recognize the signs of grief in themselves and others.

Individuals in the denial stage may appear easily distracted and forgetful. They may also appear to avoid situations such as walking by a room where a resident they cared for has passed. If they don’t see the empty bed, then it didn’t happen. They may also state they are “fine” when asked how they are doing. People in the denial stage may express confusion, numbness, or even that they are shutting down.

Staff in the anger stage may be easier to identify. They can appear pessimistic or cynical and may voice sarcasm when conversing with others. Individuals may appear irritable and become passive-aggressive, or even aggressive, and may get into arguments or physical fights with others. They may turn to alcohol or drugs to deal with the anger and grief. Those in the anger stage often express frustration, resentment, rage, or even feelings of being out of control.

Those in the bargaining stage can appear to be thinking about the past too much, overthinking, or worrying. They may compare themselves to others or assume the worst about the future. Increased judgement toward themselves or others may also appear. They may express feelings of guilt, shame, fear, anxiety, or insecurity during this stage (Perina, 2021).

Indications that one may be in the depression stage of grief may include sleep and appetite changes, withdrawal from others, decreased motivation, or crying. Physical manifestations of headaches or other aches and pains may be present. Individuals in this stage also may turn to alcohol or drugs to deal with their sadness. They may express experiences of despair, helplessness, hopelessness, and even feelings of being overwhelmed.

In contrast, those who have reached the acceptance stage of grief may engage with others again and appear to be present in the moment. They are adapting and coping with the changes in their world (Stanaway, 2020).

Helping Others Experiencing Grief

Most individuals will proceed through the stages of grief successfully. Although they may not need it, knowing that support is present, and assistance can be obtained if needed, is a comfort during this time. Others may have a harder time going through the stages and need some extra support from facility leadership. Although caring for others is typically second nature to facility leaders, employing the tips below can assist leaders to help staff cope with grief in a healthy way.

  1. Recognize that grief is normal. Almost everyone experiences grief when they suffer a loss. Feelings of grief are a natural reaction to important losses. Leaders can talk openly about their own losses to help staff feel less alone.
  2. Remember that everyone grieves differently. Some people may grieve loudly, while others feel grief is personal and show no outward emotion. People often rely on their cultural beliefs and traditions to help with the grieving process. To understand grief reactions from a different culture, research the customary ways they display grief and the traditions used to help support them. Remember, no one should feel pressured to grieve in a way that isn’t comfortable for him or her. Pressure to grieve in a way that is not comfortable may lead to the individual never properly learning to deal with the loss (Taylor, 2019). Once the different traditions are understood, leaders can react and offer support appropriately.
  3. Show empathy. When leaders acknowledge staff members’ loss and let them know it is okay to grieve, staff may feel more at ease to go through the grief process.
  4. Acknowledge that grief is a process. Some may proceed through the grief process in a few weeks to months, while others may take months to years. An individual may also have gone through all the steps and seem to be coping well, when out of the blue, something like a song reminds them of the loss and they feel sad all over again. Leaders should offer their support no matter how long it takes and recognize the journey to acceptance is longer for some.
  5. Offer support. Take cues from the individual experiencing the grief to determine if he or she is ready to receive support and just how much support would be welcome. Support can be as little as asking the individual how they are doing or being physically present. If the employee would benefit from support from a mental health professional, encourage him or her to use the employee assistance program (EAP), if the organization offers one.
  6. Provide a break. If a staff member is seen struggling due to grief, give that person a break from the floor. Just a small break can help reset one’s emotions (NYC Health, 2020).
  7. Be a good listener. Often, people just need someone to listen to them without being judgmental or offering “free” advice. Give staff a safe place where they can discuss their feelings.

Points for discussion with staff regarding their grief can be found in AAPACN’s Death and Dying Education Bundle for Nurses.

Coping with One’s Own Grief

Staff are not the only ones who experience grief when there is a loss. Good leaders should recognize the signs of grief in themselves, as well. Leaders can use the tips below to help themselves navigate the grieving process.

  1. Accept your own feelings of loss. The pandemic has been a trial. Grieve the losses, but don’t let the grief define you.
  2. Talk about your loss. Sharing our feelings often makes us feel less alone. You may find others who feel the same way. Connect with others through phone, social media, group therapy, or any other way comfortable.
  3. Consider what is going well in your life. Write down your strengths and bright areas daily. Share these with others if you are comfortable.
  4. Take a break. Do something relaxing or energizing that makes you feel good.
  5. Be part of a community. This can offer you many avenues of support when needed.
  6. Ask for help when feeling overwhelmed. No person can handle everything all the time. It is a sign of strength to ask for help when you need it (NYC Health, 2020). If feelings persist and your mood does not improve or worsens, reach out for professional help.

References

Gregory, C. (2021). The five stages of grief: An examination of the Kubler-Ross Model. https://www.psycom.net/depression.central.grief.html

Mayo Clinic. (2016). What is grief? https://www.mayoclinic.org/patient-visitor-guide/support-groups/what-is-grief

Merriam-Webster. (n.d.). Grief. In Merriam-Webster.com dictionary. Retrieved February 27, 2022, from https://www.merriam-webster.com/dictionary/grief

New York City Health Department. (2020). Grief and loss in the workplace during COVID-19. https://www1.nyc.gov/assets/doh/downloads/pdf/imm/workplace-grief-and-loss.pdf

Perina, K. (2021, June 24). 5 Emotions you didn’t realize were part of grief: Disillusionment during the grief process. Psychology Today. https://www.psychologytoday.com/us/blog/between-the-generations/202106/5-emotions-you-didnt-know-were-part-grief

Stanaway, C. (2020). The stages of grief: Accepting the Unacceptable. https://www.washington.edu/counseling/2020/06/08/the-stages-of-grief-accepting-the-unacceptable/

Taylor, G. (2019, February 13). Manage grief in a healthy way. Facty Health. https://facty.com/lifestyle/wellness/manage-grief-in-a-healthy-way/3/

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