Grief education in healthcare
Nursing and medical education do not prepare healthcare providers (HCPs) for the grief of treating and caring for the dying. Despite this, new HCPs are expected to immediately start in on helping grievers while not necessarily knowing how to deal with their own state of mourning or that of their coworkers. They may quickly find themselves experiencing grief related to complex patient situations and deaths, ambiguous patient deaths, and cumulative deaths which can lead to bereavement overload, compassion fatigue, and burnout.
In discussing grief education, I do it from the view of a nurse. We are expected to autonomously care for patients as part of a multidisciplinary team in whichever specialty we choose, and ideally should participate in advocacy, nursing research, and continuing education to both improve our fields and practice to benefit patients. Nurses are required to hold licensure beyond their educational programs which can range from hospital-based diploma programs to post-doctorates. For those in bachelor’s programs, they are also expected to have a liberal arts education on top of nursing science classes. What is often missing from these classes, however, are offerings in palliative, hospice, and end-of-life care or any specific course material on healthcare provider bereavement.
My nursing schools were only two of the schools that don’t have this education. Studies have shown that there is little to no grief education either in school or in facility orientations, so nurses in high-death fields may not experience a major loss until their first loss of a patient to whom they’ve grown close. This can pile up quickly if you don’t know how to face it, and leaving grief unaddressed means that some nurses may find themselves never leaving the grief process.
A major issue that affects my field is the fact that we must harm people to treat them. This can affect quality of life, causing upset for the patient and their loved ones as they try to prolong life. Everyone in this situation gets overwhelmed and emotions are often high. When patients die, if we didn’t send the hospice referral or the patient died without a notification, we may not find adequate closure from finding out too late about funerary activities.
There’s a stigma associated with grieving in the workplace which leads to ignoring grief and continuing to provide care without recovery time. Grief-positive workplaces are healthy workplaces, and positive environments include open communication, a good work/life balance, providing and encouraging of professional development, recognition of grief situations, and development of a strong team for learning and support around grief.
Every episode of grief is unique, but we need to intervene early. Employees who know that there is nothing embarrassing or weak about grief are in a place for success, and acknowledging this increases the chances that they will stay in nursing. Without grief education and support for HCPs, patient and caregiver care can suffer through nurses being jaded and lacking compassion due to becoming hardened by loss.
Nursing education needs to train students on how to deal with complex psychological issues following deaths. Training nursing students or nurses helps them not only support themselves and their coworkers but also improves patient and caregiver care. It is only through wider education that we can affect positive changes in the realm of complicated grief support from a nursing perspective.
