How Clinicians Who Work in Hospice / Palliative Care Deal with Death
As we discussed in our previous article, November is the National Awareness Month for Home Health, Hospice, and Palliative Care. Registered nurses (RNs), licensed practical or vocational nurses (LPNs/LVNs), and certified nursing assistants (CNAs) have integral roles in these settings, which means these clinicians experience and witness and grieve the process of the dying on a rather routine basis.
Of course, not every clinician has a close rapport with every one of their patients, but dealing with death at work, regardless of the relationship, is heavy. Our culture has a natural fear of death, and the medical industry is primarily focused on curing, lengthening our life spans, and avoiding death. Nevertheless, it is a natural part of the cycle of life, of the human experience.
Pandemic Deaths Stressed Nurses and Aides
The last two years have been even more stressful than usual for all workers in the healthcare industry. Staffing shortages, pandemic deaths, pandemic panic, and division on top of the regular life stressors have led many nurses to the point of burnout. The stories of nurses working COVID units and being the only human contact for COVID patients as they grieve their own impending death and separation from family due to contagion are harrowing, tragic, and unfortunately were quite common at the peak. Throughout the process of dying, the nurses and aides are held to the expectation that they continue their work duties and do so professionally in addition to providing support and answering questions to family members, however, how many nurses receive training to deal with the onslaught of emotions not only from the loved ones but of their own feelings?
Analysis of Emotions Surrounding Patient Deaths
This past June, a study was published that analyses the topic of death with nurses. Titled, Feelings and Emotions of Nurses Related to Dying and Death of Patients – A Pilot Study, the authors surveyed 160 nurses from four different departments of a hospital (ICU, ER, Surgery, Internal Medicine). According to the study:
“11% of the nurses admitted that they reacted very emotionally to the death of a patient, nearly 56% of the respondents stated that they tried to control their emotions, 33% of the respondents answered that they kept their distance. The research shows that nurses with long service in work manage their emotions best.
Nurses, regardless of the type of workplace or the length of work experience, face a high level of stress and strong emotions triggered by the observation of dying patients. Various styles of coping with stress are observed depending on job seniority and a place of employment. Due to the emotions evoked by the necessity to deal with death while performing professional duties, it is advisable to develop effective ways of coping with difficult situations.”
Tips For Coping with Patient Death
Ask to meet with the staff grief counselor. Most healthcare facilities have a grief counselor or social worker (or both) on staff, and while this role is typically thought of to be in service to the patients and their family members, there is no harm in asking for yourself.
Allow that your grief is different from that of the family members but no less real. You are allowed to grieve the passing of a patient, regardless of the level of closeness or rapport you had. Death is final and while your grief is different because of your role and relationship to the patient, that does not mean it does not matter or should simply be ignored.
Take care of yourself. Grief is taxing on our minds and emotions, which is all the more reason to ensure you are sleeping enough hours, eating, and exercising.
Don’t take it personally. If a patient’s family lashes out, you don’t need to be a punching bag, but try not to take any hurtful words to heart. Grief is complex and manifests in anger sometimes, unfortunately, as the nurse, you may be the closest target.
Acknowledge death. Sometimes this may be in sharing stories or listening to family members. Other circumstances may be lonelier, and therefore mean that you simply take a few moments of silence to acknowledge for yourself the death and your emotions surrounding it.
Seek therapy or counseling. Sometimes we need more help than simply self-care and a sit down with the facility counselor. A therapist can help you navigate your complicated emotions and grief for as long or as short of a time as you want.
Training Opportunities for Grief, Compassion Fatigue, and Death
- Not every training opportunity will offer you CEs, but that doesn’t mean you can’t gain valuable insight. Books and podcasts can be wonderful sources.
- Ask Nurse Alice is a podcast, and if you aren’t already a listener, then check it out as she covers a wide variety of topics for nurses. Ask Nurse Alice has a podcast episode particularly on point for the subject titled, “Death is a Reality for Nurses: How to Cope with Death”. This podcast episode can be found on Apple Podcasts and Spotify.
- The podcast, “Grief from the Other Side: Karen’s Story”, is an interview with a hospice nurse with over 25 years of experience.
- Final Moments: Nurses’ Stories about Death and Dying, by Deborah Witt Sherman, is a compilation of stories and their experiences and coping strategies for dealing with patient deaths.
- The Online Grief Literacy Workshop Series is offered by BeingHereHuman.com, you’ll have to inquire to see if you can earn CEs for your license.