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Nurses Coping with Personal Grief

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Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.

Because nurses work so closely with dying patients....providing intimate care to the whole person...including physical, emotional, and spiritual care.....sharing in conversation the patient's fears and concerns...... we expose ourselves...our personal feelings. When patients die, we seldom allow ourselves to adequately acknowledge our own losses, or to fully comprehend the intimacy of our relationships with clients.

Nurses Coping with Personal Grief

How many of you have felt helpless or guilty when caring for a seriously ill or dying patient?

How many become overwhelmed with emotion after a particularly "bad death", or the death of a patient you have allowed yourself to become attached to?

What should nurses do to avoid the pain that such circumstances often cause?

Or are there appropriate ways to deal with these feelings?

Too often we think we are to be "pillars of strength" in times of crisis or death. While we provide supportive care to patients and families, we fail to recognize our personal need to process loss. We fail to see our need to grieve.

In order to offer compassionate care for the critically sick and for the dying, as nurses we must be able give of ourselves without being destroyed in the process. For self preservation, we may resort to ineffective coping mechanisms such as withdrawal, psychological numbing, and avoidance of personal involvement with patients. Failure to work through the grieving process leads to potential burnout.

As nurses, we strive to provide compassionate care, sharing in the grief, loss, and fear experienced by dying patients and their families. We want to do more than just go through the motions, becoming numb to the pain of others.

What are some of the ways you have found to cope with the repetitive emotional strain that you face on a daily basis as you care for people in physical, emotional, and spiritual pain?

It is important that we see ourselves as humans and recognize the emotional reactions that traumatic events evoke in us. Acknowledgment of our vulnerability to tragedy is a fundamental factor in the way each of us handles the senseless losses we are faced with every day in our professional lives.

Feel free to share your stories of situations that have been particularly difficult for you to deal with. We can learn from each other.

As the Community Director, I'm here to help make your time here enjoyable. Please contact me if I can help you. I'd love to hear from you.

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Has anyone out there had a patient overdose to medication due to a defective PCA pump? I programed the pump correctly but something went wrong and the pump released too much medication. After a Narcan drip and overnight in SICU... the patient is OK but I am having a terrible time. I have been a nurse for 29 years and never had anything like this happen before. Any words of comfort out there?

kurisuchine08

Specializes in Trauma Surgery.

our profession makes us most susceptible to trauma than we think.. every day, we face emotional and psychological challenges as we nurse our patients back to health. but what could be worse than having to play the "professional" nurse when it is your own mother who is lying on her deathbed? i was put in that role last summer, i was on duty when my dad brought my mother to the hospital where i was working. i was the one who saw the signs of congestive heart failure at its worst stage. my mother's lungs were drowning, and i asssisted the doctor intubate my mom while she was conscious. i could not afford to be worried or anxious for it may cloud my judgment and make me commit a grave error that would jeopardize her life more. i was the one who suctioned the secretions out of her lungs, and all the while i have to maintain a straight face to assure my family who had been watching all the time. do you think a person could go through this unscathed??

we nurses have been through all these and more. we have kept the profession alive despite all the trials. its only just to be each others' support system. feel free to comfort each other, we nurses need to heal to. how can we care for the sick when we, ourselves have been wounded deeply?

with this post, i am reaching out to all the nurses. i may be a stranger for some, but this stranger is willing to hear all your worries. i may not have all the answers but i do have the heart to share with you all.. feel free to contact me.

I worked in the primary care setting as a MA for years. My perspective is a little different, because I was with patients for years at a time. I've had older patients pass, and been with patients from diagnosis to death.

I had a patient in my age range who had a type of osteosarcoma. My age - it was my "that is not fair moment". We were quite close, as was his family. I was with this man as he fought with every fibre of his being. He was amazing! But he didn't succeed and he did eventually go to hospice and died. I worked very hard with his physician to make sure that he was adequately medicated for pain, that he got the referrals to specialists that he needed, and eventually that he and his family got the hospice care he needed. I went to his funeral, and I cried. I had been with this family for several years. I knew about his work, his life, his girlfriend. He knew about nursing school and prereqs while I worked. His family came to thank the doctor and I for the care that all of them received. Before he went into hospice in his last office visit he told me that he thought I would be a wonderful nurse. That's a recommendation that I will never forget.

I think that sometimes to protect ourselves we distance ourselves from patients, and yes sometimes you need to keep perspective. These are not your best friends. But they are human beings, with lives and hopes and dreams, and sometimes those are cut short early. As they are in our own families, with our own friends.

I'm "only" a nursing student, but it seems to me a good cry once in a while never hurt anyone. We also are human beings, not just human DOINGS - we are more than the sum of our nursing interventions. We need to give ourselves permission to be, to feel, and to accept.

Sorry that's so long - but I obviously have some strong feelings on this one.

tnbutterfly - Mary, BSN, RN

Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.

I think that sometimes to protect ourselves we distance ourselves from patients, and yes sometimes you need to keep perspective. These are not your best friends. But they are human beings, with lives and hopes and dreams, and sometimes those are cut short early. As they are in our own families, with our own friends.

I'm "only" a nursing student, but it seems to me a good cry once in a while never hurt anyone. We also are human beings, not just human DOINGS - we are more than the sum of our nursing interventions. We need to give ourselves permission to be, to feel, and to accept.

You make some very excellent points. Yes, our patients are human beings as are their families. When we forget this...the humanness...the emotions..the hopes and dreams....of our patients AND ourselves....we lose sight of why we are doing what we do.

You may be "only a nursing student", but I believe you are going to be a very compassionate nurse.

nerdtonurse?, BSN, RN

Specializes in ICU, Telemetry.

The ones that drive me crazy are the ones where the pt is dying -- cancer that's mets'd or a dying liver, etc. One doc at our hospital would tell a 3 day dead corpse they are going to be fine. It's wrong, and it's immoral for the doc to not tell a patient they are dying. I mean, if the person's A/O, give them time to face end time issues, don't make their final days filled with a sense of betrayal. If it happens to me, I'd rather the doc told me so I could make my arrangements, say what needs saying, do what needs doing.

I've seen people with liver CA, lung CA sent home without ever being told they found a malignancy -- and sadly, the ones they usually send home with a kiss and a shove out the door are the ones without insurance. It breaks my mean old heart.

tnbutterfly - Mary, BSN, RN

Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.

The ones that drive me crazy are the ones where the pt is dying -- cancer that's mets'd or a dying liver, etc. One doc at our hospital would tell a 3 day dead corpse they are going to be fine. It's wrong, and it's immoral for the doc to not tell a patient they are dying. I mean, if the person's A/O, give them time to face end time issues, don't make their final days filled with a sense of betrayal. If it happens to me, I'd rather the doc told me so I could make my arrangements, say what needs saying, do what needs doing.

I've seen people with liver CA, lung CA sent home without ever being told they found a malignancy -- and sadly, the ones they usually send home with a kiss and a shove out the door are the ones without insurance. It breaks my mean old heart.

What are some ways the nurse, as the patient advocate, can use to approach the physician in situations like this? Don't we have a responsibility to speak up?

It is very hard to control my tears in front of the patients. I am too emotional. When I first time watching the newborn baby delivered, my happy tears came out, not the mother's. The doctor gave me a strange glance, made me think whether am I professional or not.

I worked in Fetal Assessment Unit/complicated OB clinic. Most pregnant women had more or less issues to visit us. I hate to see anything wrong happened to those innocent, immature fetus. They are so LIVE to me when I watch them thru the ultrasound. I feel what mother's feel. Hide my heart become extremely difficult to me. I don't know how to handle this problem. I know I should treat them professionally, emotional support, but not personally involved, but how could I control my tears when a newborn baby just passed away in my arm after several hrs living, or I had to tell a happy young pregnant mother that her baby didn't develope the brain?

Anyone can tell me the way or any resource that offer solution?

Hello, I found this to be a very interesting blog. My main reason for wanting to become a registered nurse is because I went through a devastating experience seven years ago. My son's father (which was my husband at the time) was in a terrible car accident.

For the first 3 months me and my son spent day after day in the ICU. Watching and waiting for any answer, a miracle ...something. It was the most painful time in my life. He remained on a ventilator..and was unresponsive. What made all the difference was the attitude of some of the nurses. He had nurses that did their job and went about their day, and then there were nurses that gave care with love in their hearts. They were not only there as a caregiver, but as a friend and a support system. They took time to explain procedures, medications, etc. some even took time to pray with us. It made a huge difference. It made our situation bearable.

I think those are the best kind of nurses~the ones that put their heart into their work~.I feel their is no limit to how much you can put into a patient both emotionally and physically. At the end of the day, if you know that you gave all you could to your work, that is the most important thing. I do believe that all the good you do for others will come back to you. Once you have become a calloused nurse you have lost your purpose. Nursing is about giving of yourself, and putting your whole heart into your work.

Hi, I too found this blog to be interesting because I at first believed that we were supposed to be always the pillar of strength, But now after working 30 years I think it is the good nurse who lets her feelings out, but I did it with the patients. I learned to be emphathatic rather that sympathatic. Empathetic means you can relate to their pain by putting yourself in their shoes for a time, but knowing that you will be taking them off when you leave and go home. But when you are sympathetic you tend to wear the shoes home, and keep them on much longer than you intended to.I always took my cues from the patients own reaction and allowed my emotions to match theirs. I also tried to stay out of myself and focus on the patient or and what their needs were. And how important to them that I could experience and reflect the feelings they may have been haveing..... That how I would want to be treated and its how I try to treat others..The old golden rule...I have found that nurses either handle things that way, or they become hardened and cynical...GOOD LUCK.:nurse:

tnbutterfly - Mary, BSN, RN

Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.

hi, i too found this blog to be interesting because i at first believed that we were supposed to be always the pillar of strength, but now after working 30 years i think it is the good nurse who lets her feelings out, but i did it with the patients. i learned to be emphathatic rather that sympathatic. empathetic means you can relate to their pain by putting yourself in their shoes for a time, but knowing that you will be taking them off when you leave and go home. but when you are sympathetic you tend to wear the shoes home, and keep them on much longer than you intended to.i always took my cues from the patients own reaction and allowed my emotions to match theirs. i also tried to stay out of myself and focus on the patient or and what their needs were. and how important to them that i could experience and reflect the feelings they may have been haveing..... that how i would want to be treated and its how i try to treat others..the old golden rule...i have found that nurses either handle things that way, or they become hardened and cynical...good luck.:nurse:

what an excellent post!!!! thank you so much for sharing this. your differentiation between sympathy and empathy is spot on. i think some nurses fear to even be empathetic......they are afraid to show their emotions or feelings. but as you state......take your cues from the patient and match your emotions to theirs....stay out of yourself and focus on the patient or what their needs are. that should be a standard for all nursing care.

i find it is harder on my own emotional state when i do "get involved" with the patient....being empathetic....and allowing myself to feel. but........i would rather have those feelings than become "hardened and cynical".

wondern, ASN

Has 20 years experience.

Amen, feeling is a good thing. It gives us a conscience. I like this thread. It's so hard to talk about sometimes, though. Grief hurts. We are all humans :redpinkhe:redbeathe:heartbeat before nurses, aren't we?

tnbutterfly - Mary, BSN, RN

Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.

Yes grief does hurt. But I find it helpful to talk about it. It helps to get the hurt out and also helps to know others feel the same way. It is good for us to share ways to cope with the pain as well.

wondern, ASN

Has 20 years experience.

our profession makes us most susceptible to trauma than we think.. every day, we face emotional and psychological challenges as we nurse our patients back to health. but what could be worse than having to play the "professional" nurse when it is your own mother who is lying on her deathbed? ..... do you think a person could go through this unscathed??

we nurses have been through all these and more. we have kept the profession alive despite all the trials. its only just to be each others' support system. feel free to comfort each other, we nurses need to heal to. how can we care for the sick when we, ourselves have been wounded deeply?

with this post, i am reaching out to all the nurses. i may be a stranger for some, but this stranger is willing to hear all your worries. i may not have all the answers but i do have the heart to share with you all.. feel free to contact me.

great post and intriguing questions. imho, no, you can't get through this unscathed unless you were without a heart or soul. not that it matters from a stranger, but as a nurse and a daughter, i have such a need to tell you that you did a great job for your mom that day. :redpinkhe this story must be hard to relive. thanks for sharing it.

talking is important and listening, really listening, is grand too. i guess that is one of the wonderful things about this site and your blog. thank you, tnbutterfly and kurisuchine08, too. :flwrhrts:

usadavewave

Specializes in N/A.

Hello everyone,

I am a new Nursing student at Kaplan College in the Registered Nurses Program. It is 20 months long and I am very excited about my new carreer change. I have an A.A. in Psychology, and a B.A. in Organizational Leadership from Chapman Univerisity in Orange Country California ,but most of my experience is in the hospitality industy. I love working with people and making them happy, but I do have a few concerns adapting to my new carreer.

I realize that I will be working with sick people. My goal is to work in the Emergency Room, because I like high energy and excitement. However, I am wondering how to deal and cope with the stress and slight possible depression of seeing people at their worst in critical conditions. I realize that I am there to assist in making them feel better, and put them on a path to recovery; but the idea of seeing small children critically injured concerns me. I know I will adapt and overcome my anxiety about this, but I would appreciate any tips, suggestions, techniques, or personal wisdom on how to deal with the stress and feelings associated with seeing people at their worst. Also, I would like some advice on dealing with grief of patients who have pasted that you have grown attached to.

In addition, I could use some advice on excelling at school; and how to deal with the stress of all of the information and assignments.

Thank you in advance,

Dave

c_beshore_rn

Specializes in Psych, LTC, M/S, Supervisor, MRDD,.

Great posts guys!!! Ive been a nurse for about 13+ years. I've always cried like a baby!! I just learn when to release it and when not to release it. I participate in dark humor at times! More calloused nurses make a habit of this. But, I hope to never be a consistant purveyor of morbid humor to cope with my emotions..:yawn:

The first time I had a patient die....I was an LPN in LTC the cna came up to me and said "Mrs so n so is c/o chest pain." (which she had some somatic c/o every minute!) I blew it off, went on with mealtime meds, and thought I'd take her Mylanta a little later. Two minutes later the cna came to me and said "mrs so n so in unconsious". Actually Mrs so and so was DEAD!! Most likely acute MI?? I felt HORRIBLE!! I cried and cried. My charge nurse (who was an old heartless battleaxe, I thought!) told me "get it together, this isn't about u it's about her right now! Dont u dare let that family see u cry! This is their time to grieve!"

I went into the little chapel area and bawled like a baby! Partly for feeling responsible, partly because I felt like a failure, and partly because the battleaxe yelled at me. I disobeyed a golden rule in nursing school....I ignored a c/o chest pain!! After I pulled myself together, the family had left, the post-mort care was done. I went down the hall to find the battleaxe. She was in the dead womans room, before the funeral home people arrived, at mrs so n so's bedside. I silently entered the room and witnessed one of the most beautiful images in my career. That old, snippy, charge nurse was kneeling at the head of the patients bed, holding the lifeless hand of Mrs so n so, bowing her head, praying and grieving in her own way!!!!

I started crying again, of course!! But, it taught me really important things on emotional maturity. That 65 year old nurse was not uncaring--she just had priorities and saw to them before her own feelings or grief. My 20 year old self did not have a grasp on that yet.....My 33 year old self still works on it daily- my anger, my frustration, my grief, etc......I feel in time when I'm 65 or so I will get there!!

CrufflerJJ, RN

Specializes in ICU. Has 5 years experience.

Amen, feeling is a good thing. It gives us a conscience. I like this thread. It's so hard to talk about sometimes, though. Grief hurts. We are all humans :redpinkhe:redbeathe:heartbeat before nurses, aren't we?

Some caregivers deal with pain & hurt by "raising shields". This may keep them from feeling pain after a patient suffers or dies, but it can also keep them from feeling at all. It's a careful balancing act - caring/feeling enough, without caring/feeling too much. If you raise your shields, you run the risk of being an insensitive (purely technical) caregiver, which I think will impair your ability to give your patient all that they need, including a true connection with their caregivers. If you don't protect yourself (emotionally), you run the risk of being hurt too deeply by a patient's suffering or death. It can be a hard balance to maintain.

Just my opinion....

mama_d, BSN, RN

Specializes in tele, oncology. Has 10 years experience.

I work on the oncology/tele floor at my hospital, so we tend to see a lot of oncology readmits, from diagnosis to hospice.

It took me a long time to adjust to the different mode of caring that is needed between say an acute MI or CHF and a cancer patient. I honestly wasn't sure at first that I'd be able to handle it, but I think that I've managed to get it straightened out in my head somewhat.

I've learned a lot in the last several years, working with our oncology patients....

I've learned how to compassionately tell patients and family members "It's just not going to get any better, no matter how had we all fight it." Or "I'm so sorry, but the pain is not going to get any better, to be more aggressive with pain management, we really need to sit down and talk about code status."

I've learned that finding out which family member is on your side can be of great importance...as in, the one who has accepted the patient's wishes and will support you in your quest to provide the best care for the patient within those parameters, regardless of if it's to fight it all the way or to go hospice.

I've learned that it's okay to cry a little in front of families when their loved one passes, and to offer hugs to them in addition to kleenexes.

I've learned that sometimes I'll be the one to hold their hand when they pass, so that the family knows that their loved one did not die alone.

I've learned that being able to recognize family members in the halls or on the elevators and asking about their loved one goes a long way to building up rapport and trust with them...they'll remember that you remembered, and the next time you care for the patient you'll usually get "You're the nurse that asked about Richard's surgery while we were on the elevator, we were hoping you'd get to take care of him."

I've learned how my coworkers respond to deaths, and how to treat them individually when it happens to one of their patients.

But I haven't learned yet how to leave it at work all of the time, or how to stop asking "Why?", or how to stop worrying about the family. I wonder sometimes if I ever will, and if I do, if that will be a good thing or a bad thing. The part of me that allows me to be a compassionate care giver seems tied up with that part of me that worries and questions, so I'm afraid that if it goes away it will affect my abilities to connect.