The Career Needs Caring Too Essay
Nurses go through a whole gamut of emotions in their career. They often experience the rewards of their hard work when their patients recover from their illness. It is very fulfilling for them to be able to take part in another individuals healing and achievement of comfort and well-being.
On the other hand, they also go through difficult emotions such as anxiety and sadness for their very ill patients. This is heightened when they take care of whom they know as having no more chance at recovery and are facing death any moment soon.
Often, they are privy not only to the physical but also the emotional pains of their patients. This may also extend to the patients close family and friends. Nurses are at hand to provide comfort and care. They are trained to empathize with their patients. They witness their patients journey and struggles with their health difficulties and even help them towards a peaceful and hopefully, painless death. However, little is done to give nurses the attention they also need when they grieve for the patients they have lost. These carers also need caring and understanding themselves. Although they are trained to project a professional stance by being strong in the face of death, they are still human beings who get affected when the people they care for pass away. It is difficult for them to bottle up their emotions as they should have the ability to mask their own pain in order to give comfort to the family left by their loved one.
This paper will discuss how nurses deal with their own grief when they lose a patient to death and what can be done to support such grieving nurses thorough those difficult times.
Brunelli (2005) comments that in nursing courses, there is nothing that prepares nurses for the possible overwhelming grief they can experience over and over with patients who die. She defines the grieving process as how one deals with the great and all-consuming feelings of loss of someone they have cared for. Reese (1996) further adds that it is how a person develops his or her own peace with his or herself regarding the loss before moving on with life. The famous Kubler-Ross (1969) stages of the grief process have been used to explain the emotions that people go through after a devastating event in their life. She theorizes that people go through five stages of grief, namely: denial, anger, bargaining, depression and acceptance.
However, there is very little literature on how nurses deal with the grief they experience with patients they have lost to death. Petraki (2002) did an exploratory study of Greek nurses grief reactions to their patients who are children dying from cancer. It was reported that the nurses reactions to death ranged from mere crying for the deceased, sadness and anger at the event and constant thoughts of the child patient dying after suffering from pain. When the child eventually dies, the nurses took comfort from their colleagues who remind them of the positive qualities of the child and the nurses contribution to make the childs life more comfortable and death more peaceful. Lenart et al. (1998) claim that nurses usually repress their grief. However, grief manifestations run from fatigue, disturbances in sleep patterns, anxiety, sorrow, mood shifts, and difficulty in concentrating (Brunelli, 2005). These symptoms become documented as unresolved grief responses. Grief that is repressed and unresolved is also known as disenfranchised grief or grief that persons experience when they incur a loss that is not or cannot be openly acknowledged, publicly mourned, or socially supported (Doka, 1989, p. 4).
If nurses keep repressing their grief, it would then lead to burnout. That is why the therapy for unrecognized loss is to recognize and acknowledge it.
Brosche (2003) contends that when grief is not fully expressed, the consequences can range from burnout to damaging addictions such as alcoholism or drug addiction or even to suicidal thoughts. This affects the morale of the staff and possibly the delivery of patient care since such grief that is not properly expressed may lead to being emotionally distant, depressed, apathetic, angry and burnt-out. On a macro level, the hospital can experience a high turnover of staff and low customer service and satisfaction. This is especially true in settings where patient diagnoses are usually poor and the repetitive deaths of patients they care for cause nurses physical, mental, emotional and even spiritual burden. That is one of the main reasons why nurses shift to other professions, causing a nation-wide shortage of nurses (Brunelli, 2005).
As an intervention, Brunelli (2005) recommends a multidisciplinary approach involving disciplines such as nursing, physicians, pastoral care, and psychology. Periodically, memorial services for patients who have passed may be held in the chapel or church and after the service, everyone including the family members of the deceased and the nurses and staff who cared for them would get together to eat, drink, tell stories to remember the deceased and just have some closure together. This is a good start for the grieving nurses to move on and regain the vigour and efficiency they may have lost after their patients have passed away.
A nurse needs to be emotionally strong if he or she expects to stay in the career for a long period of time. Resilience is an attribute that needs to be developed since the work puts the nurse in a constant state of stress. Patients recover and/or their health condition worsens and the nurses who care for them would experience peaks and valleys of emotions. Resilience keeps them in control of their emotions because they are able to hold up over time under conflicting issues. They learn to thrive despite the pressures and manage to survive with the uncertainty of what happens next. Resilience helps nurses maintain their mental, physical and emotional health and their spirit for living life with joy (Boss, 2006).
Bonanno (2004) notes that resiliency is more than just recovery from a stressful situation. The individual is able to maintain normal functioning even when undergoing the situation. Resilience is not just part of ones recovery after the crisis but is a continuous healthy functioning with regenerative growth and positive emotions (Bonanno, Papa & ONeill, 2001). Another observation is that resilience is more common that we thought (Bonanno, 2004). Grief therapists seek the grieving individuals under-reactions and overreactions of grief after the death of a loved one while trauma specialists focus only on the negative reactions of individuals after a traumatic event. Usually, the factor of resilience of such individuals is overlooked. Although what is manifested is usually the negative responses, it is highly possible that they have some level of resilience within them to push them forward to full recovery. Bonanno & Keltner (1997) found evidence that positive emotions enhance resilience and that resilient individuals who did well after a loss were actually ready for the eventuality (Boss, 2002). It is normal for them to go through negative emotions and even through Kubler-Ross stages of grief, but these emotions did not interfere with their normal functioning. Boss (2006) adds her observations of family caregivers of Alzheimers disease patients who showed resiliency throughout the duration of their care. Because Alzheimers disease presents ambiguousness in the patients recovery/ progression of illness, it allows for the patients caregivers to grieve gradually so by the time the patient eventually dies, the caregivers have shed all their tears and may even express relief as it is finally their turn to care for their own needs that have been neglected when the patient was still alive. It is now time to rebuild their own health and emotional well-being.
A third observation of Bonanno (2004) on resilience is that there are various paths to achieving it. Some people use repression of sad feelings as a way of coping while others resort to laughter and optimism to build their resilience (Bonanno, et al, 2003; Bonanno et al, 2002). Kobasa et al (1982) found that some people develop hardiness to buffer extreme stress. Bonanno (2004) suggests that pathways to resilience are affected by an individuals development, genetics, environment, gender and other yet undetermined risk/protective factors.
Boss (2006) notes that community-based therapy with extended family groups much like practices done by American Indian tribes may be more effective than individual therapy for people undergoing much grief. However, in these more contemporary times, it may not always work because independence and self-sufficiency is highly promoted. Boss (2006) observes that treatments may have swung too far away from family and community approaches.
Williams (2008) planned out a grief and loss program for a remote village in Zambia, Africa for people who constantly lose their loved ones to HIV/AIDS. Her program planning followed a modified version of the nursing process assessment, planning, implementation and evaluation (Williams, 2008).
In the assessment stage, Williams gathered insights from about adults and children who undergo overwhelming sadness and stress and have no resources for assistance. Williams (2008) was informed that feelings of loss that prevail long after a loved one dies does not easily dissipate and even continue to affect peoples ability to lead healthy, productive lives. It should be remembered that these individuals are constantly battered by death in the family due to the prevalence of HIV/AIDS in the area. Such a case may be paralleled to nurses who are constantly exposed to patients deaths after a lingering disease that involved their care. The volunteers in the Zambia study add that supporting the physical needs of the grieving individuals is not enough and addressing emotional needs is what is more important.