A family experiencing the loss, how-ever, is usually devastated and mayneed assistance to manage the initialshock. If health care professionalsaren’t accustomed to death or loss, theymay also become as distraught as thefamily and may not be able to helpeither the family or themselves unlessthey learn about the grieving process. Itmay be very difficult to relate fully tosomeone else’s grief; however, we knowas nurses that families must begin thegrieving process in order to move tothe eventual stages of accepting the lossof a loved one.

As a nursing instructor, studentsoften tell me that a patient has lost aloved one. When I inquire about thedetails, students typically tell me theyare afraid to ask for such because theydon’t want to upset the patient. I oftenask if the students may also be afraidof their own feelings of loss.

The death ofmy husband two years ago helped melearn how to grieve. As our familytalked about our loss with others wholoved and worked with him, we sharedmany stories that brought both tearsand laughter for us. Sharing our tearsand memories helped to keep our lovedone with us. It’s not in holding on tothe person who has died that we learnhow to go on but in cherishing the mem-ories they have bequeathed us. I don’tpretend to know exactly how someonefeels about the loss of a loved one, butas a nurse and as a woman I canempathize with this person, which mayhelp her or him to start the grievingprocess. Using my own experience, Iguide students to help patients andtheir families do the work of grieving.Many students say they don’t knowwhat to say. I tell them that that isexactly what they need to say, “I don’tknow what to say.” Other helpfulstatements are: “I can’t imagine howsad you must be. If you want to talkabout anything, I am here.”

Dealing with loss is never easy.Helping another human deal with thedepth of emotion that loss brings canbe very rewarding and add a newdimension to nursing practice. Thegrieving process can promote personalgrowth, both for nurses and for thosepersons for whom they’re providingcare and comfort. It has been said thatknowing the depths of loss makes thejoy of happiness much sweeter.

HHEELLPPIINNGG FFAAMMIILLIIEESS GGRRIIEEVVEEIn nursing school, most nurses aretaught the five stages identified byKübler-Ross regarding grief and reac-tions to death (Table 1). Individualsmay follow the stages in the order theyare identified or they may go back andforth between stages. They may getstuck in a certain stage. The final stageof acceptance suggests coming to termswith the loss. Nurses familiar with thestages of grieving can use them as aguide; however, it’s important to notethat just recognizing a particular griev-ing stage does little to direct the griev-ing process.

Dianne F. Hayward, RNC, MSN, WHNP, isa nurse educator specializing in maternal/child and women’s health nursing at WayneState University in Detroit, MI.

Dianne F. Hayward, RNC, MSN, WHNP

Memoriesof a

180 AWHONN Lifelines Volume 6, Issue 2

Death and loss are part of everyday life for many health

care professionals. To survive, some health care profes-

sionals erect a barrier as a shield from the constant pain and

sadness. They become so protected from the pain of others

that it may be difficult for them to help a grieving family.

(continues on p. 179)

Loved OneFrom Caring

Comes Comfort

Hogan, Greenfield, and Schmidt(2001) developed a Grief ReactionChecklist using data collected frombereaved adults who had experiencedthe death of a loved one (Table 2). Thechecklist follows behavioral patternswith a positive trajectory toward per-sonal growth as the outcome. Personalgrowth suggests an expansion orimprovement of the self and seems tobe a healthier and more desirable out-come than Kübler-Ross’s last stage ofacceptance.

As a former NICU and Labor andDelivery nurse, I have helped initiatethe grieving process for families suffer-ing one of the most devastating lossesof all—the loss of a baby. People expe-rience and act on grief in a very indi-vidual manner. Some go through theexperience quietly and internalize theevent. Others loudly wail and draw inall around them to join in their grief.There are many variations between thetwo extremes. A family’s reaction todeath may be culturally structured.Those families that are highly emotion-al react to grief in a highly emotionalway. Families who are more reserved intheir demeanor may view displays ofany emotion as disgraceful. The differ-ences in reaction between and withingroups make it difficult to assess thedegree or stage of grieving.

Individuals also have personalboundaries concerning death that dic-tate what is acceptable. In our culture,death is neither a polite nor a comfort-able subject for discussion—it’s evenconsidered a taboo topic for many. It’simportant that just as death is oftendifficult for individuals to discuss, it istypically just as difficult for health careprofessionals to talk about—becausewe are nurses doesn’t mean we’re morecomfortable with issues of mortality.

It’s important that as nurses we askourselves whether our own discomfortwith death limits our therapeuticinteractions with a grieving patient orfamily. Do we protect ourselves fromothers’ pain to distance ourselvesfrom the everyday sadness many of ourjobs bring into our lives? Are weafraid we may shed tears and appearless than professional? Have we buriedsome grief of our own and fear it maysurface?

Many health care professionalsattempt to limit their exposure to thegrieving family by ushering them into asmall room with the door closed. Thismay give a family space in which togrieve, but it does little to guide theinterventions that are necessary tobegin the process of grieving. Modelsof grieving may teach grief stage recog-nition, but they don’t guide the process.The most important need a grievingperson has is not addressed in eitherthe Kübler-Ross Model or the HoganGrief Reaction Checklist. It’s not untilwe are in the depths of our own griev-ing that we understand to some degreewhat a grieving person is experienc-ing—only then can we begin to under-stand the need to talk about the experi-ence. Nurses may feel uncomfortabletalking about loss. Acting as if nothinghas happened won’t make the pain ofloss go away. Nurses need to recognizeand tell grieving families that while it’spossible to push sad feelings away for awhile, they will eventually resurface,sometimes in very surprising ways, trig-

gered by unexpected events. For exam-ple, if the work of grieving is delayed, aperson may later find themselves react-ing to insignificant events in ways thatare way out of proportion. If grief isrepressed and not expressed, depressionis likely to develop. Talking about thesad feelings and shedding tears are thevery important work of grieving.

Sadness needs to be experienced toallow a grieving person to come to res-olution. There’s another loss, however,when feelings are buried. If grief is notresolved, the loss remains as a very sadpart of a person’s memories. When aperson can’t think about the sad feel-ings, then she or he also loses the goodmemories. It can be too painful tobring up all the wonderful times sharedif the sad feelings are still intermingledamong those good memories. Just hear-ing the name of the deceased personcan be devastating to a family who hasblocked the pain of grief. What familiesdon’t often recognize is that when thepain of loss is blocked, so are the mem-ories that could be cherished—eventu-ally, it’s as if the deceased person neverlived.

So what does good grieving looklike? Sharing both the good and the sadmemories. Crying and laughing simul-taneously are signs of healthy grieving.By moving through the sad, we keepthe happy memories alive. As healthcare professionals, don’t assume yourpatient or patient’s family doesn’t wantto talk about their loss. Not wanting totalk about loss may be a reflection ofyour own fear, not theirs. Find out.Talk about the person who has died.The family will probably cry, and that’sOK. You may cry, and that’s OK, too.When you come to terms with yourown feelings regarding loss and griev-ing, you become a much more compas-sionate caregiver. ♦

RReeffeerreenncceess

Hogan, N. S., Greenfield, D. B., &Schmidt, L. A. (2001). Develop-ment and validation of theHogan Grief Reaction Checklist.Death Studies, 25(1), 1-32.

Taylor, C., Lillis, C., & LeMone, P.(1997). Fundamentals of nursing:The art & science of nursing care(3rd ed.). Philadelphia: Lippincott.

April/May 2002 AWHONN Lifelines 179

TTaabbllee 22Hogan Grief ReactionChecklist

1. Despair

2. Panic behavior

3. Blame and anger

4. Detachment

5. Disorganization

6. Personal Growth

Source: Hogan, Greenfield, Schmidt,2001

TTaabbllee 11Five Stages of Kübler-Ross’s Grief and Death Reactions

1. Denial and isolation

2. Anger

3. Bargaining

4. Depression

5. Acceptance

Source: Kubler-Ross, as cited in Taylor,Lillis, & LeMone, 1997