When engaging with a family member of a patient who has died, nurses should consider using immediate interventions aimed at supporting the loved ones who are in shock and in pain following their loss.
The COVID-19 pandemic turned 2020 and then 2021 into the deadliest years in United States history.1 In this time, the deaths caused by the coronavirus, an increase in deaths from heart disease and cancer, and the almost doubling of overdose fatalities has left the country living and working through unprecedented loss.1,2 Health care professionals, and specifically those who manage the day to day care of patients such as nurses, have lived through a collective traumatic pandemic with little to no training on how to manage loss – their own, their patients’, and that of the families of their patients.
Although the pandemic has brought loss and trauma to the forefront, historically, most individuals in the United States die in hospital or nursing homes. Stanford School of medicine calculates that about 80% of all deaths happen in institutions.1 By default, nurses become the first line of support for grieving family members. When engaging with a family member of a patient who has died, nurses should consider using immediate interventions aimed at supporting the loved ones who are in shock and in pain following their loss.
Given the devastating loss of the past two years, as a nurse, it is necessary to take a moment to understand and process your own experiences. When working with end of life and bereaved individuals, it is helpful to identity your own triggers, acknowledge and process your own losses, and find compassion for yourself and your experiences. Understanding yourself will allow you to better understand and support others.
Hospitals and hospice institutions have traditionally offered bereavement support through educational materials, referrals to services, individual counseling, and support groups, which typically begin weeks after the death. These services are necessary and provide a map for bereaved individuals as they move through their grief. But what happens at the moment of death? What interventions can you use to support people as they are witnessing their loved one die and immediately afterwards?
Immediate interventions at the time of loss:
1. Be present and hold the space: Although death is inevitable, most of us are not comfortable seeing, talking, or thinking about death – our own or someone else’s. To be a good support for a grieving family member, you must identify, acknowledge, and accept your own feelings. Perhaps you are feeling scared, frustrated, impatient, numb, or simply sad.Be aware of your own emotions so that you may be able to provide the emotional space needed for your patient’s grieving loved ones.
2. Emotional safety first: Always assess family and friends present. Are they able to feel and sustain the emotions they are experiencing? Are they physically able to stand and be present in the room? Do you need to offer a chair or a drink of water to those present? Should you offer psychiatric or bereavement resources?
3. Acknowledge and normalize: Regardless of how long their loved one was sick or how expected or unexpected the death is, almost everyone’s initial reaction will be shock or numbness. Your best approach is to use concrete and clear language to communicate and normalize what has happened (I am sorry that your loved one has died, I cannot imagine your feelings right now, etc). Remember, you cannot make things worse by using accurate and precise language.
4. Say no to platitudes: You can make things worse by using platitudes. Never make assumptions about people’s feelings or experiences. Even though you may believe that the death is a relief from the patient’s pain, the griever may not be ready to see it at that moment.Statements such as ‘he is in a better place’ or ‘at least she is no longer suffering,’ will not help the loved one see the loss in a different way. But such comments will make the griever feel guilty about the yearning for more time with their loved ones.
5. Always use the name of the deceased: “I am sorry Peter has died” or “I know you loved Mary very much.” Most of us wrongly believe that using the proper name will elicit painful reactions from their grieving friends and family. On the contrary, hearing the loved one’s name brings comfort.
6. Validate: Allow the person to feel exactly what they are feeling and confirm for them that that is exactly what they should be feeling. As nurses, you are trained to cure or alleviate pain. When supporting a griever, nobody can fix or take away their pain.The grieving person must experience the intense emotions that come with the death of a loved one.
7. Psychoeducation: Share with the grieving family and friends that grief is an emotional, behavioral, and a physical experience. Review with them the basic symptoms of grief.Emotionally, they might feel sadness, anger, guilty, anxiety, loneliness, etc. Physically, they might feel exhausted, unable to sleep/sleeping too much, change in eating habits, tightness in throat, shortness of breath, general distress. And their behavior is likely to change as well: forgetfulness, excessive worrying, withdrawal from normal activities.
Nursing is a profession that has always been defined by compassion, understanding, and empathy. Applying the traditional nursing skills, coupled with the immediate interventions mentioned in this article, will help the newly bereaved begin their grief journey in a supportive way.