Nurses have faced grief on overdrive in the last several years with the unexpected challenges brought by the pandemic. Many days, your job requires you to show up and care for others while you continue grieving for someone else. Your grief may look very different than your coworker's down the hall. At times, the grief feels manageable. But on other days, it can feel almost unbearable, especially when it involves a life-altering loss. The burden can be alleviated when you have support and understanding.
Coping with grief over patient deaths
When we think about nurses coping with grief in this era of the coronavirus pandemic, we naturally think about patients dying from COVID-19. However, nurses have always had to manage their distress and grief over patient losses -- especially in certain specialties. Nurses working in a pediatric intensive care unit (PICU) reported in a study that patient deaths led to persistent and intrusive symptoms of grief. Some PICU nurses said they felt mentally exhausted and emotionally drained, had traumatic thoughts and images recur, and had distress over patient suffering. Other PICU nurses reported finding validation in the positive care they provided, support from conversations with colleagues and friends, and comfort in their own families.
For those working in hospice, "Living with dying each day helps nurses appreciate the gift of life," one former hospice nurse told Nurse.com.
Caring despite personal challenges
However, many nurses are grieving from their own personal losses unrelated to patient deaths. That can make caring for others even more challenging, as we explored in "Caring While Grieving," our first NurseDot Podcast episode. Host Cara Lunsford, RN, talked with guest Sona Daldumyan, RN, about her experiences caring for pediatric oncology patients and their families while navigating her own grief. Lunsford is Vice President of Community at Nurse.com. Daldumyan, who has 23 years of experience in nursing and 21 years in pediatric oncology, has witnessed the death of young patients and seen their families struggle. But she has also endured her own personal tragedies.
Experiencing profound loss
In recent years, Daldumyan's husband and father both became seriously ill with forms of cancer. Both went through chemotherapy and passed away within six months of each other. About five years ago, Daldumyan was taking care of oncology patients at work and then caring for her husband, who had pancreatic adenocarcinoma, at home. Patients' families would say that she couldn't understand their pain because she wasn't going through it. Daldumyan kept her professional face showing, she said, "But inside, you're dying because you know exactly what they're going through because you yourself are going through it." Lunsford observed that it must be incredibly difficult to care for other people when you're in deep pain yourself. Unfortunately, Daldumyan's husband ultimately died. "And the second his heartbeat stopped, I experienced profound loss," she said.
"I decided that moment that I wasn't going to allow his death to change me for the worst. I was going to allow his death to teach me lessons and become even better," Daldumyan said.
Her experiences led her to enhance her efforts at patient advocacy. She shared suggestions with nurses and doctors to improve how they support patients.
The losses add up
After Daldumyan's husband and father died, her mother got sick. "My mom passed away in November of last year, while I was still grieving the loss of my husband and my father," she recalled. During the pandemic, Daldumyan began to experience grief because of the struggles of being a single parent and not always being able to be home with her children. "Because then you kind of had to choose -- 'Am I going to be at the hospital taking care of patients who need me, nurses that need me, because we're short-staffed and people are getting sick, or be there for my kids?'" She felt both guilt and grief because "There was no one at home to home-school my kids while I was taking care of other people's kids at the hospital," she said. Daldumyan ended up leaving her hospital role to be home with her children.
Feeling grief, expressing mourning
In the aftermath, Daldumyan began to recognize all the changes she had gone through in such a short period of time. She had left her hospital role and lost her husband, her father, and her mother. "It was tough to kind of lean into the grief," she said. Behavioral health professionals note differences between grief and mourning. Grief encompasses the internal feelings experienced from a loss. Mourning is the external response, including how you celebrate the person's life and death. Coping with grief occurs differently for individuals, and it can sometimes develop into complicated grief. Complicated grief, which is more intense and lasts longer, may affect 7-10% of people who experience bereavement, according to Medical News Today.
Support from other nurses
Being able to talk about your feelings with coworkers and family can help nurses cope with grief, and Daldumyan has done that. Acknowledging her need for support to her coworkers helped a great deal. "Without those strong relationships, those strong bonds, this profession would not be possible," Lunsford said. Daldumyan also talked with her children about her grief and the challenges she was facing. Early on, she felt that if her children saw her as weak, they might not come to her for support with problems. "But it did actually work the opposite way. Now that they know that I'm not this superhero...it has normalized me. So they're more able to come to me, which has been a pretty cool experience." She also advocates for healthcare organizations to offer nurses coping with grief more options for psychological support, counseling, and peer support. "Grief is a feeling. It shouldn't be taboo," Daldumyan said. "People need to talk about it, normalize it, learn from it, and forge ahead." So forge ahead when you are ready to forge ahead. If you would like to connect with other nurses for support, download the Nurse.com social networking app and join the nurse community's conversations. 
