For many healthcare workers, caring for people at the end of their lives is a regular occurrence. Although commonplace in healthcare settings, dealing with a death is never easy.
The emotional toll of death is often played down in healthcare settings as an expected, even routine part of the role.
However, healthcare workers can experience grief and loss as much as anyone else, whether they are close to the dying person and their loved ones, or just a passing player in this important stage of life.
What is grief?
Grief is the deep sadness, sorrow and distress usually caused by a loss such as the end of an important relationship, or following a death. A person can grieve the loss of anything important in their life; the loss of a home or important life events can trigger the grieving process.
Grief is an emotional response, but there are physical and social aspects of grief that can be just as profound and important.
Grief is a normal reaction to a loss and although it can be incredibly difficult, it is natural and it does get better.
Healthcare work as a trigger of grief
Looking after people who are coming to the end of their lives takes many forms. Workers in acute or emergency settings may experience traumatic deaths which may be unexpected, unpredictable and difficult to manage.
Source: Unsplash | Photo by Mufid Majnun
Healthcare workers may be expected to attend to a cardiac arrest, perhaps working for an hour or more trying to resuscitate a patient without success, then after this physically and emotionally draining experience go immediately back to their other patients.
Those working in healthcare settings may experience the particularly emotive and tragic deaths of babies and children, and need to help manage the grief of parents, siblings, and other traumatically bereaved people.[i]
An expected death, perhaps that of a very elderly person or someone who is coming to the end of a long illness may be well managed with good nursing and medical care to ensure that the dying person doesn’t experience any discomfort or distress at the end of their life.
This does not, however, mean it is necessarily any easier to cope with for the people who are close to the patient and their family.
As well as dealing with their own feeling of grief and loss, healthcare workers are expected to retain a level of stoicism and resilience that will allow them to comfort family members and other loved ones of the deceased in a professional way.
Care home workers may have known their residents for years and experience their loss as much as with a close friend or family member. Acute healthcare workers may only know their patients for a short time but can be significantly affected by the death, condition and situation, or deterioration of their patient.
Of course, a healthcare worker will experience personal loss and grief as frequently as anyone else, and after the death of a loved one in their own life will return to work alongside numerous reminders of their own loss.[ii] The snippets of insight into tragedy that healthcare workers experience can act as triggers for strong and difficult personal memories and emotions.
Stages of grief
One of the most widely accepted theories regarding the grieving process is the idea that there are five main stages of grief, and that people move through these stages in a reasonably predictable way [iii] with some periods of regression but an overall gradual trajectory towards resolution and recovery.
This model does not necessarily work for everyone and the grieving process can be more complex than a march through specific stages, but understanding some of the expressions of grief can be useful.[iv] The five stages comprise:
Denial
The first feelings after a bereavement include shock and a feeling that this can’t have happened, and a feeling of unreality. It can feel like the world is coming to an end and that it’s hard to imagine life going on in anything like a normal way.
Anger
Feeling rage and anger after a loss are a natural, even important part of the grieving process. It can include anger towards oneself and anger towards the person who has been lost.
Thoughts like ‘how could they leave me?’ and resentment over the idea of living without that person are common ways to feel, and it’s alright to feel like that.
Anger can also be directed towards the world in general; towards friends, family, caregivers; can take the form of spiritual questioning, and can also make a person feel guilty for feeling that way.
Bargaining
Thoughts of ‘if only…’ or ‘what if…’ are a natural part of grieving. At times, loved ones of a deceased patient may regret certain decisions, which may then implicate nurses and doctors (for example: “Why did I let him go through with the surgery?” “If only we didn’t start her on chemotherapy…”). This is something that has to be managed logically and practically.
Depression
Depression goes beyond simply feeling sad, and can be all-consuming with both emotional and physical symptoms. Depression is often the most difficult stage of grieving, as it can impact every aspect of life.
Acceptance
Acceptance does not mean that the same emotions aren’t still there, just that they aren’t affecting everyday life. The feelings of loss and sadness may never fully go away, but may fade from the forefront of a person’s mind.
The loss is profound, but the feeling is less and less frequent.
Effects and symptoms of grief
Grief is an emotional response, but there are physical and social aspects of grief that can be just as profound and important.
The physical aspects of grieving can include fatigue, feelings of generalised physical pain and non-specific symptoms like headaches and stomachaches.[v]
Grief is a normal reaction to a loss and although it can be incredibly difficult, it is natural and it does get better.
Normal symptoms of grief can include:
- Sadness – with or without episodes of crying and sighing.
- Depression – depression may be considered one of the stages of grief, but can also be distinct from the grieving process. They are two similar and overlapping conditions, and feeling depression during a time of grief is normal, although it can be very difficult.
- Fatigue – feeling tired all the time or without any other reason, even after a good night’s sleep
- Sleep disturbances – insomnia can be common during times of grief; finding it hard to get to sleep or frequent periods of wakefulness. Sleep disturbances can also include excess sleeping, napping too much through the day and feeling unable to wake up properly in the morning.
Physical symptoms like generalised pain, nausea and stomach ache, indigestion, and headaches can be somatic expressions of grief and depression. Physical symptoms with an emotional cause are as real and unpleasant as any physical symptoms with more tangible causes.
Grief can also make people more vulnerable to unhealthy behaviours like drinking alcohol, smoking, comfort-eating and getting less fresh air and exercise.
Tips on coping with grief and loss
Everyone’s experience of grief is different, but some common advice includes:
- Acknowledging one’s emotions and accepting that they will be painful
- Counselling and talking therapies
- Workplace debriefings after a death
- Self-care – allowing oneself time and soothing activities
- Maintaining the practicalities of physical care – continuing to eat, drink, wash, see other people and exercise
- Identifying the difference between normal grief and debilitating depression, and getting appropriate help.
Some people may need to take time off work following a bereavement, and others prefer to keep working throughout. Above all, talking to others and accessing support can be instrumental.[vi]
Flexible work schedules, better work-life balance ❤️
If you are a nurse, it might be worthwhile to consider being a freelance nurse instead. You will have full autonomy on how much you’d like to work, giving you time and space away from the workplace to take better care of your own health.
Find out the benefits of being a Homage nurse here and join us today.
Affordable therapy and counselling services in Singapore
If you would like to seek external help and support, here are some places you can go.
| Name of centre | Prices | Description |
|---|---|---|
| Within public healthcare organisations | Free | Some of the local hospitals offer free mental health support and counseling services for their employees. Take for example, in the National University Healthcare System (NUHS), healthcare workers can have access to art therapy, music therapy, mindfulness sessions, as well as counseling services. |
| National Care Hotline | Free | This hotline has been set-up to offer support during COVID-19. Call the hotline to speak with someone about stresses and seek support for mental well-being. Calls after midnight will be routed to contact other available 24-hour crisis hotlines, including those supported by the Institute of Mental Health (IMH) and Samaritans of Singapore (SOS). |
| Singapore Association for Mental Health (SAMH) | Free | Individuals seeking counseling can call the helpline to arrange for an appointment, or just to speak with someone about their problems. When necessary, clients may be referred to a psychiatrist or relevant agencies in the community. Fees are by donation only. Operating hours from 9am – 6pm on weekdays (except public holidays) |
| AWARE | Free | The AWARE Women’s Helpline is run by women, for women. Trained volunteers and staff will be able to provide you with assistance about various concerns, offering empathy, support, information and encouragement. You can also engage counseling help through this helpline. For counseling services, prices are as below: |
| Fei Yue eCounselling Centre | Free | eC2 is an e-Counselling Centre where you can talk to a trained counselor. SImply go to the website and start a chat with a counselor. |
| Counselling and Care Centre | *Subsidised rate: $40-$150/hour Full rate: $180/hour | Counselling and Care Centre is a non-government, non-profit, registered charity offering professional counseling services. They offer individual psychotherapy sessions. *For Singaporean/PR earning <$10,000 monthly |
| Calvary Community Care (C3) | $50/session $5 for those who need financial assistance | C3 provides counseling services to youths between 12 to 25 years of age. |
| WINGS Counselling Centre | $80 for the first session, $60 for follow-up sessions | A community project of Ramakrishna Mission, WINGS counseling centre offers assistance to individuals and adults who may be experiencing a variety of personal issues such as work stress, relationship difficulties, transitional challenges, or family and personal dilemmas. |
| Reach Community Services | $80.00-$120.00/hour based on means testing on per household income | Reach Community Services is a professional social service agency commissioned by the Ministry of Social and Family Development to serve families and individuals residing in the Bishan, Sin Ming, Shunfu and Thomson Community. They offer counseling services for mental health, amidst their focus on marriage and family counseling. |
| Grace Counselling Centre | Online counseling session: From $130/hour Face to face counseling session: From $150/hour | Grace Counselling Centre offers Christian counseling services, and non-religious counseling services as well. |
| Singapore Counselling Centre | Starting from from $171.20 for 1 session | Singapore Counseling Centre offers professional counselling in various languages, and are open 7 days a week. There are options to purchase counseling packages. |
How to help others cope with bereavement
Source: Unsplash | Photo by National Cancer Institute
Healthcare workers are often in a position where they are the closest professional person to a family at a time of intense and acute grief and emotional trauma.
Proper support at the workplace
Appropriate training in care of the dying person and their loved ones can help give the worker the resources and skills to support those people – all while allowing that worker to experience their own grief – and if that kind of training is available, it can be invaluable.[vii] Some employers also offer courses in aspects of personal resilience to help staff maintain good mental health through difficult times.[viii]
Being present and sensitive to friends who are grieving
Being part of someone else’s grief is difficult, and there is no right thing to say or do. Some people may have a lot of questions about their loved one’s death, and it’s important to try and answer these sensitively and honestly, or give access to someone who can.
Being present and available, letting people know that you’re there if there’s anything they need – while remaining unobtrusive – is important. In a healthcare setting there should ideally be a place where bereaved people are able to go and have peace, to eat and drink, to contact relatives, and to rest before they need to make any journeys.
Hospitals may provide places to meet people’s spiritual needs too.
Provide practical support by helping with death-related administrative matters
For a healthcare worker, being able to advise on the practical steps one needs to take after a death can be helpful, so it’s useful to know the next steps in the worker’s own area; how death certificates are created and issued, how to access an undertaker and begin the process of planning a funeral.
When to seek professional help
Caring for people at the end of their lives is a common part of a healthcare worker’s role. This can mean that the emotional toll is downplayed but caring for dying people and their loved ones isn’t easy, and healthcare workers need the right resources to remain resilient, and to value and accept their feelings.[ix] Peer support can be an important part of that, and the camaraderie of colleagues who have experienced similar things can be invaluable. Personal networks – friends and family – can be essential when dealing with difficult physical and emotional symptoms.
Professional help is also important, and there are a number of support groups both online and in person that can help. Healthcare workers may also be able to access support through their employers. Anyone struggling to cope with any emotional trauma or symptoms of grief or depression can access professional support through their GP.
Just because an experience is a common part of the job doesn’t mean anyone has to bear it alone.
Learn more about our careers as a Homage Caregiver or Nurse and apply to be a Care Pro with us today.
- [i] Lerea, L. E., & Limauro, B. F. (1982). Grief among healthcare workers: A comparative study. Journal of Gerontology, 37(5), 604-608.
- [ii] Rabow, M. W., Huang, C. H. S., White-Hammond, G. E., & Tucker, R. O. (2021). Witnesses and victims both: Healthcare workers and grief in the time of COVID-19. Journal of Pain and Symptom Management, 62(3), 647-656.
- [iii] Kübler-Ross, E., & Kessler, D. (2009). The five stages of grief. In Library of Congress Catalogin in Publication Data (Ed.), On grief and grieving (pp. 7-30).
- [iv] Stroebe, M., Schut, H., & Boerner, K. (2017). Cautioning health-care professionals: Bereaved persons are misguided through the stages of grief. OMEGA-Journal of death and dying, 74(4), 455-473.
- [v] Shuchter, S. R., & Zisook, S. (1993). The course of normal grief. In M. S. Stroebe, W. Stroebe, & R. O. Hansson (Eds.), Handbook of bereavement: Theory, research, and intervention (pp. 23–43). Cambridge University Press. https://doi.org/10.1017/CBO9780511664076.003
- [vi] Houck, D. (2014). Helping nurses cope with grief and compassion fatigue: an educational intervention. Clinical Journal of Oncology Nursing, 18(4).
- [vii] Harder, N., Lemoine, J., & Harwood, R. (2020). Psychological outcomes of debriefing healthcare providers who experience expected and unexpected patient death in clinical or simulation experiences: a scoping review. Journal of clinical nursing, 29(3-4), 330-346.
- [viii] Rogers, D. (2016). Which educational interventions improve healthcare professionals’ resilience?. Medical teacher, 38(12), 1236-1241.
- [ix] Holman, C. (2008). Living bereavement: an exploration of healthcare workers’ responses to loss and grief in an NHS continuing care ward for older people. International Journal of Older People Nursing, 3(4), 278-281.
