Advice on how to be a better healing presence for those experiencing loss
By Karen Skillings
January 2, 2024
I’ll never forget that night 47 years ago, when I arrived to work my shift on the maternity ward. I was a two-year graduate, a novice nurse. I was pleased to hear we had a labouring patient being induced and dilating. Good. She would deliver on my shift, which would help the night pass quickly. But what was the reason for the induction? Her baby had died the previous week. I asked the supervisor for an assignment change, but that was not possible with our small staff complement. So I went to meet the couple, my eight months pregnant belly preceding me into the room. Perhaps you can imagine the grief experienced during that long shift.
I had not learned much in nursing school, or in life, about being a healing presence in the face of such suffering. I have since cared for many dying patients and their families. I have taught nursing and developed end-of-life curricula. I have lost my own stillborn babies, grandparents, parents, siblings and so many dear friends. Then the greatest loss of all: my soulmate. None of my experiences or research had prepared me for the agony of this death. I wrote and published poems birthed during that time of deep pain, which led to gradual healing. I joined groups where bereaved soulmates express their suffering and receive support. I visit hospice societies to share poetry and participate in conversations that support this very individual journey of loss, grief and healing.
What I have discovered from the experience of my own and others’ loss is that North American society, including the health-care professions, has not advanced far in preparing each of us to be a healing presence for those in grief. As nurses, we are so knowledgeable and skilled with our arsenals of interventions as we set out to achieve our goals to promote health and alleviate suffering.
Bereaved folks overwhelmingly report being wounded again by the “comfort” they are offered from others. Words that are supposed to be soothing can be so discordant with what grieving family and friends are experiencing. The recommendations to medicate their way through suffering, the litany of platitudes: “He’s in a better place,” “God needed him more,” “Life goes on,” etc. The endless advice: “Fake it ’til you make it,” “Set aside one hour of the day to mourn,” “Be thankful that his suffering is over,” “Get on with your life,” “Go back to work,” “Don’t go back to work,” “Get a dog,” “Don’t get a dog,” “Move,” “Don’t move.” And those painful comments that come from such caring hearts: “You should be better by now,” “You look awful,” “He would be so disappointed in you getting stuck in grief,” “You’ll find love again.”
There is also the compounded suffering of being abandoned by family and friends, avoided by those who cannot bear to witness this pain. And there is the added pain from those who launch into their own detailed stories of loss. For the most part, grievers graciously listen and remind themselves, again and again, that a compassionate desire to diminish pain is the loving intention behind the hurtful words.
The shift to a healing presence
I wonder if health-care professionals can shift the way we understand grief so that we can be a healing presence for our patients, families and friends. My observation is that our nursing minds equate suffering with disease, which is appropriate for physical pain. We dispense medications and advice, which often alleviate the physiological suffering our caring hearts recognize and ache to relieve. But how do nurses respond to grief? We apply the nursing process: recognize what is often diagnosed as emotional distress, identify causes, provide emotional support, connect the griever with professionals such as social work or mental health colleagues to offer their expert assistance, and then complete the nursing process by evaluating the outcome of these interventions.
But what if grief is an experience of spiritual, rather than emotional, distress? Let us compare the two. Emotions are changeable. They come and go like the wind because they live on the surface of our physical lives. They can easily arise and be inflamed, calmed or transformed by hearing a comment, a piece of music, or reading a news article. Any action in the outer, worldly life — any illusory belief or bias — can influence emotions.
Now, let’s contrast the emotional with the spiritual domain. The Search Institute, a non-profit organization that works to support youth, conducted international and cross-cultural research into spiritual development. The institute describes spiritual development as the “constant, ongoing, and dynamic interplay between one’s inward journey and one’s outward journey.” The institute identifies three important processes to develop your spiritual awareness: awakening to one’s self, others, and the universe (which may be understood to include the sacred) in ways that cultivate identity, meaning and purpose; embracing relationships with others, the world and the spiritual domain in ways that give meaning to human experience; and living an integrated life, which means to authentically express your “strengths, identity, passions, values, and creativity” in ways that build meaningful and diverse connections.
Although my nursing coursework taught me well about physical and psychological health, it did not teach me about the spiritual domain. My spiritual direction curriculum taught me indicators of spiritual health (which are well articulated above by the Search Institute), as well as indicators of spiritual distress. This is associated with events that disturb one’s spiritual equilibrium, disrupting their sense of identity, meaning and purpose, and the experience of being in relationship as the beloved. I recognize common themes of spiritual distress in my poems and in the descriptions of others: alive but not living; profound loss of meaning, identity and unconditional love; and deep despair, abandonment and hopelessness. Grief is an existential, spiritual crisis rather than an ephemeral or emotional phenomenon.
What does this paradigm shift mean to our way of being with the bereaved? It feels to me that the journey into and through spiritual distress could be recognized more helpfully as a sacred experience (a metaphorical “sacred space” in one’s life) that can only be supported with behaviours arising from the spiritual domain. I’m thinking, for example, of the compassion and empathy that moved us into health care and keep us there during challenging times.
The key is to approach the bereaved from one’s fully open heart, not from one’s head space, and join with them in this sacred space. What might our nursing interventions be then? We can do the following:
- Be compassionate, above all else.
- Acknowledge their pain and accept that everyone experiences it uniquely.
- Be quiet to create space for the bereaved to express themselves.
- Be courageous and offer deep listening, with the humility that prohibits platitudes and advice.
- Choose to be a healing presence rather than a healer.
- Access your wisdom to transcend your usual healing role because you cannot heal another’s wounded soul.
- Follow your soul’s intuitive guidance for what’s needed right here, right now — a listening ear, a touch, a tear.
The world of the nursing profession has been so very challenging these past several years. Nurses are struggling to provide the safe care that people need, in a caring manner that goes beyond ethical responsibilities. Nursing the bereaved is about revealing our empathy and compassion, giving our attention to another (active listening), and being with rather than doing for. Even if only a few moments are available, we can know we have helped and not hurt. We can be a healing presence. Let’s offer that.
Karen Skillings, RN, BSN, M.Ed., author of Love, Loss, New Life: Writing Your Way from Grief to Happiness has certificates in therapeutic touch and spiritual direction. Learn more at karenskillings.com.