Monica is a registered nurse who provides incalculable healthcare to her patients. She loves her job and deeply cares about everyone she works for. However, there is one thing she hates in the hospital: patient death. Monica still remembers the first time she was assigned a patient. He was an old man with a heart disease. During the first few days Monica looked after him, he was still well and so she imagined how soon he can be discharged from the hospital.
After a few days, the patient’s condition got bad to worse. Monica was replaced with another nurse and was reassigned to another. She could no longer take care of him. But, what she hated the most was knowing that her first patient’s condition was worsening.
A few days later, Monica saw a priest being called to his room. His family was grieving at the bedside. Monica was heartbroken. Her nursing care plan didn’t go as expected. She lost her first patient who she had already established a connection with.
Depression among nurses
Depression among nurses is real, and it’s becoming an epidemic. According to the Interdisciplinary Nursing Quality Research Initiative (INQRI) of the Robert Wood Johnson Foundation, twice as many nurses suffer from clinical depression compared to the general public. It was reported that while only 9 percent of the general citizens experience depression, 18 percent of the nursing population do.
Despite being a common occurrence, most nurses never talk about their mental condition. Nurses either don’t know they have it, are afraid patients will no longer trust them, or are afraid they’ll no longer be accepted by the team. They care less about their own mental health because of the need to always portray a caring role.
Nurses experience depression due to a variety of factors. One is because of the sadness associated with losing a patient, just like what Monica dealt with. This feeling of sadness is triggered by the disappointment of not being able to help a patient through. As days pass, the emotional hurt fades and the sadness remits.
Other causes of depression among nurses are caused by the implicit ‘survival game’ in hospitals. Nurses and other healthcare providers are always under tension because of stress from lack of rest, anxiety, and depression. However, some hospitals, groups, or nurses seem to take pride in having survived all the horror. Failing to comply with the standards could add to the negative feeling of nurses already suffering from depression.
Nurses’ depression may also be exacerbated by their job satisfaction, patient load, stressful shifting, family problems, and body mass index. Whatever the causative factors are, depression affects the mental and emotional state of nurses which, in turn, may affect their ability to perform their job.
Death anxiety and the importance of death education
Among the major contributors to nurses’ depression is death anxiety. The fear of death arises from the desire of a person to preserve life. One’s attitude towards death is influenced by each person’s cultural, personal, social, and philosophical background that shaped his attitude. When a nurse witnesses the death of a patient, he doesn’t only feel for the patient but also thinks of his own mortality. Too much thought could lead to ‘death anxiety’.
Death anxiety is a strong emotional factor that may influence how nurses care for their patients. This especially affects those patients who are in the terminal stage of life. Experts agree that education remains the primary method to treat depression among nurses. A study conducted in Turkey, for example, has shown that nurses’ death anxiety and depression significantly decreased after a 90-minute teaching session for over seven weeks. Several others have shown that death education workshops and seminars have positive effects on a nurse’s attitude towards caring for end-of-life patients.
Aside from clinical nursing skills, it is important for nurses to learn skills on how to deal with patient death and their grieving families. Since it demands maturity on their part, some nurses employ strategies to avoid letting out their own emotions. Some, for example, will tend to maintain emotional distance from the grieving family although they may continue to lend emotional support.
Nurses may not be aware of it or accept it, but death anxiety could negatively influence their clinical skills performance. Therefore, experts advise that nurses should receive death education, especially the younger nurses who tend to have a higher negative perception about caring for dying patients.
Tips for Getting Through the Emotional Rollercoaster
It is important for nurses to be emotionally stable when dealing with patients. Losing a patient is synonymous with losing a loved one, but they have to make sure that their roles are fulfilled no matter what. Recovering from death anxiety will help them personally. Most importantly, the patients will experience the best care possible. Here are some tips on how a nurse can overcome the emotional rollercoaster:
Don’t suppress feelings
As a nurse, you have to be professional and composed even after a patient dies. However, it isn’t wrong to feel bad, sad, angry, disappointed, or confused. After all, these are all human emotions and one is dealing with human life. Remember that it is not only psychologically dangerous for a nurse to suppress feelings, but can also affect his or her work. Be emotional, accepting, and positive.
Debrief the family the right way
You may be sad, but the family is grieving. Debriefing the family of a late patient is a way of telling them that everything has been done and that everyone will eventually be at the point of death. Be direct to the family as they have every right to learn right away what has happened, but learn what and how to say it right with proper timing.
Provide time for grieving
Everybody goes through the process of grieving when losing someone. The process goes from denial, anger, bereavement, depression, and acceptance. Understand that the process is normal and that one has to experience each stage when grieving. There is no shortcut to acceptance. However, remember that life must go on and that other patients are waiting. Let it all out but do not get overwhelmed with the emotion.
Have a break
Dealing with a sentiment for a patient who passed away can be emotionally exhausting. Thus, nurses have to dedicate time for relaxation to rid themselves of the stress. A simple conversation with a friend, meal with a family, or a walk in the park are some ways to eliminate one's emotional stress. Getting a massage can also offer therapeutic effects, so consider getting one.
Prevent emotional fatigue
Some nurses will tend to drown themselves to work to avoid getting too emotional. Others overload their schedule leaving nothing for grieving. Clearly, this isn’t a good way of coping and can only lead to emotional fatigue. There is no need to ingest emotions in ways that will only drain one’s energy.
Death is a natural way of life that everybody will eventually meet. To nurses, this may be treated as a failure to conduct duty but is actually not. While they had the chance to provide care for these patients, they do not hold their lives. As it is part of the job, a nurse should always portray professionalism. However, this doesn’t mean hiding one’s own emotions towards the death of a patient. Keeping a nurse’s mental health is essential for the best kind of health care provision.