Guest Columns

Healing practices for nurses in LTC

Lynne Wagner
Lynne Wagner

Nurses and other healthcare providers are privileged to intimately care for their patients and patients' families daily during patients' most vulnerable and life-altering times of illness, trauma, and end-of-life — times of profound loss and grief. This is particularly evident for nurses working in long-term care  settings, caring for residents over long periods of time who are chronically ill or disabled, dependent, and dying. Your professional knowledge, care skills, and caring presence make a difference for residents, increasing their experiential quality of living and dying.

A shared human-to-human connection often elicits a strong heart-centered relational bond between nurses, residents, and families—what Watson (2008) calls a caring moment. However, if nurses do not attend to their own self-care and healing, the sense of making a difference and the desire to care for others often fades when they are bombarded by the residents' grief and by their own loss when those they care for experience declining health and death. In addition, nurses also experience loss in their personal lives, which adds to their burden of grief. Unresolved grief accumulates. Although skilled in helping others experiencing grief, nurses often ignore their own grief-healing needs, perhaps due to lack of time or safe healing space, expectations of others “to be strong”, other responsibilities in professional and personal lives, and being unprepared to grieve. This avoidance of attending to grief-healing causes a decreased well-being, which, in turn, can lead to caring-fatigue, job dissatisfaction, and burnout. Provision 5 in the Code of Ethics for Nurses reminds nurses that caring for yourself and your healing and growth are requisites in giving safe competent care to others.

One model that supports nurses through self-grief-healing in meaningful ways is Watson's Caring Science and 10 Caritas Processes (2005, 2008), which frame best practices of caring for ourselves and others, attending more fully and holistically to our mind-body-spirit healing. Five of Watson's key processes are described briefly below in relation to compassionate grief-healing. These processes also can guide you to better help LTC residents and their families experiencing loss and grief.

  1. Practice loving-kindness, compassion and equanimity with yourself and others. Be gentle with yourself, practicing loving-kindness and self-compassion, holistically attending to your physical and emotional needs; acknowledging your loss; honoring your tears, time to grieve, time to say goodbye. Accept help and seek comfort with family, friends, and nature. Attend to your spiritual needs to find balance and peace in your values and beliefs. Listen to your heart. Forgiveness and gratitude are important aspects of compassionate self-care, being present to your grief without blame or judgment, accepting the loss you cannot change. Practice centering pauses throughout your day, being grateful for what you do have. With these practices, you are creating a trusting relationship with yourself.
  2. Be authentically present, enabling faith/hope/belief system; honoring subjective inner, life-world of yourself and others. Daily intentional presence to yourself, reflecting on who you are—what you are feeling and doing around your loss, how you are caring for yourself, what you are remembering, what your coping resources are—foster a deeper understanding and wisdom that comes from your heart. Exploring your beliefs and hopes enlightens the path ahead of you. Such presence can be accomplished by journaling, meditating, walking in nature, or talking with friends. You can also create art or poetry to express your feelings aesthetically, often revealing a deeper essence of experiences. Being present to who you are and what you are experiencing, you begin to hear your own story.
  3. Cultivate and sustain spiritual practices. Explore through reflective practice what nurtures your spirit and gives meaning to your life amid your joys and pain. Personal spiritual practices are important in compassionate caring of yourself. Developing and practicing daily rituals that bring you close to your heart and renew your spirit, such as prayer, reading, meditation, walks in nature, time with friends, journaling and aesthetic expressions, help you also to foster practices of forgiveness and gratitude that aid healing.
  4. Create safe healing environments on all levels. Healing environments at home and work that sustain human dignity nurture your mind-body-spirit well-being. Nurses are charged by their Code of Ethics. (Provision 6) to maintain environments conducive to quality health care. Healing environments are created through trusting relationships; physical and emotional spaces that hold you safely in your grief, allowing for expression and sharing of your grief; and availability of healing modalities, such as meditation, massage, healing touch practices, pet therapy, aromatherapy, aesthetic expressions of writing, art, photography, poetry, dance, music, water therapy, and the presence of nature. At work you can create “healing rooms”—spaces where staff can retreat to for healing pauses in times of loss. Supporting each other is essential. Sharing of stories and narratives around loss is healing.
  5. Be open to mystery and unknowns of life and death, allowing for miracles. Many experiences of loss are accompanied by feelings of chaos, unknowns, and unanswered questions about life, suffering and death. Part of grief-healing is to acknowledge these unknowns, fears, and despair, and to accept our lack of control over many events. This opens us to be receptive to uncertainties, to surrender to the mysteries, and to accept change as part of life. Through a reflective healing process, grieving moves us closer to our emotional hearts, teaching us about the miracle of human resiliency and legacy, how to reshape our lives amid our pain. In the process we discover our capacity to love and care for others during the living-dying cycles.
Grieving is a universal complex human experience around loss, but grief-healing is a personal journey. There is no prescribed timeline or process for grieving. We are forever changed by loss and each unique experience becomes part of our life fabric. However, a healthy grief-healing process of acknowledging grief after each loss and developing intentional healing practices to cope with your grief-journey are necessary for sustaining your well-being.

A. Lynne Wagner, EdD, MSN, RN, is a nurse consultant with a focus on developing and facilitating mentoring programs based on her published Caring Mentoring Model. A former director of Watson Caring Science Institute's (WCSI) Caritas Coach Education Program, Wagner currently serves as WCSI faculty associate and adjunct faculty at the University of Colorado-Denver School of Nursing. She is the author of Four Seasons of Grieving: A Nurse's Healing Journey with Nature, published by the Honor Society of Nursing, Sigma Theta Tau International.

References

Watson, J. (2005). Caring science as sacred science. Philadelphia, PA: F.A. Davis.

Watson, J. (2008). Nursing: The philosophy and science of caring. Boulder, CO: University Press of Colorado,


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