Nurses have an important role in facilitating the safe expression of negative feelings. Expression of intense emotions at times of trauma or loss can help the client to relieve distress, decrease intrusive thoughts (“repeated, unbidden thoughts about stressful experiences” [p. 191³]), and better understand his or her emotional experiences. Expressing distress decreases isolation and promotes intimacy, elicits helpful responses from others (e.g., validation and support) and motivates the mourner to cope more effectively.³

At times, it is best to accept clients’ avoidance of grief. In the first hours or days after a trauma, the bereaved may experience no emotional response to the loss. It may signal a period of shock and disbelief in which the bereaved has not yet processed the loss. The nurse’s role is to accept the client’s nonexpression of
grief. The client may be suppressing painful emotions until a time when he or she is able to grieve. Perhaps the mourner has experienced considerable anticipatory grief before the loss occurred or may fear that emotional expression would be unbearable.³

Another common response to loss is anger.⁴ Although anger is expected, it can be destructive to relationships. Nurses can help angry clients to express their emotions constructively.

Families such as the Sorens need help to express intense anger safely. The argument among the Soren siblings could lead to long-lasting resentments and permanent damage to their relationships with one another. The nurse’s empathic listening may help to prevent expression of destructive emotions. You can explain the role of anger in the grief process to help the siblings focus on their grief rather than one another’s perceived shortcomings.

Nurses can also be helpful long after a loss has occurred. Opportunities to talk about the loss diminish with the passage of time. Friends and family members have “moved on” and may expect the mourner to be “over it.” The need to talk about the loss of a close family member will persist for years. For example, the opportunity to discuss a loss can arise when taking a history. The client may tell you about an unresolved loss or share a memory of a deceased family member. The nurse can facilitate healthy grieving by showing interest and asking for further details. In the following example, a nurse misses an opportunity to demonstrate compassion and to communicate about a patient’s grief. As part of an assessment interview, a nurse interviews an 80-year-old woman:

Be prepared for guilt reactions because they are a normal part of the grief process. Family members will need to be reminded more than once that they were not at fault.

Nurses and other health care providers often believe that speaking about death and dying will upset clients and families who are otherwise calm.⁵ When nurses do discuss these topics, clients and family members may cry and express emotional pain. Nurses may conclude that they caused the client to experience emotional pain. Emmanuel and colleagues⁵ interviewed 988 individuals with six months or less to live. In general, research participants said that talking about grief was perceived as helpful rather than stressful. Clients who are grieving experience emotional pain whether they talk about it openly or not. Too often grieving individuals suppress their distress to put others at ease. When the nurse introduces the topic into conversation, he or she provides clients with the opportunity to express rather than hide their pain.

When an individual cries, refrain from touching them, offering tissues, or interrupting with consoling remarks. Consoling behaviors may interfere with the client’s expression of emotions. When crying ceases, comfort may be offered. Accept the feelings that arise. Comments such as “You shouldn’t feel that way” or “Your husband wouldn’t want you to feel that way” are judgmental and not helpful.

Crying is an important response to grief that may be misunderstood by significant others. Loved ones may worry that intense crying is a negative outcome and should be discouraged. Potentially supportive others may believe that crying means that the mourner has been needlessly reminded of their grief. The nurse can help by explaining that crying is normal and helpful.

The question of “What should I say?” is guided by theories about grief and mourning. Worden’s⁶ tasks of mourning can help to structure the nurse’s response. Soon after loss, the task of the mourner is to “accept the reality of the loss” (p. 11). Acceptance occurs in degrees
and may take days, weeks, months, or years. A family member may believe that a loved one has died on one level but resist acceptance at other levels. A nurse may be helpful by asking the mourner “What happened?” The mourner is given the opportunity to relate his or story of the loss. Each time the story is told, the mourner benefits by facing the loss and gradually progressing toward acceptance. The next task of mourning is to “experience the pain of the loss”(p. 12). Experiencing and expressing intense emotions is necessary for healing. The nurse can encourage the client to talk by asking about the loved one. “Tell me about your husband” can provide an opening for the client to cry, rage, or express guilt and remorse.

Mourners who have no prior experience with grieving may be shocked by their own reactions. Not knowing if thoughts and emotions are normal can introduce additional stress into an already difficult experience. The nurse can provide information about normal feelings following loss such as anxiety, anger, guilt, ambivalence, and depression and the importance of sharing those feelings. For the client who expresses guilt, the nurse can educate the client about normal reactions to death. “Many people have regrets after the death of a loved one. These are normal reactions.”

Gradually family members must “adjust to an environment in which the deceased is missing” (p. 14). Assisting the client to think of ways to memorialize their loved one can help with this task.⁷ This provides a means to include the deceased in their new life. The nurse can encourage bereaved individuals to share their progress in coming to terms with the changes in their lives. Clients may have questions such as “What should I do with his/her belongings?” Because there are no right or wrong answers to these questions, the nurse can facilitate problem-solving behavior by asking “What have you considered doing?” The nurse can help by normalizing the mourner’s experiences. For example, an older adult client whose husband died asked “How can I sleep in our bed alone?” The nurse can assure the client that difficulty sleeping is a common response to loss that gradually resolves. If sleeplessness does not begin to improve, the nurse can assess the client’s need for referral for additional assistance.