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Grief in our hospitals and homes
In:. 1. .Vurs. Sad. Vol. 2. pp. 293-296. Per&mm Ptess, 1966.
Rinted in
tiat Btitata
Grief in our Hospitals and Homes E. GARDNER Edinburgh 3
“1 KNOW that truth lies in the facts, and not in the mind that judges of them, and that the less 1 introduce what is merely my own into the deductions 1 make from them, the more certain 1 shall be of approaching the truth”-&ussenu. Grief is sorrow, mental distress, and it is to be found in the young, the adolescent, and the adult. It may be individual, or shared with family relations and understood and shared by those who care-the nurse, the doctor, the minister. In almost al1 national groups, grief has certain ‘permissive’ actions. 1 wel1 remember the way that grief was shown by the Yugoslav peasants, while refugees in Egypt, when death occurred. A shared wailing outside the hospita1 tent, a demand for photographs of the dead-grief was open-al1 were permitted to join in, the young and the old. This form of demonstration is not unknown in many countries; in this country, we need to understand grief and what open expression is acceptable. It is only by first understanding our .own cultural patterns and then by using and understanding the differences of other human beings that we can begin to have full humanity. Do nurses working in the home and the hospita1 have the quality of compassion and sympathy ? 1 mention nurses as 1 am one; and we expect to find compassion in the family, the doctor, the minister. Particularly in hospita& grief must be recognized and understood, and those caring given the opportunity to assist so as to aid in the prevention of further mental distress. There are many stress diseases, and it may be that grief wrongly handled could bc one of the causes. Grief may be shown by withdrawal, anger, aggression, argument, hysteria, a series ofaches and pains, etc. Griefoccurs before an operation, when there is violent death, long illness, death of old and young, or loss of a job, and in other jvays. It may be most apparent in the patient or in his relations, for example, the death or severe illness of a young infant is felt strongly by the parents. Nurses are often told to show empathy, give support and be sympathetic, but are our nurses enabled to do so in the hospita1 or the home? What is the role of the family doctor and the minister? Empathy is a forerunner of sympathy; grief is understood but nothing may be done. Sympathy should mean a willingness to help and to collaborate. The 293
294
E. GARDNER
sympathetic person assists others, not because it is an assigned job, but because he is motivated by compassion. The empathic person can perceive another’s distress, identify its source, and anticipate the behaviour that wil1 resuit from it. On the other hand the sympathetic person feels another’s distress; he is touched and moved by it and actively wants to do something to alleviate it. Certainly taking action in order to meet a patient’s needs is an essential nursing function and is often undertaken by the nurse, midwife and health visitor. Student nurses and others are warned about the dangers involved in being sympathetic. A picture is painted of the ‘too sympathetic’-the one who joins the patient or relative in his emotional ‘binges’, cries when he cries, becomes depressed when he is depressed. This is not sympathy. The nurse is not focussing on those in need, but on herself; she is relieving the tensions of her own unmet needs. The quality of sympathy may also be confused with pity. Pity-sympathetic heartfelt sorrow for one who is otherwise distressed or unhappy-is a warm and natura1 human feeling. But it is often twisted, and one wonders if ‘Oh, you poor thing’ refers to an object or a human being. This type of pity implies condescension, and that the person is a ‘thing’ or a bed number. Few patients and relatives want to be pitied; a few, however, behave as if they do, and adopt an attitude of ‘I’m sorry for myself’. This type of patient or relative is not easy, and the nurse often has difficulty in controlling her own feelings. These people tend to engender anger and guilt feelings in the nursing personnel; they need understanding, not condemnation, and it must be considered why they want pity. The nurse does not lecture such a person, but agrees with him whenever his complaints are reality based, gives support whenever possible, and tries to lower his anxiety leve1 and anticipate his demands; this is good nursing care. Often problems are caused because of lack of sympathy and if this is recognized, it may be possible to give help. Is there not a danger that we are developing a mental black towards the concept of sympathy ? “We must not express sympathy; we must not become involved,” but can we achieve a meaningful relationship without ivolvement? The humanizing qualities of support may be questioned if missed-this is so-yet they should not be abolished, but understood. In the case of patients, we hear that they wil1 ‘enjoy’ the case-they wil1 regress. It is difficult to comprehend how the transmission of concern, interest, and the desire to alleviate distress can make patients have regress. NO patient was ever ‘ruined’ by kindness and sympathy-many suffered from the lack of those qualities. We must continually ask ourselves about the loss of young student nurses> doctors and ministers who are not sufficiently supported when exposed to grief. The young nurse in particular is often so exposed without adequate help. Those of US responsible for their education and service today and in the future should consider how those in our charge can work and learn in a permissive atmosphere-an atmosphere that entourages, demonstrates and is forever questioning the problems presented by our patients at home and in the hospital. In the years that lie ahead, we may continue to see, as we are seeing now, less and less shared grief in the home. Illness and death are to be found in the hospital; those whose loved ones are involved are removed. How are we to ensure that
GRIEF IN 0 UR HOSPITAU
A.ND HOMES
the relatives are given a share in this most important attained in two ways:
aspect of life?
295
This can be
1. The education of our future doctors, nurses, ministers and social workers should be concerned with the care of patients at home and in the hospital. They should be given the opportunity to study together and to gain practica1 experience. 2. The hospita1 and home care services should be united under one adminiRelatives should be given the opportunity to care for their sick in stration. the hospita1 as wel1 as in the home. The honest desire of al1 those who care should be to create an atmosphere where al1 those in grief can be shown love and understanding, and be able to receive comfort and accept. Peace of mind cannot be achieved unless those who hold these beliefs press for education, atmosphere and continucd research into the Aanging patterns of society. Carlyle said of Robert Burns that therc was no trucr gentleman in Europe than the ploughman poet because he loved everything-the mouse, the daisy, and al1 things great and small. The gentle man cannot in the nature of things do an ununsymgentle, or ungentlemanly thing. The ungentle soul, the inconsiderate, pathetic nature cannot do anything else. Love must prevail in our homes and hospitals. Résumé-La douleur s’exprime de nombrcuses manieres différentes dans divers pays: elle est inséparable de la vie a l’hôpital et des troubles dûs à la réaction peuvent Les infirmières sont-elles équipées pour pouvoir découler d’un maniement error& s’occuper de la douleur et comprennent-elles le rôle joué par le médecin de famille ou par le pretre? L’empathie ne suffit pas; la sympathie-sentiments partagés avec le malade ou le parent-est nécessaire aux infirmières pour les aider dans leur travail. Ces sentiments nedoiventpasse transformerencegenre de pitié qui se traduit par de la condescendance. On n’a jamais nui à un malade à force de bonté et de sympathie-nombreux sont ceux qui ont souffert par leur absente. Les attitudes changeantes exigent la coordination du foyer et de l’hôpital en fonction des malades. Ceci devrait exercer une influence sur la formation des futurs mkdecins, infirmières et assistantes sociales, alors que les services hospitaliers et des soins à domicile ont besoin de l’administration. Le but de notre formation aussi bien que des administrateurs devrait &re de savoir apporter 2 tous ceus qui souffrent un sentiment d’affection et de compréhension. Resumen-La tristeza cxpresa 10 mismo en muchos modos distintos y en diferentes países : es inseparable de la vida de hospital, y pueden derivarse enfermedades de Están preparadas las enfermeras para tratar tensión a consecuencia de malos cuidados. la tristeza y pueden comprender el papel del mbdico de cabecera o del sacerdote?. El trato correcto no es suficiente; la simpatía-en relación con el paciente o sus NO debe desarrollarse en forma de una parientes-es necesaria para ayudarles. compasión tolerante. Jamás un paciente ha sido perjudicado por la bondad 1 simpatía-muchos han sufrido por la carencia de ellas. El cambio de pauta necesita coordinación de hogares y hospita1 en cuanto al paciente. El10 debería influenciar la formación de los futuros médicos, enfermeras, y assistentas sociales, y los servicios assistenciales del hospita1 y hogar precisan dirección. Nuestros educadores y directivos deberían desear llevar amor y comprensión a todos los afligidos.
E. GARD.NER
AmnoTaunn -
Cmpóa BbrpamaeTcn paanwmm oópaeou y pammHbr~ Haponos. O~a~eoT~earraraoT6onbr~n~Ho~~~sH~,~oTHenpasnnbHoroyXo~amoryTBoa~u~aTb HepBHne óoneeau. ~OcTaTowo SM oópeen MeAcecTpn, s~oóar CnpamiTbcfi CO CHOpóbno, H nomMamT m 0~11 poab cerkfetinoro Bpaqa H HYXOBH~~O Jrrrsa? Ha oxm 6omsolt He 6arn umnop'%H~ ~~oópo~oflHJIIICo9yBcTBHeM, HO MAome CTpai[am OT 11x OT~~~TCTBUSI. Meamonprecir oópasn ?KHBHH TpeóyroT CoTpyRHmecTBa noma R 6omi~4nnoOTHO~~e~m~60m~0~y. ~TO~OSDKHOBJI~~RT~H~O~~~HH~~~~ID~~HX Bpaqetl, mencecrep 11 06lqeCTBeHHbIX pa6oTaEKon. kl 6OnbHWHOe oócqwumanwe, II o6c.nymiiBamie Ha AOMY HyWAaEOTCR B ynpaBneHm. Hame o6yseHIie U HaIIIH &W&MS4CTpaTOpbI ~OJIHtIfbI BMC!Tb CBOeit UCJIbIO HBCTII JIlOóOBb II IlOHIIM~He BCBM c~op6s14an1.
Rinted in
tiat Btitata
Grief in our Hospitals and Homes E. GARDNER Edinburgh 3
“1 KNOW that truth lies in the facts, and not in the mind that judges of them, and that the less 1 introduce what is merely my own into the deductions 1 make from them, the more certain 1 shall be of approaching the truth”-&ussenu. Grief is sorrow, mental distress, and it is to be found in the young, the adolescent, and the adult. It may be individual, or shared with family relations and understood and shared by those who care-the nurse, the doctor, the minister. In almost al1 national groups, grief has certain ‘permissive’ actions. 1 wel1 remember the way that grief was shown by the Yugoslav peasants, while refugees in Egypt, when death occurred. A shared wailing outside the hospita1 tent, a demand for photographs of the dead-grief was open-al1 were permitted to join in, the young and the old. This form of demonstration is not unknown in many countries; in this country, we need to understand grief and what open expression is acceptable. It is only by first understanding our .own cultural patterns and then by using and understanding the differences of other human beings that we can begin to have full humanity. Do nurses working in the home and the hospita1 have the quality of compassion and sympathy ? 1 mention nurses as 1 am one; and we expect to find compassion in the family, the doctor, the minister. Particularly in hospita& grief must be recognized and understood, and those caring given the opportunity to assist so as to aid in the prevention of further mental distress. There are many stress diseases, and it may be that grief wrongly handled could bc one of the causes. Grief may be shown by withdrawal, anger, aggression, argument, hysteria, a series ofaches and pains, etc. Griefoccurs before an operation, when there is violent death, long illness, death of old and young, or loss of a job, and in other jvays. It may be most apparent in the patient or in his relations, for example, the death or severe illness of a young infant is felt strongly by the parents. Nurses are often told to show empathy, give support and be sympathetic, but are our nurses enabled to do so in the hospita1 or the home? What is the role of the family doctor and the minister? Empathy is a forerunner of sympathy; grief is understood but nothing may be done. Sympathy should mean a willingness to help and to collaborate. The 293
294
E. GARDNER
sympathetic person assists others, not because it is an assigned job, but because he is motivated by compassion. The empathic person can perceive another’s distress, identify its source, and anticipate the behaviour that wil1 resuit from it. On the other hand the sympathetic person feels another’s distress; he is touched and moved by it and actively wants to do something to alleviate it. Certainly taking action in order to meet a patient’s needs is an essential nursing function and is often undertaken by the nurse, midwife and health visitor. Student nurses and others are warned about the dangers involved in being sympathetic. A picture is painted of the ‘too sympathetic’-the one who joins the patient or relative in his emotional ‘binges’, cries when he cries, becomes depressed when he is depressed. This is not sympathy. The nurse is not focussing on those in need, but on herself; she is relieving the tensions of her own unmet needs. The quality of sympathy may also be confused with pity. Pity-sympathetic heartfelt sorrow for one who is otherwise distressed or unhappy-is a warm and natura1 human feeling. But it is often twisted, and one wonders if ‘Oh, you poor thing’ refers to an object or a human being. This type of pity implies condescension, and that the person is a ‘thing’ or a bed number. Few patients and relatives want to be pitied; a few, however, behave as if they do, and adopt an attitude of ‘I’m sorry for myself’. This type of patient or relative is not easy, and the nurse often has difficulty in controlling her own feelings. These people tend to engender anger and guilt feelings in the nursing personnel; they need understanding, not condemnation, and it must be considered why they want pity. The nurse does not lecture such a person, but agrees with him whenever his complaints are reality based, gives support whenever possible, and tries to lower his anxiety leve1 and anticipate his demands; this is good nursing care. Often problems are caused because of lack of sympathy and if this is recognized, it may be possible to give help. Is there not a danger that we are developing a mental black towards the concept of sympathy ? “We must not express sympathy; we must not become involved,” but can we achieve a meaningful relationship without ivolvement? The humanizing qualities of support may be questioned if missed-this is so-yet they should not be abolished, but understood. In the case of patients, we hear that they wil1 ‘enjoy’ the case-they wil1 regress. It is difficult to comprehend how the transmission of concern, interest, and the desire to alleviate distress can make patients have regress. NO patient was ever ‘ruined’ by kindness and sympathy-many suffered from the lack of those qualities. We must continually ask ourselves about the loss of young student nurses> doctors and ministers who are not sufficiently supported when exposed to grief. The young nurse in particular is often so exposed without adequate help. Those of US responsible for their education and service today and in the future should consider how those in our charge can work and learn in a permissive atmosphere-an atmosphere that entourages, demonstrates and is forever questioning the problems presented by our patients at home and in the hospital. In the years that lie ahead, we may continue to see, as we are seeing now, less and less shared grief in the home. Illness and death are to be found in the hospital; those whose loved ones are involved are removed. How are we to ensure that
GRIEF IN 0 UR HOSPITAU
A.ND HOMES
the relatives are given a share in this most important attained in two ways:
aspect of life?
295
This can be
1. The education of our future doctors, nurses, ministers and social workers should be concerned with the care of patients at home and in the hospital. They should be given the opportunity to study together and to gain practica1 experience. 2. The hospita1 and home care services should be united under one adminiRelatives should be given the opportunity to care for their sick in stration. the hospita1 as wel1 as in the home. The honest desire of al1 those who care should be to create an atmosphere where al1 those in grief can be shown love and understanding, and be able to receive comfort and accept. Peace of mind cannot be achieved unless those who hold these beliefs press for education, atmosphere and continucd research into the Aanging patterns of society. Carlyle said of Robert Burns that therc was no trucr gentleman in Europe than the ploughman poet because he loved everything-the mouse, the daisy, and al1 things great and small. The gentle man cannot in the nature of things do an ununsymgentle, or ungentlemanly thing. The ungentle soul, the inconsiderate, pathetic nature cannot do anything else. Love must prevail in our homes and hospitals. Résumé-La douleur s’exprime de nombrcuses manieres différentes dans divers pays: elle est inséparable de la vie a l’hôpital et des troubles dûs à la réaction peuvent Les infirmières sont-elles équipées pour pouvoir découler d’un maniement error& s’occuper de la douleur et comprennent-elles le rôle joué par le médecin de famille ou par le pretre? L’empathie ne suffit pas; la sympathie-sentiments partagés avec le malade ou le parent-est nécessaire aux infirmières pour les aider dans leur travail. Ces sentiments nedoiventpasse transformerencegenre de pitié qui se traduit par de la condescendance. On n’a jamais nui à un malade à force de bonté et de sympathie-nombreux sont ceux qui ont souffert par leur absente. Les attitudes changeantes exigent la coordination du foyer et de l’hôpital en fonction des malades. Ceci devrait exercer une influence sur la formation des futurs mkdecins, infirmières et assistantes sociales, alors que les services hospitaliers et des soins à domicile ont besoin de l’administration. Le but de notre formation aussi bien que des administrateurs devrait &re de savoir apporter 2 tous ceus qui souffrent un sentiment d’affection et de compréhension. Resumen-La tristeza cxpresa 10 mismo en muchos modos distintos y en diferentes países : es inseparable de la vida de hospital, y pueden derivarse enfermedades de Están preparadas las enfermeras para tratar tensión a consecuencia de malos cuidados. la tristeza y pueden comprender el papel del mbdico de cabecera o del sacerdote?. El trato correcto no es suficiente; la simpatía-en relación con el paciente o sus NO debe desarrollarse en forma de una parientes-es necesaria para ayudarles. compasión tolerante. Jamás un paciente ha sido perjudicado por la bondad 1 simpatía-muchos han sufrido por la carencia de ellas. El cambio de pauta necesita coordinación de hogares y hospita1 en cuanto al paciente. El10 debería influenciar la formación de los futuros médicos, enfermeras, y assistentas sociales, y los servicios assistenciales del hospita1 y hogar precisan dirección. Nuestros educadores y directivos deberían desear llevar amor y comprensión a todos los afligidos.
E. GARD.NER
AmnoTaunn -
Cmpóa BbrpamaeTcn paanwmm oópaeou y pammHbr~ Haponos. O~a~eoT~earraraoT6onbr~n~Ho~~~sH~,~oTHenpasnnbHoroyXo~amoryTBoa~u~aTb HepBHne óoneeau. ~OcTaTowo SM oópeen MeAcecTpn, s~oóar CnpamiTbcfi CO CHOpóbno, H nomMamT m 0~11 poab cerkfetinoro Bpaqa H HYXOBH~~O Jrrrsa? Ha oxm 6omsolt He 6arn umnop'%H~ ~~oópo~oflHJIIICo9yBcTBHeM, HO MAome CTpai[am OT 11x OT~~~TCTBUSI. Meamonprecir oópasn ?KHBHH TpeóyroT CoTpyRHmecTBa noma R 6omi~4nnoOTHO~~e~m~60m~0~y. ~TO~OSDKHOBJI~~RT~H~O~~~HH~~~~ID~~HX Bpaqetl, mencecrep 11 06lqeCTBeHHbIX pa6oTaEKon. kl 6OnbHWHOe oócqwumanwe, II o6c.nymiiBamie Ha AOMY HyWAaEOTCR B ynpaBneHm. Hame o6yseHIie U HaIIIH &W&MS4CTpaTOpbI ~OJIHtIfbI BMC!Tb CBOeit UCJIbIO HBCTII JIlOóOBb II IlOHIIM~He BCBM c~op6s14an1.