Sanjay Patole (ed.)Management and Leadership – A Guide for Clinical Professionals10.1007/978-3-319-11526-9_20
20. Managing Grief and its Consequences at the Workplace
Robert Anderson1, 3 and Marie-Louise Collins2, 3
Department of Pastoral Care Services, Women & Newborn Health Service, King Edward Hospital for Women & Child & Adolescent Health, Service Princess Margaret Hospital for Children Perth, City of Perth, WA, Australia
Department of Pastoral Care Services, Women & Newborn Health Service, King Edward Hospital for Women & Child & Adolescent Health, ervice Princess Margaret Hospital for Children Perth, Perth, WA, Australia
Child & Adolescent Health Service, Princess Margaret Hospital for Children, Perth, WA, Australia
Grief is a normal and personal response to loss that all will inevitably experience at some or various points of life. With increasing emphasis on clinical leadership, clinicians (e.g. doctors, nurses) are expected to handle more and more responsibilities including grief. Clinicians confront and/or experience grief on a scale more intense and more frequently than people may normally encounter in life outside a hospital. Historically doctors and nurses are not well equipped for providing skilled grief management, leadership and support. The failure to observe and address this reality may therefore pose a significant risk to the staff member, the grieving person and the organisation. It is thus incumbent upon management to develop a capacity for responding appropriately when this turbulence descends within the workplace This chapter attempts to contextualise grief and its consequences within the dynamic of the clinical setting. It highlights the importance of recognising the personal but subtle formative shaping through the grief experiences of both the grieving person and the carer or manager; and summarises some core understandings of grief and loss. It is suggested that good grief management within the clinical context, is both a necessity for organisational risk management and for staff care, with potential to enhance the quality or spirit of the workplace.
GriefComplicatedCounsellingUnresolvedManagementLossSupporting colleagueAssessmentResponseBereavementTips for health care professionalsGenderTolerance of differences
Everyone can master a grief but he that has it
—Much Ado About Nothing
Grief is a normal and personal response to loss. People in grief seek and require the sense of belonging and support from peers.
Grief has much to do with loosening of attachment. It is a process of transition that the clinical leadership needs to understand and tolerate.
Compassion and development of a healthy resilient and flexible work environment is critical and central to grief care.
Understanding the relational complexity of role diffusion when moving from management to care of a staff member in grief is important.
Management should be aware that loss experience(s) may predispose staff to put clients, colleagues and/or themselves at risk, and should take necessary steps to protect them.
Early recognition of the signs and symptoms is essential for effective management of grief and its consequences.
With increasing emphasis on clinical leadership , health care workers including medical staff, managers, and supervisors are expected to handle more and more responsibilities including grief . They also confront and/or experience grief on a scale more intense and more frequently than people may normally encounter in life outside a hospital. Historically doctors and nurses are not well equipped for providing skilled grief management, leadership and support. The failure to acknowledge and address this issue poses a significant risk to the staff member, the grieving person and the organisation. Effective leadership in the context of grief lies in the awareness, management and/or enablement of processes associated with loss and grief. This chapter briefly discusses the contemporary understanding of grief and its consequences, and suggests guidelines for its effective management at the workplace.
Grief and Loss
Grief may be defined as a response to loss . It is part of a normal process of adjustment to change. A grief response may range from being mild and transient to being intense and prolonged. Loss experiences can accumulate without being fully integrated and unresolved grief may contribute to a response which is seemingly more intense than warranted for a situation.
Grieving is as normal as it is complex. Loss is the shadow side of attachment, the deeper the attachment the greater the loss. Deep attachment however may not necessarily be a ‘healthy’ or life-giving attachment. It is an exhausting individual journey with no short-cuts. It is a road littered with potholes; a terrain sometimes never travelled before or at least a road less travelled . It involves physical , emotional, psychological and social dimensions of living. Grieving is not a condition to be fixed but an unwelcome journey requiring companions along the way. These companions can be sometimes physically present, other times absent but not disconnected. The most important thing is not to add further regrets or resentments for the person to carry along this difficult road. The task is to provide road maps and nourishment for this journey. This is best achieved by empowering the bereaved person to recognise and mobilise their inner resources and the supports we can place at their disposal.
“If you touch one thing with deep awareness, you touch everything”
Thich Nhat Hanh speaks of the “Ocean of Peace” within each of us; he distinguishes between “the wave” and “the water” within the ocean. He speaks of the wave as a metaphor of the historical lived experience that each of us are in between being born and dying. The world of waves is the world of ups and downs, hopes and dreams and fears, success and failures , friendships and betrayals, attachment and loss . It is the world informed by the current and received historical context be that familial, cultural, or academic.
Loss will threaten equilibrium in our lives. Grief and loss is usually experienced as a time of intensity. Emotions are often intense and can range widely. It is a time for re-evaluating many things. Freud described grief as an attachment that has been lost and mourning as detachment from one who is loved. Since his initial work other theorists describe grief as stages , predictable, identifiable phases  to be experienced; and understood as descriptive rather than prescriptive, or a dynamic process of tasks to be achieved . Building upon Freud’s earlier work, Bowlby has further explored attachment theory  but from a very different perspective. More recently the challenging work of Klass and Silverman  has drawn considerable consensus amongst practitioners for their construct of developing successful re-adjustment to loss through maintaining a continuing bond with the deceased.
Whatever the understandings behind our knowledge of the experience of grief it is always a profoundly personal, a unique and individual experience, and it is always the result of a reflective process. Living the turgid experience that loss causes is, while generic to being human, a universal experience.
Loss usually involves a transition process. The disequilibrium tends to engineer a shift in attachment to beliefs, work practices, relationships, and ways of experiencing the world. The workplace manager and/or colleague is confronted with the task of supporting a staff member going through such a transition while ensuring that risks to staff and patients and case management are minimised.
Understanding the Experience of Grief
Grief is about the human response or reaction to loss, often described as the objective state of having lost someone or something precious. There are many varied experiences of grief not related to death such as loss of a job, role or income; loss of youth, a limb or organ, hopes , dreams, reproductive capacity, identity or body image to name a few.
Bereavement is a term used for the objective state of the individual when the loss is a relational loss through the death of someone close whereas mourning describes the outward behaviour and symptoms of someone who has experienced loss. Mourning is a process sometimes culturally defined through cultural or religious practises.
Understanding grief is an evolving study not dissimilar to our evolving understanding of what constitutes biological death. Parkes  points out that in recent times more attention has been paid to the context in which grief arises and in particular the nature of the attachments that precede and influence the grief experience . Moving from the traditional concepts based in the psychoanalytical tradition of Freud, various researchers notably Kubler Ross, Parkes, and Bowlby have understood grief as a process of identifiable or recognisable stages/phases aiming for resolution. Resolution is achieved when the grieving individual has emotionally detached from what has been lost and has made new attachments. More recent understandings such as those of Worden  who aligns more closely with the early work of Freud define the mourning process as a system of tasks. A significant feature in his more recent work fits with the concepts of Klass, Silverman and others who speak of continuing bonds with the dead, “We now know that people do not decathlete from the dead but find ways to develop ‘continuing bonds’ with the deceased” [10
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