Nurses, midwives and living loss: Navigating the grief of loss and change

All of us will experience grief and loss at some point in our life. Grief is a highly individual experience, and it comes with no rule book. Feelings that accompany grief are often painful and confusing. Grief and loss are most often assumed to be related to the death of someone we care about, but today we want to talk about a different type of loss: ‘Living loss’. Living loss is a type of grief we experience in the aftermath of losing something in our life. It can be equally difficult as grieving a death.

“Sometimes, what dies might be an individual’s hopes or dreams, a relationship, or perhaps an ability that is no longer readily accessible as it was before.” — Darcy Harris, author of Non-death loss and grief

Because these losses may not be as obvious to those around us, support might not be offered as readily as if we lost a loved one to death. The experience can turn into what is known as ‘disenfranchised grief’, compounding our feelings of loss.

The types of living loss you might experience can be broken into four broad categories.

• Relationships: Losing connection with ourselves or sense of knowing ourselves, or the loss of any kind of meaningful relationship whether it be with a person or a pet.
• Health: Experiencing health impairment that diminishes our agency and independence. Health issues can create a sense of uncertainty about our lives, including our ability to care for ourselves and others.
• Finances: Losing our financial independence can lead to feelings of fear, insecurity and loss of control.
• Professional: Starting a new job, losing or changing a role, or being terminated or made redundant can all lead to a feeling of loss of identity and damage our sense of self. A change in staffing or workplace culture can also diminish the feeling of belonging, sense of security, and feelings of friendship and community.

Sometimes, these losses can be so paralysing that they upturn our lives, leaving us questioning our sense of self and who we are in the world. Many of you may have experienced a living loss as a result of changes that occurred through the pandemic. The lives of nurses and midwives were altered in unpredictable and frightening ways.

It is important to know that grief is a healthy and normal response to significant change or important loss. Grief is different for everyone and can change over time. Grief can have a profound impact on your life and impact you physically, emotionally, spiritually, mentally, and behaviourally. 

“Life’s most grievous losses disconnect us from our sense of who we are and can set in train an effortful process of not only re-learning ourselves but also the world” — Christopher Hall, CEO of Grief Australia

Reactions to grief are many and varied. Common reactions to grief include:

• anxiety
• shock
• panic
• anger
• change in values and beliefs
• loneliness
• helplessness
• guilt
• sleep disturbances
• changes to focus and concentration and
• changes to appetite.

Grieving is a painful and challenging process. How it presents depends on many factors, such as your personality, coping style, and the type of loss.

The cycle of grief is messy and nonlinear and doesn’t always occur in order. Exploring the stages of grief and loss can help you understand and contextualise where you are in your grieving process and the emotions you feel.

1. Shock: Shock can be intense and sometimes paralysing. You may feel numb and detached from your feelings.
2. Denial: Disbelief it has occurred. You may feel unable to face the truth
3. Anger and frustration: Anger that the loss occurred may be directed inward at yourself, the world, or other people.
4. Depression: Feelings of fatigue and extremely low energy and motivation, sometimes coupled with feelings of intense sadness, negativity, or emptiness.
5. Testing: Figuring out what the new situation means for your life through experimentation with finding ways to help facilitate the change
6. Acceptance: This doesn’t mean being ok with what happened, but an acceptance of the new reality.
7. Integration: Finding a new way of being in the world such as a reorganisation of roles and forming new relationships.

There is no set time for how long the process of grieving will or should last. It is normal to cycle through the different phases of grief.

Although grief can feel never-ending and debilitating for some, you can find strength and mobilise resources to heal. Over time, it’s possible to live with grief and cope with its effects. Engaging in self-care practices, reaching out for support, practising self-compassion and finding new ways to manage at work can help you to cope better with grief and loss.

Psychologist Martin Seligman identified the ‘three Ps’ of grief and other emotional setbacks. Sometimes, you can get stuck in the following beliefs:

• Personalisation: blaming yourself for the loss
• Pervasiveness: believing that grief affects every part of your life.
• Permanence: believing your grief will never end

These beliefs can keep us stuck in grief. You can use the three P’s to gain perspective when you are feeling bad. Seligman highlights that none of your experiences will endure forever, no matter how strong they feel right now. Self-reflect to challenge your beliefs and increase wellbeing.

We have an incredible ability to help ourselves. By taking especially good care of ourselves, we can learn strategies to cope with our difficult emotions. Focusing on simple approaches can be most supportive in a period of grief and loss. Good nutrition, sleep, a regular exercise routine and proper rest can go a long way in healing from grief. Especially in challenging times, these essential practices become even more important. For more tips on self-care and where to begin, see our article by RN Dianne Lee: Self-care for nurses and midwives.

Other useful strategies for dealing with grief are:

• Journaling: This can be a time when you sit down and fully choose time for you. See our article by mental health nurse Tessa Moriarty about the benefits of journaling: Case Notes on Self: The benefits of journaling as self-care.
• Music: Music can be very therapeutic! Research shows that listening to or playing music helps us to feel more empathy and warmth towards others, builds positive emotions, and reduces stress and cortisol levels. A research publication that reviewed 26 studies on music’s effect on mental health found that it was associated with similar improvements in mental wellbeing as exercise and weight loss. Check out the study: Association of Music Interventions With Health-Related Quality of Life: A Systematic Review and Meta-analysis.
• Express and create: Engaging creatively might be one of the best ways to deal with grief, according to Dr. Shelley Carson, Harvard University lecturer and author of Your Creative Brain, Seven Steps to Maximize Imagination, Productivity, and Innovation in Your Life. Shelley explains that we can channel difficult emotions into creative work as a means to help with grief and loss. Even if you don’t consider yourself a creative person, there are many ways to express this side of yourself that you may not have thought of. Shelley says, “Research shows that the mere expression of emotion in artistic form when you are hurting is beneficial.”
• Being in nature: Spending time in a natural setting such as the beach, the bush, or a park offers many benefits to mental health. According to studies, time in nature has positive effects on mood, stress reduction, and emotion regulation. One study showed that even spending just 17 minutes a day in nature improved health and wellbeing.

Seeking guidance: You don’t have to carry feelings of persistent grief alone. If you’re feeling lost on how to move forward, consider reaching out to your GP to discuss the support available, or get in touch with us at Nurse & Midwife Support to talk about what’s going on — we’re here 24/7 on 1800 667 877 or by email.

It can feel overwhelming to try to maintain a busy job as a nurse or midwife while also grieving a loss. You may have low motivation, find it hard to concentrate, feel distracted and anxious, or have difficulty attending to tasks the way you did before. However, some people find that being at work can be an effective way to bring stability and structure to their lives. Communicating to others about how you are feeling can help you to get support. Speak to your manager, let them know what’s happening for you and make a plan together for how they can best support you. It might be that you need extra time off, to temporarily reduce your hours, or to modify your duties.

If you’re not sure how to start this conversation, give us a call on 1800 667 877 and we’ll help you plan out what you want to say.

Offering yourself compassion, patience, forgiveness and encouragement is key. We can become our own worst critic when we feel emotionally chaotic. Learning to treat yourself with kindness can take a lot of practice, especially if you are used to beating yourself up.

According to Kristen Neff, a self-compassion researcher:

“We need to turn toward our struggle, toward our sorrow, toward our suffering with the same loving-kindness and tenderness like we’d show to a friend who is suffering; we need to do that with ourselves, really in order to be able to cope and get by in life.”

To get started, you could try this meditation offered by Headspace: Meditation for Self-Compassion, or learn how to Fill your cup with self-kindness.

Grief is hard work. But it is possible to grow from grief and gain insight, skills and wisdom from the experience.

“There is also a growing awareness that losses can also provide the possibility of life-enhancing 'post-traumatic growth' as one integrates the lessons of loss and resilience. Personal growth following even seismic experiences of loss is common.”— Christopher Hall, Grief Australia

“Thus, change, loss, and transition can challenge us in ways that may be initially overwhelming; however, these same experiences can provide the catalyst for growth and a deeper appreciation for life.” —Darcy Harris, author of Non-death loss and grief

We can’t force growth, but over time, we can come through the other side with a renewed sense of self and outlook on life.

We are here for you if you need to talk. It’s also important to surround yourself with people who care for you when you are grieving. It can be hard being open and vulnerable with our feelings, but it’s crucial to recovery. Isolating yourself is a common reaction to grief, but we all need people, especially in hard times. Call us on 1800 667 877 — we’re here for you 24/7, free, confidential and nationwide.