Unravelling grief: A scoping review of physicians’ and nurses’ experiences of grief during COVID-19

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About the project

Coping with grief is difficult at any time, but amid a pandemic where we have been challenged to physically seek or demonstrate support due to necessary social distancing measures and personal protective equipment, grief can feel insurmountable. For healthcare providers (HCPs), these last few years have been especially turbulent as they shouldered unprecedented workloads, experienced greater than normal patient and coworker loss, and faced higher threat of infection for themselves and their loved ones. To make matters worse, an already injured healthcare system is succumbing to further systemic and organizational challenges, heightening levels of stress and uncertainty amongst the health workforce. While some may argue that attending to grief is ubiquitous in healthcare, HCPs are beyond their breaking point, bearing witness to grief and loss in new and unforeseen forms. Left unaddressed, the burnout HCPs were already experiencing pre-pandemic will intensify, with severe downstream effects on patients and the healthcare system. This scoping review was designed to deepen our understanding of the unique losses physicians and nurses experience during this challenging time so that healthcare and education stakeholders can promptly and meaningfully respond.

Our specific research questions were:

  1. What does the literature tell us about physicians’ and nurses’ experiences of grief during the COVID-19 pandemic?
  2. How has the pandemic influenced physicians’ and nurses’ experiences of grief?
  3. What steps might healthcare and education institutions take to address the inevitable toll of healthcare work, and support grieving physicians and nurses?

Key findings

  • Terminology around grief remains ambiguous and is often conflated with other closely aligned but different concepts such as burnout, wellness, moral injury and resilience.
  • Physicians and nurses are experiencing many kinds of loss simultaneously during the COVID-19 pandemic. The most obvious forms of loss were experiences of bereavement. Other forms of loss were more subtle (e.g., professional identity). The intensity and prevalence of these losses are influenced by a combination of factors: geographic context, professional norms and values, clinical specialty, political climate, pandemic wave, previous trauma or loss and an individual’s social location.
  • Physicians’ and nurses’ reactions to and experiences with grief can be intensely physical (e.g., extreme fatigue), emotional (e.g., anger, sadness), spark changes in behaviour (e.g., hypervigilance, deepening of faith and spirituality), and deeply impact one’s identity and career trajectory.
  • The cause of grief is often situated within the literature as an inevitable result of working in healthcare or individual circumstance. Similarly, suggested coping mechanisms tend to treat grief as a problem to be solved rather than addressing the institutional factors that may be triggering a grief response.
  • Both physicians and nurses report little attention during their formal training on how to manage their own grief, particularly in situations where they must persist with their work. As a result, many feel ill-prepared to openly discuss their grieving experiences and/or seek support for fear of negative social reaction (e.g., being stigmatized, perceived as weak).
  • First-person narratives exploring physicians' and nurses’ direct experiences of grief and loss are powerful and abundant. The flexible structure and intimate nature of this genre affords HCPs a therapeutic outlet to delve into the messiness of their grief.

Policy implications

Academic and healthcare stakeholders should develop goals and objectives focused on creating “grief literate” (Breen et al. 2022) learning and work environments. In medicine and nursing this means:

  • Encouraging HCPs to frequently and openly talk about grief—with patients, families, colleagues and learners without fear of repercussions or stigma.
  • Integrating grief education throughout formal health professions educational curricula. Educators and learners would be required to take a multi-dimensional and inclusive approach to talking about grief by ensuring that different forms of loss (e.g., non-death losses) and the perspectives of marginalized groups are not minimized or overlooked.
  • Equipping employee assistance programs with diverse resources and treatment options so that HCPs can engage in a process of healthy grieving.
  • Broadening the types and prominence of qualitative research and literature synthesis methods to generate valuable insights into HCPs’ grieving experiences.
  • Educators and leaders being strategically proactive in acknowledging the potential for a grief response in crisis situations.
  • Employers recognizing that their own internal structures and policies may be contributing to the prevalence of grief and high rates of burnout.
  • Employers collaborating with various professional groups and community agencies to embed the language and practice of grief and loss into their organizational culture.

Further information

Read the full report

Contact the researchers

Sarah Burm, assistant professor, continuing professional development and medical education, Faculty of Medicine, Dalhousie University: sarah.burm@dal.ca

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