Blog
Supporting bereaved healthcare workers.
My name is Jules Lewis and I am a Swan End of Life Care Lead Nurse at The Shrewsbury and Telford Hospital NHS Trust and PhD Student at Staffordshire University. I am also bereaved by suicide, my beautiful best friend Janet took her own life in February 2019 aged 47, a caring and compassionate friend and nurse for over 20 years. I set up, with the support from our lead volunteer & our administrator, a staff bereavement support service at the hospital where I work.
by Jules Lewis RGN MSc
My name is Jules Lewis and I am a Swan End of Life Care Lead Nurse at The Shrewsbury and Telford Hospital NHS Trust and PhD Student at Staffordshire University. I am also bereaved by suicide, my beautiful best friend Janet took her own life in February 2019 aged 47, a caring and compassionate friend and nurse for over 20 years.
I set up, with the support from our lead volunteer & our administrator, a staff bereavement support service at the hospital where I work. This intervention includes 1-2-1 support sessions, a safe space to be heard, with compassion, kindness, understanding, support and signposting to other support services as required.
Funding for this service was gained from Health Education England following a successful business case application. This money is used to backfill my hours to allow me to do this work for a few hours per week, and to cover the cost of room bookings to ensure we have a safe space to support staff. We are lucky enough to have a perfect venue on the hospital site but not in the main building.
Bereavement support cafes.
We also offer an ongoing peer support group, in the form of staff bereavement support cafes, these run every few months throughout the year. This support is for all bereaved staff who work at the hospital, it is to support staff with personal bereavement or professional deaths (the death of a person they cared for). This can range from expected, unexpected, traumatic & bereaved by suicide. I am currently supporting several staff who have been bereaved by suicide.
“It has proved more valuable than I ever thought. Just to have the space and time to process and talk about my feelings following my bereavement I have found incredibly helpful.”
Bereavement café attendee
At the December café each year we have a tree of hope where staff who attend the café and others can write a bereavement memory tag and place it on the tree in memory of their loved one. It remains in our conference centre for several weeks over the Christmas and New Year period.
“Having a safe, secure and confidential person to speak with has really helped me work through some of the difficulties of my recent bereavement.”
Bereavement café attendee
The aim of my PhD pilot project is to evaluate the effect a bereavement intervention has on healthcare staff’s health and wellbeing.
In addition to our bereavement support we have also set up a walk and talk session, available to all staff, once a month at lunchtime. On a 20–30 minute walk we offer a listening ear and kindness. Signposting to further support as appropriate and required. We aim to encourage staff to get into nature and boost their health and wellbeing.
Poetry.
I’d like to share two poems by my friend Brendon Feeley. We gift the first beautiful poem – ‘No Judgement Here’ to staff at our bereavement cafes.
Jules Lewis and Brendan Feeley
No Judgement Here
This is a safe environment.
There is nothing for you to fear.
There is no need to worry.
There is no judgement here.
If you feel you need a friend,
reach out and you will find
this world can be incredible,
with people caring and kind.
By Brendon Feeley
This 2nd poem is one that I hope will give nurses and others the hope to get help and support for the future.
Not Today
When the darkness falls around you
and the light has all but gone,
it’s then that you dig deepest
for the strength to carry on.
With the biggest smile you can muster,
stare into the darkness and say,
I’ve bested darker days than this,
and you won’t win today.
By Brendon Feeley
Thank you for reading this blog, we hope it makes a difference at the hardest of times.
Best wishes,
Jules and Brendon.
On the death of a colleague.
Working with individuals who experience suicidal ideation or intent is an integral aspect of mental health, and it is probable that all registered nurses working in this field will come across a person in this situation at some point, irrespective of the specific area in which they develop their career. As an RMN working in a crisis resolution team, this was a common concern. I took professional pride in my ability to assess risk and provide something of use to that person based on their need at that precise moment. And then I had a colleague and friend end her life.
by Leah Hosie RMN
Working with individuals who experience suicidal ideation or intent is an integral aspect of mental health, and it is probable that all registered nurses working in this field will come across a person in this situation at some point, irrespective of the specific area in which they develop their career.
As an RMN working in a crisis resolution team, this was a common concern. Whether borne out of situational crisis, a deterioration in a mental health condition, or any other number of contributing factors, a thread to the narrative of these service users was a sense of feeling hopeless and overwhelmed. Initially, when doing my risk assessments and asking people what had got them to this point, this decision, I would tread carefully with my language, use euphemisms and metaphors and be so tentative as to be ineffectual.
But my nursing skills developed, and my confidence grew. Towards the end of my clinical career, I was able to say to a service user ‘Death comes to us all, why rush that process?’ and feel competent that I could manage the response, whatever it might be. I became skilled at navigating emotions and attuned to subtle shifts in body language, I know when to speak and when to remain silent. I took professional pride in my ability to assess risk and provide something of use to that person based on their need at that precise moment.
A colleague suicide.
And then I had a colleague and friend end her life. Suddenly, abruptly, without warning. She was a fellow mental health nurse, and we had worked together on the crisis team before parting ways when this service was disbanded. We stayed connected though, largely through messaging and social media. A few weeks before her death, we had spent an evening talking about her desire to explore other avenues of nursing, and perhaps consider health visiting.
For all my skill, for all my competence, for all my confidence – I never saw this coming. I had never envisioned it, never thought or felt for a second that she was at any risk. I was devastated. All my crisis team colleagues were… What could we have said? What could we have done? How did we not know?! What did we miss?
Practice what we preach.
I do not understand why she didn’t reach out for help, but I wonder if it was because as mental health nurses, there is the expectation that we have our sh*t together so that we are able to help others. So, what then happens to those of us that are also struggling, overwhelmed or hopeless? How easy is it for us to practice what we preach? To reach out for support from the mental health professionals in our lives? Even if we work alongside them, rather than in a patient-provider capacity.
Reach out.
I would like to be able to write this blog post as a nurse who has gone through this experience and be able to say here is what I would do differently… but I cannot. I do not know. I do not know what went wrong, and I don’t know how (or if) I could have helped. Heaven knows I have contemplated this for hours, but I am none the wiser.
So instead, I write this blog as a person who grieves and who may never get the answers. But as for you, dear reader, if you see something of yourself in my friend and colleague’s story, please, please, please, do not suffer alone. Do not suffer in silence. There are barriers thrown up in life and there can be days, weeks, months or longer when it is all just too much. But with love and support might come the option to break those barriers down, to master that which overwhelms us. Professionally, I have witnessed remarkable transformations when people in need engage with that support. And personally, I have been devastated by the effects when people do not.
Please ask for help if you are in need. Please.
If you are experiencing distress or suicidal thoughts, please take a look at our support page.
How our understanding of context informs our understanding of nurse suicide; and why we need change.
There are 30 million nurses world-wide and the NHS, the largest employer in Europe, employs more women than any other organisation. It is also the principal employer of nurses of whom, 89% are women and one in four are from the global ethnic majority. Yet, the majority of suicide research and policy is gender- and colour-blind.
by Dr Ruth Riley
There are 30 million nurses world-wide and the NHS, the largest employer in Europe, employs more women than any other organisation. It is also the principal employer of nurses of whom, 89% are women and one in four are from the global ethnic majority. Yet, the majority of suicide research and policy is gender- and colour-blind.
The suicide rate among women nurses is 23% higher than women in other occupational groups.
These numbers are more than just statistics but speak of human stories of distress and suffering in women nurses across continents. Yet their voices, experiences, and stories are largely unaccounted for in dominant suicidology approaches and suicide prevention policies.
High suicide rates in women nurses have been documented for over 20 years in the UK and in other high-income countries too. Yet workplace practices, policies and research have failed to address the realities and contexts of nurses’ lives.
Current approaches and why they are failing women nurses
Deaths by suicide are often what we see or hear about but hidden beneath the surface are the diverse contexts that contribute to distress and suicidality. Our studies will argue that mainstream research approaches are not only gender- and colour-blind, but also focus on individual-level characteristics and the mental health of individual nurses and rely on methods which fail to account for wider contexts.
In North America, there is a trend which advocates screening for mental illness in nurses which may further label and individualise women’s (and others’) distress. This may compound stigma and increase shame, leading to the concealment and non-disclosure of feelings and distress and presenteeism, particularly in healthcare cultures which lack compassionate leadership and psychological safety.
Why we need to revision our understanding of distress and suicidality in women nurses
In contrast to these approaches, the ambition of our project is to address these under-researched contexts using critical suicidology which questions the mainstream approaches that locate ‘the problem’ within the individual. Our position argues that by individualising distress, attention is distracted from the political, social and economic contexts and systems within which nurses work and live. Solutions aimed at addressing these wider contexts and systemic problems – which include deep-rooted violence against women, both inside and outside the workplace, discrimination, poor working conditions, and other workplace injustices, are overlooked. Employing a feminist approach will enable us to better understand the patriarchal, social and structural systems which impact women nurses, nurses from the global majority, and othered communities. This is a timely project as we witness continued distress compounded by ongoing injustices, the pandemic and workforce and resource shortages.
Joining the dots – politics, mental health, and women.
Individualising distress and labelling distressed women as unwell goes hand in hand with current – neoliberal – political mindsets. For example, we are expected to maintain ‘good’ mental health despite changes in political and organisational systems which contribute to and sustain inequality and injustices for women and othered communities.
Messages about self-care, help-seeking and individual resilience are all examples of the drive toward individual responsibility for mental wellbeing. Therefore, the unjust systems that oppress and disadvantage women and others are excused any responsibility.
A feminist understanding of ‘mental illness’
Mainstream approaches to treating distress or ‘mental illness’ and the messages surrounding it are largely uncritical – relying on taken-for granted knowledge. Such approaches, as above, are underpinned by biological and medical models and are predominantly understood from a medical and male viewpoint. This poses a problem for women and for marginalized and minoritised communities.
In the UK and other high-income countries, women are three times more likely than men to be diagnosed with depression and anxiety. This proportion increases when women are also Black, lesbian and/or older. Historically, women are more likely to be institutionalized, in asylums and hospitals, receive psychosurgery, electroconvulsive therapy and psychotropic medication (particularly antidepressants), which can be accompanied by harmful side and withdrawal effects, including suicidal thoughts.
Medicalizing women’s distress and focusing on the individual is a form of institutionalized gaslighting, as their distress symptoms are reduced to a diagnosis yet their voices, experiences and the contexts contributing to their suffering are overlooked. In feminist research, women participants often resisted a medicalized diagnosis of depression as they attributed the cause of their misery to structural factors, including poverty and violence.
We argue that focusing on the personal, overlooks the political, and fails to hold to account those systems, structures and cultures which contribute to and sustain social, colonial and economic injustices, gender-based violence or the impact of work cultures and working conditions on women. This includes women nurses and ethnically diverse nurses and will apply to women working in other occupations, including doctors.
What is the ambition of this project?
This ground-breaking project has five different studies which will capture the diverse experiences and accounts of a range of women nurses and those from the global majority. We will also be capturing the views of the public, including friends and families of nurses to explore their understanding of what contributes to nurse distress and suicidality. In providing space and opportunities for new perspectives, we will gain a more nuanced understanding of relevant contexts while providing a voice and platform for under-represented nurses.
The project aims to transform research approaches, and trends in suicidology and significantly shift our understanding of the contexts that contribute to distress and suicidality within the nursing population. This research may also have direct implications for women working in other occupational groups. We wish to launch a more nuanced approach and debate about the contexts that impact women inside and outside the workplace.
The project will lead to societal benefits too by increasing public understanding of these issues. We want to change hearts and minds so that suicide is no longer viewed as an individual problem and its contexts are more widely understood.
I am proud to be leading this ambitious project with a passionate and experienced team, who include international experts, award-winning creative artists and, crucially, nurses themselves, who have shaped the project and research priorities. Over the next 5+ years, we will be working with nurses, for nurses, to radically revision our understanding of distress and suicidality within the nursing community.
