Following your Path

Leading through loss: Lessons for healthcare leaders

One of the most painful experiences for any parent is the death of a child. The family is deeply affected by the loss, and the extended “family” of co-workers, neighbors, and community are also affected. However, not many organizational leaders, including those in health care, are prepared for the challenges that can face an organization when a staff member loses a child through an accident or illness.

While I was serving as a commander in the military, two families in the squadron lost young children as a result of accidents. Through these tragedies, I learned important leadership lessons and the vital importance of therapeutic presence, which can help other leaders facing the challenges that arise when death occurs in the organization or workplace. According to Colosimo and Poss, therapeutic presence contains the four components of being-here, being-now, being-open, and being with and for the client.

Two tragedies

Tom’s daughter

Tom found his 2½-year-old daughter, Jennifer, face down in their swimming pool. She had crawled through a doggie door in the kitchen. Tom, an experienced emergency medical technician, performed CPR on his daughter for 25 minutes until the paramedics arrived on the scene. He rode in the ambulance to the local hospital. His daughter was pronounced dead on arrival at the emergency department (ED), where Tom’s wife Tammy was employed. Tammy had followed the ambulance to the hospital in her car. She initially chose not to enter the room or view the body once the doctors had pronounced Jennifer dead.

When I arrived at the hospital, several co-workers and friends were present in the waiting room with Tammy. I asked to go back to the ED room to be with Tom. I will never forget the look of remorse in Tom’s eyes. I sat down in a chair, expressed my sincere condolence, and explained that I came to support him through this tragedy. We sat alone in the quiet room with Jenny lying on the table. After long periods of silence, Tom gradually began to talk. I simply listened, clarified, and gently reflected his thoughts. Throughout this process, I prayed silently for Tom and his family.

Alex’s son

Alex was a healthcare provider. She went in to check on her 9-month-old son, who was lying on her king-size bed between two pillows. She had placed the pillows as barriers to prevent Johnnie from accidently rolling off the bed. When she entered the room, she saw Johnnie lying face down on the pillow wedged between the bed and the wall. She immediately picked up Johnnie, who was not breathing, and began CPR. She notified emergency medical services and continued to do CPR until the paramedics arrived. Johnnie never recovered and was pronounced dead on arrival at the local ED. Alex was devastated. She was holding her deceased baby boy with her husband when I entered the hospital room and was extremely emotional. I expressed my sincere condolences and asked if I might sit with her for a while. As I sat in the room, she began telling me about how her son died. I used the active listening techniques of reflection, clarification, and empathy.

Visit the hospital to be with family members who lost the child

These two situations show the importance of visiting the hospital to be with the bereaved family. Sometimes leaders are concerned about intruding on the personal space of those who work for them, especially during emotionally difficult times. But nothing demonstrates commitment and caring more than being present for your subordinates. Grieving parents will never forget that you cared enough to be with them during this tragedy. No phone call, text, email message, or delivery of flowers communicates your commitment to the family the way simply being present does.


It’s important to go to the hospital as soon as you learn about the accidental death. You don’t have to talk. Your presence sends a message to the parent who lost the child and the rest of the hospital staff. As a healthcare leader, everyone is aware that you are busy; spending time with the parent communicates that taking care of this family is a top priority.

In addition, sitting with the family at the hospital provides an opportunity for you to see how the rest of your staff is dealing emotionally with the situation. Just because your staff may routinely deal with the death of patients does not mean that they are prepared to deal with the death of their own child or a co-worker’s family member. Ensure that you express appreciation to the staff members for their professionalism and empathy in caring for the family and managing the death of the child. Acknowledge that this situation is difficult for everyone.

What is most important to grieving parents?

It’s important to understand how parents experience healthcare providers’ actions surrounding the death of their child. Ashleigh Butler and colleagues reviewed 15 studies that analyzed this question. Most of the studies addressed the healthcare staff’s attitudes at points during the child’s death. The highest-ranked aspect of care mentioned by the parents in the studies was the need for healthcare staff to overtly display a caring and compassionate attitude. In addition, parents wanted healthcare staff to repeatedly provide accurate information directly, in a clear and understandable manner.

Research by Mullen and co-workers concluded that grieving families desire compassionate, sensitive care that respects their wishes and meets their needs. Several nursing interventions that support the family after the death of a child were highlighted, including expressing condolences, asking open-ended questions regarding the family’s needs, praying or crying with a family, describing physical changes that occur in the body after death, providing a quiet environment to spend time with the child’s body, and not rushing the family to leave the body.

The way families experience the events at the time of their child’s death will influence their grief, as a recent study by Parris showed. Hospital staff members have a tremendous ability to influence the grief reaction of survivors, for better or worse. The accurate and clear communication of information and the acknowledgement of the cultural and religious needs of

Prepare the family for what comes next

If the child died as the result of an accident, especially at home, state child protective services and law enforcement officers will conduct interviews as a part of their investigation. There may be some very direct questions that the family might find offensive during this period of initial grief and shock. Ensure that someone who can support the family is with them at home during these interviews. If the child died in the house, the initial return to the home may be emotionally intense. Within the Air Force there is typically a First Sergeant who is assigned to a squadron. I asked the First Sergeant to go with the family to the house where the police officers were waiting. The First Sergeant’s role was to support the family through the initial investigative process and to ensure that the family had the support and resources that they needed. In a civilian organization, this role might also be accomplished by a supervisor or close co-worker.

Several states require that criminal investigators examine the death scene for all cases of unexpected or sudden infant, toddler, or child deaths under the age of 6 years old. A death scene may be assessed by a combination of police and medical personnel. This process may involve taking photographs, conducting interviews, and possibly making videotapes. Depending on the state, the Department of Child Protective Services may also be involved in part of the investigation as well. The police investigation can begin within minutes to hours after notification of a child’s death. According to Jeffery Jentzen, personnel investigating the death may represent up to 72 different job categories, including but not limited to physicians, nurses, lawyers, law enforcement personnel, forensic pathologists, and coroners. It’s important to let families know that police and/or other personnel will be arriving at the death scene in their home to conduct an investigation.

With the consent of the family, share information in a group venue with staff members

In their 2006 article in Nurse Leader on the subject of coping with workplace deaths, Patricia Keresztes and Gail Wegner note that it is the immediate manager’s responsibility to notify staff of the death, impending funeral services, and the family’s wishes regarding contact via phone or visits to home. Stick to the facts. Be sure that you inform the family exactly what you will be communicating to co-workers and fellow staff members. Let staff know the ways they can appropriately provide support for the family. Also, ensure that you do not violate any HIPPA privacy rules. Protect the family’s private information. HIPAA rules protect the individually identifiable health information about a decedent for 50 years following the individual’s date of death. Information relayed to staff and co-workers should be based on public facts that are known.

Gather appropriate information to support decision making

There are many decisions that must be made at the time of death. Some funeral homes reduce costs or even donate services for an infant or child. If there is a benefits expert at your organization, ensure that this person is available to answer questions for the family. Families under stress can experience information overload and may need information repeated on multiple occasions to facilitate decision making. Keresztes suggests that it is the workplace manager’s responsibility, in cooperation with human resources staff, to ensure that the family is aware of insurance and other benefits.

Connect the family to resources

Co-workers are often eager to help the bereaved family. Allow co-workers to engage in helping to care for the family. Tasks such as helping to arrange transportation, deliver meals, and coordinate reservations for incoming family and friends can be very helpful to the grieving family. In a study by Benkel and others, the main social support desired by the grieving person was from their network of close family, family of origin, relatives, and friends.

In addition, parents may be concerned about the impact of the incident on their other children. Ensure that the family is aware of resources that are available in the community, as well as any Employee Assistance Programs (EAPs) to help them work through this difficult experience. Again, repeat information on resources several times. During periods of stress, people do not always comprehend or retain information clearly.

Be patient, steadfast, and understanding as you help the family examine their options. The greatest need for professional support may be close to the time of death and shortly thereafter. Provide flexibility in work hours, even time off, to help a parent cope with combined stressors of work and grief. Expect tears, possible mood swings, and decreased work performance following the death.

Acknowledge the grief of the family and of co-workers

Allow the grief process to unfold. A debriefing session facilitated by a chaplain or mental health professional can be useful to help co-workers verbalize their thoughts and process their feelings. A debriefing can also provide education regarding normal signs and symptoms of the grief process. Grieving can be a long process and varies with the individuals. Be supportive, but also allow each person to work their way through the painful grief process at their own pace. EAPs may be available within your organization to provide grief counseling services.

Depending on how the family members are handling the grief, some changes may be needed in responsibility or shift work schedule to accommodate the grief process, as Keresztes notes. In Tom’s case, he requested to be transferred to a different work location. He could not wait to sell the house where his daughter died. Every time he looked at the pool, he was painfully reminded of the accident. On the other hand, Alex wanted to teach her other children that “we do not run from our problems, we work through them.” Her family went through grief counseling and she continued to reside in the same house where her son died.

“Grieving in the workplace, if not handled properly, can create a toxic situation,” Alan Goforth has noted. A 2003 study by the Grief Recovery Institute surveyed 25,000 grieving workers and concluded that grief associated with the death of a loved one costs U.S. businesses $37.6 billion annually. The study found that 85% of management-level decision makers indicated that their decision making was very poor to fair during the weeks following the grief incident. Ninety percent of blue-collar workers reported a much higher incidence of physical injuries related to a reduction in concentration following the grief incident.

During the months following the death, it is important to recognize signs and symptoms that the parent and co-workers may be experiencing some difficulty with unresolved grief. Symptoms such as excessive absenteeism, lateness, inability to focus on work, withdrawal from colleagues and inability to provide care for family or patients may indicate unresolved grief issues, Keresztes cautions. These employees may need professional assistance. Kirsti Dyer (2002) recommends three actions that can be taken by managers at the workplace following a death: send a clear, open message of support to family and co-workers, maintain an “open door” policy for all staff, and provide for qualified counseling services.

Attend the funeral

Pay your respects to the family and the child that they lost by attending the funeral. Your presence during this difficult time for the family sends a message of caring and support. Butler and colleagues found that parents have a strong need for follow-up care that may include the staff’s presence at the child’s funeral. When these aspects of care are missing, parents reported feeling isolated and abandoned. It is important for leaders to attend funerals and also to allocate time for co-workers to attend the funeral.

After learning of a fatal accident among my staff, I remember thinking that I could have lost one of my children in the same manner. I could not imagine how I would have handled the loss of one of my children. There is no greater pain for a parent than the death of a child. I desperately wanted to help these families cope with their loss and rebuild their lives. By going through this grief and healing process, I learned the vital importance of therapeutic presence. Being present helps you to discover what the family needs. Being present helps you to understand what the family is experiencing. Being present allows you and your organization to heal along with the family.

Selected references

Benkel I, Wijk H, Molander U. Family and friends provide more social support for the bereaved. Palliat Med. 2009;23:141-149.

Butler A, Hall H, Willetts G, Copnell B. Parents’ experiences of healthcare provider actions when their child dies: an integrative review of the literature. J Spec Pediatr Nurs. 2014;20:5-20.

Colosimo KA, Pos AE. A rational model of expressed therapeutic presence. J Psychother Integr. 2015;25(2):100-114.

Dyer KA. How to cope with loss, grief, death & dying – professionally & personally. Presentation: California Maritime Academy, CSUM California State University, Maritime SOC 210. Dying: The Final State of Living, February 7, 2002.

Goforth A. Grieving at the office. Benefits Selling. 2015;13(9):49-53.

Hochstadt NJ. Child death review teams: a vital component of child protection. Child Welfare. 2006;85:653-670.

Jentzen JM. Death Investigations in America: Coroners, Medical Examiners, and the Pursuit of Medical Certainty. Cambridge, MA: Harvard University Press; 2009.

Keresztes PA, Wegner GD. Coping with workplace death. Nurse Lead. 2006;32-33.

Mullen JE, Reynolds MR, Larson JS. Caring for pediatric patients’ families at the child’s end of life. Crit Care Nurs. 2015;35(6):46-55.

Parris RJ. Initial management of bereaved relatives following trauma. Trauma. 2011;14(2):139-155.

U.S. Department of Health and Human Services Website. Health information of deceased individuals.

 

Vickie Hughes is associate professor in the Department of Nursing at Appalachian State University College of Health Sciences in Noone, NC.

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