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Persistent Uncertainty: What Do I Need to Be Ready for Next? A Post by Phyllis

It has been about seven weeks since the first Covid-19 related death was reported in Washington State. Since then, everyone in healthcare has been challenged beyond imagination. We are accustomed to developing Action Plans in response to anticipated and unforeseen events. We took for granted the luxury of implementing those strategic initiatives and conducting an analysis of their effectiveness in achieving desired outcomes. Covid-19 forced everyone of us out of our comfort-zones and into a state of groundlessness. We were all about to discover our potential to be agile, flexible, and fluid is response to what realities were about to roll up onto our doorstep.

We are finally at a point beyond chaos

What once was considered normal life is gone, for the immediate future, and it has been replaced with a new way of working and living on a day-to-day basis. Incredibly, we are starting to settle in. We are starting to exhale. However, now that the feeling of an immediate threat has subsided, we are also slowly starting to reflect on and connect with some feelings about the events of the past weeks.

The main question I am being asked by my coaching clients in leadership positions is, what do I need to be ready for next? They are not asking about pandemic preparedness. They are concerned and focused on the needs of their amazing interprofessional healthcare staff members. That dedicated angels-on-earth who have left it all on the field day in and day out from the beginning. My answer is this, start to expect some very human behavior from your extraordinary heroes.

Elisabeth Kübler-Ross published her groundbreaking work on Death and Dying in 1969. In it, she outlines the model for the five steps her grieving patients traversed until they reached peace of mind. I offer her insights as a guide to understanding what you and your staff are currently experiencing and what to anticipate next. The five steps are: Denial, Anger, Bargaining, Depression, and Acceptance.

The key here is accepting that there is no “appropriate” behavior for grieving. Grief and other stress reactions are broad-based and very individualized. The reactions often surprise the person experiencing them just as much as the person witness the behavior. It is vital to observe without judgment. Witness in a supportive manner as long as that behavior is not a danger to the staff member or other members of the team.

Denial:

  • Most of us are right here. We are immersed in the sense that this just cannot be happening. We find ourselves asking how is this possible? How could these things be happening? There must be a treatment or cure? How could my patient’s/loved one’s condition be critical or terminal so fast? Denial is our minds way of asking everything to just slow down a bit until you can catch up.

Anger and Frustration:

  • Anger is a signal that the person is starting to comprehend the actual scope of the situation and is trying to piece together the cues and clues that may have led up to the event. Anger can also serve to anchor you to the reality of the situation. There are elements of wanting to assign blame or accountability in the anger stage. There can also be elements of guilt and shame. Successfully working through one’s anger is vital to processing the emotion and letting go. It is never easy to feel anger fully. It can be unsettling to some and terrifying to others. However, if the anger is not acknowledged and worked through, there is an increased risk of getting stuck in the anger. This often leads a person to choose isolation and other maladapting way of coping.

Bargaining:

  • Bargaining is our attempt to negotiate for the best possible outcome. It is the action we take to avoid or minimize the grief we suspect is closing in on us. This stage is often accompanied by ruminating about, “what if” and “if only”. It is a coping mechanism used to try to give ourselves the sense that we can somehow control circumstances and outcomes.

Depression:

  • As the emotions of sadness and regret show up, an individual may often appear withdrawn and only going through the motions of life. Depression is often described as a sense of helplessness. This can often serve as a quiet time for preparing to say goodbye to once was and to begin to mourn the passing of a person, time, or role in one’s life.

Acceptance:

  • This is the stage of coming to terms with the event and the new reality that it created. People often share that they feel an unexpected but welcomed sense of being calm. It is important to remind staff of the strength and heroism they demonstrated when things were at their worst so that they can tap into the knowing that they are strong and capable of moving forward from here. Important to understand that reminiscing does not signal regression. Just the opposite. It signals that the person is strong enough “to go there” and cruise their memories in safety.

Important to remember:

  • Be observant and try not to ignore the behaviors that begin to manifest.
  • There is no conventional way to grieve. Coping with a loss is a deeply personal experience.
  • Allow people to talk and just listen. Don’t put the added burden on yourself for having any answers.
  • Be accepting and resist the temptation to assign judgment.
  • The best gift you (as a leader) can offer your staff is the creation of a safe and accepting place at work to feel the grief as it bubbles up in the company of those who can best relate to the situation.  
  • Look for in-house resources such as Code Lavender Groups. These are rapid response teams specializing in responding to the needs of staff. You may also have access to pastoral care, coaches, or therapists.
  • Keep in mind, people with mental health challenges can be particularly vulnerable at this time.
  • Be especially aware of those individuals (and we all have them) that engage in the behaviors of bullying or chronic incivility. It will be hard for them to resist engaging in judging and gossiping about vulnerable staff members. Be sure to set boundaries early do not be taken in by their claims of just trying to be helpful. Preying on the vulnerable is their stock in trade.
  • Don’t place a timeline on the grieving process. This is especially important right now since we still have no idea when the challenge will be over.

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