Rhada Hartmann, BSN, RN, CT, director for palliative care and bereavement at York Hospital in York, PA, was working on an ob unit and felt unprepared to comfort parents who've experienced loss. When her supervisor showed her a training brochure, she thought she was just attending a conference but found herself hooked. She recently became recertified and vows to keep up the certification until retirement because of its importance for credibility.
Once an LPN, Sandra Wolf, MSN, RNC, CT, felt called to pursue the study of grief after her infant son who had a birth defect died. She went back to school for her bachelor's and master's degrees and found her niche in thanatology. Today, Froedtert Hospital's bereavement coordinator is quick to point out that she'd give up her passion in a heartbeat to have her son back, but her career has been a gift to the Milwaukee nurse.
"One of the cool things about nursing is there are opportunities in whatever makes us tick," she said. "I ended up developing a specialty in perinatal loss but now have the opportunity to apply the same principles to families who lose a loved one of any age or relationship and through many causes. We teach folks they don't have to forget; it is healing to remember and to make meaning of their loved one's life. One of my gifts, of knowledge and of heart, is to let people know they are not crazy to hurt so much - that's what happens when you love so much. And love never dies."
With grief support programs proliferating throughout the country, hospitals are distancing themselves from the days when Hartmann said segments of the population were "left alone with their grief, with nothing but platitudes." Still, the pool of nurses certified in thanatology is comparatively small.
Illustrating this, Nancy Ludwick, BSN, RN, CT, of Ohio's Akron Children's Hospital was at a conference for the Association for Death Education and Counseling (ADEC) when a fellow attendee fainted during the welcome reception. Ludwick ran over, expecting to be part of a team to restore consciousness. She ended up resuscitating him herself as a group of PhD-prepared social workers, chaplains and counselors looked on.
"It's still a growing profession in nursing," she concluded. "A lot of thanatology nurses are going into hospice or even palliative care."
The road to becoming a thanatology nurses is a long one. According to ADEC, a two-level certification program includes a certificate in thanatology (CT) and a fellow in thanatology (FT), both of which must be updated every 3 years. To apply for the certificate exam, candidates must have a bachelor's degree and 2 years related experience or a master's or doctorate and 1 year related experience. It's also mandated that 60 contact hours and two letters of support must be presented before the test. Candidates for a fellow in thanatology need a master's or doctorate degree, 5 years related experience, two letters of recommendation, the CT certificate from ADEC and 12 documented units on their professional portfolio.
Need for Nurses
Despite the time commitment, nurses who've been through the program insist it's essential their profession is represented in the specialty.
"I can let my families vent and pat them on the shoulder," said Ludwick. "That'll help the first time but the second time they need my full assessment about medication, food, physical exercise. The medical component of grief can be ignored and that's something nurses can address."
For Hartmann, much of her efforts are devoted to ensuring the whole person and his family is being considered in the grief process.
"I use my assessment skills to help make sure the person is comfortable and ready to talk," she said. "Do they have healthy coping skills? Where is their support network? The whole time I'm assessing cognitively, socially, emotionally and spiritually. You want to meet them at their point of need with unconditional empathy."
Supporting families during a difficult period is half the equation. Thanatology nurses are also called upon to assist fellow staffers when a patient dies. Ludwick is the resident expert at obtaining a death certificate and finding a funeral home but also considers herself a bridge between families and doctors.
"I attend the autopsy with the family and neonatologists if they have been involved in the baby's care and I think we can bring another component of caring there," Hartmann said. "As the coordinator of our Precious Parents support group, I get an opportunity to work with families from all over the area who have suffered a perinatal loss. My bereavement training has really been invaluable with them."
Robin Hocevar is senior regional editor at ADVANCE.