“More can be done to raise awareness about how nurses can assist patients and their families through the complicated issues of grief, death and dying.”
Those are the words of Debora Cowie, a Registered Practical Nurse who has more than 20 years of experience working on the front lines of Ontario’s health care system. Debora currently works at the Ontario Shores Centre for Mental Health Sciences in Whitby, Ontario, where she specializes in the areas of Rehabilitation Schizophrenia and Forensic Psychiatry.
The specialized nature of the job requires Debora and her colleagues to work in a locked, high-security unit working with patients diagnosed with schizophrenia, mood and behavioural disorders. While such safety precautions are necessary for the forensic clients, they can also create additional challenges around many of the typical aspects of daily nursing care. Even more unique to Debora, however, is the specialized expertise she has developed in the areas of grief and dying. In the course of her work and in speaking with her nursing colleagues, Debora recognized that grief and dying were extremely important topics that simply didn’t receive the attention they deserved. She first came to this conclusion when she examined her own area of mental health nursing and recognized nurses could benefit from additional support to help clients and families cope with their intense feelings of sorrow and loss. Debora sent out a brief survey to fellow staff members and quickly discovered that her colleagues were also very interested in learning more about know how to deal with the issues around death and dying (particularly since suicide, homicide and unexpected deaths do occur in the mental health setting). Her colleagues were also interested in learning more about how to deal with the feelings of loss and grief that can affect families when a loved one is diagnosed with a mental illness.
While it is essential for mental health nurses to understand the indications of an illness, effects and interactions of medications, the challenges of individual clients and families, stigma of mental health and cultural aspects of families in caring, it is equally important to understand grief and loss as part of a holistic approach to supporting clients and families.
As part of her personal quest to provide more support in this important area, Debora set out to become a Grief, Death and Dying Educator. Since the successful completion of her training, she has developed and taught numerous specialized workshops for fellow health-care professionals; including caregivers caring for terminally ill patients, long-term care home staff, trauma and emergency room professionals and other specialty areas of health care. Her teaching focuses primarily on promoting a holistic approach to care, with care providers developing:
- A better understanding of the factors that can impact a person experiencing grief, death or dying,
- An approach that recognizes dignity when dying, and
- Recognizing issues surrounding loss, such as what the individual may be dealing with when they enter the process of dying.
Debora stresses that as nurses, it is our professional obligation to provide the most ethical care possible and that it’s important for caregivers to consider multiple factors that can impact each person, such as the generational aspects, experiences with death (e.g. living through a war), and the unique cultural aspects related to dying.
In addition to her nursing career, Debora is currently a panel member for the RNAO End of Life Care Best Practice Guideline. As a member of the committee, she is honoured to represent three distinct aspects of healthcare. First, she brings knowledge of mental health. Second, she is a specialist in the areas of grief, death and dying education. And finally, she is proud to be the only RPN representative on this committee. Her hope is that this guideline will help provide support to all nurses throughout the various healthcare sectors. Debora has also helped to support quality practice in several of her previous positions, including serving as Nursing Council Chair, Nursing Practice Committee member and CNO PN Accreditation Approval Committee member.
As with many other RPNs, nursing wasn’t Debora’s first career. She initially developed an interest in nursing while she worked in psychiatry as an occupational therapy assistant. During the three years that she worked in a neuropsychiatric unit, she realized she wanted to expand her knowledge in health and pharmacology. This was the catalyst that led to her pursuing a new career as an RPN, Debora graduated from the Durham College RPN Certificate Program in 1991. When the opportunity became available she applied for a position and has never left the mental health nursing setting since, saying she enjoys the daily challenges and critical thinking required to work in this area.
Debora advocates for all nurses to be leaders. This is an idea she consistently promotes in her work as a mentor to new graduates and practical nursing students. She also says that for her, the opportunity to gain and apply knowledge, to collaborate with other professionals and to work with students, family members and colleagues represent some of the greatest benefits of a career in nursing.