Hidden in Plain Sight: A Scoping Review of Professional Grief in Healthcare and Charting a Path for Change

Abstract

Healthcare workers frequently experience emotional distress from repeated exposure to patient death, yet professional grief remains poorly recognized and inadequately supported. The COVID-19 pandemic further magnified these challenges, bringing professional grief into sharper focus. The purpose of this scoping review was to comprehensively examine professional grief among healthcare workers (HCWs) across different professions and specialties, map existing literature, identify research gaps, and provide educational, clinical, and policy recommendations. This scoping review followed Arksey and O’Malley’s methodological framework and PRISMA-ScR guidelines. Databases searched included PubMed, CINAHL, and PsycINFO for literature from 2004 to 2024. Studies were screened based on inclusion criteria focusing on professional grief experiences of HCWs dealing with patient deaths. Qualitative, quantitative, and mixed-method studies were included. Eighty-one publications were reviewed, with most studies published since 2020, highlighting increased attention post-COVID-19. Key findings identified significant individual (eg, early career vulnerability, lack of formal education), interpersonal (eg, patient demographics, relationship quality), and systemic factors (eg, emotional suppression culture, workload constraints) influencing professional grief. Existing interventions were predominantly peer-based and lacked demonstrated efficacy in reducing grief intensity. Measurement inconsistencies revealed discrepancies between qualitative and quantitative assessments of grief intensity, indicating a need for specialized measurement tools tailored to professional contexts. Professional grief among HCWs is multifaceted and deeply influenced by cultural, educational, and systemic barriers. Comprehensive strategies addressing these barriers must include structured educational curricula, ongoing clinical support programs, validated grief measurement tools, and institutional policies promoting open emotional expression. These approaches are essential to fostering resilience, enhancing professional well-being, and improving patient care outcomes.

Introduction

Healthcare workers (HCWs) are facing a mental health crisis in the United States, which was intensified by the COVID-19 pandemic. ¹ A recent study showed an increase in mentally unhealthy days between 2018 and 2022 (3.3 in the past 30 days vs 4.5 days). ¹ HCWs face occupational exposures such as infectious diseases (including bloodborne illnesses), chemicals, ergonomic hazards, and workplace violence. ² While these occupational hazards are well-recognized, exposure to psychologically straining situations like suffering, death, and dying have not been characterized as workplace exposures. ² Even though there may be significant impacts of these experiences, including grief, compassion fatigue, diminished psychological and physical health, and healthcare workforce stability. ³ Furthermore, patient outcomes are impacted by both workforce turnover and HCWs whose grief has gone unacknowledged and/or unaddressed.^4-6

Grief is considered a universal human experience and an expected reaction to loss. ⁷ For HCWs, grief may be experienced not only due to the loss of a patient but also due to observing suffering and losses related to illness. While the relationships between healthcare workers and patients are often time-limited, the emotional connection created when caring for someone in their extremity may relate to the depth of a worker’s grief. ⁷ In addition, the cumulative losses HCWs witness and experience, and the subjective experiences related to these losses may intensify grief.^3,8 Grief is not an inherently negative experience and can potentially produce positive outcomes such as increased meaning and purpose, deeper connections with others, and post-traumatic growth.^3,9

Papadatou first proposed the Model of Health Professionals’ Grieving Process in 2000, based on her extensive work as a clinical psychologist and research with oncology and critical care nurses coping with the death of children. The model pulls theoretical influence from the Dual Process Model of Coping and Bereavement ¹⁰ and conceptualizes HCWs reactions to cumulative patient deaths. Unlike traditional bereavement models that focus on the grief experienced with the loss of a loved one, Papadatou’s model specifically addresses professional grief, which differs from personal grief as it is anticipated daily, and a result of the job chosen by the HCWs. Because the professional’s first responsibility is to attend to workplace demands, professional grief is often hidden in “private shadows” and not openly expressed. ¹¹

What makes professional grief so challenging for HCWs is that they not only accept it as part of the job, but they also return to work where they are likely to face loss again and again. ¹¹ Without space or time to address grief in response to these losses, healthcare workers are at risk of experiencing complicated grief, ¹² which is persistent grief that impacts daily life and relationships.^12,13 In addition, HCWs may navigate feelings of guilt, anger, or despair, report feeling isolated due to their grief, be forced to confront their mortality, and have to balance their grief with ongoing work demands. Finally, HCWs’ ongoing exposure to grief and loss may lead to compassion fatigue. There are serious occupational and health consequences related to compassion fatigue including emotional blunting, increased work absenteeism or presenteeism, leaving the workforce, depression, anxiety, post-traumatic stress disorder (PTSD), insomnia, and poor physical health.^{3,4,7,8,14-16}

Previous literature reviews have explored grief among HCWs. However, ours is the first to comprehensively examine professional grief across all healthcare professions and specialties, incorporating quantitative, qualitative, and mixed-method designs. While Yazdan et al ¹⁷ reviewed 29 articles on hospital-based interventions to address physician and nurse grief, highlighting the limited and heterogenous nature of existing studies, and Burm et al ¹⁸ reviewed 173 studies on physician and nurses’ experiences during the COVID-19, emphasizing the need for institutional support, these reviews were profession- or context-specific. Other reviews have also been limited in scope: Tamworth et al ¹⁹ examined grief among mental health practitioners, Findlay and Robertson ²⁰ focused on home care workers, and Weiss et al ²¹ explored disenfranchised grief (a type of grief that is not openly acknowledged, mourned, or supported by others ²² ) within a nursing paradigm, while Fernández-Basanta et al ²³ conducted a meta-synthesis on midwives’ and nurses’ grief related to pregnancy loss. In contrast, our review provides a holistic and cross-disciplinary perspective on professional grief, offering a broader understanding of how grief manifests and is managed across diverse healthcare roles.

The purpose of the current study was to (1) conduct a 20-year scoping review of studies on professional grief across healthcare disciplines and specialties; (2) map the field of study on professional grief in healthcare and identify gaps in the existing literature; and (3) provide recommendations that will inform future research, theory, education, and clinical practice.

Methods

We conducted a scoping review, which is a systematic literature review that is particularly useful for exploring the breadth of literature on a complex and diverse topic. ²⁴ This methodology is appropriate for addressing our broad research question. Our review followed the Arksey and O’Malley ²⁵ framework, which outlines five key stages: identifying the research question, identifying relevant studies, study selection, charting the data, and collating, summarizing, and reporting the results. Additionally, we adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) protocol. ²⁶ The PRISMA-ScR checklist is provided in Supplemental Additional File 1. A protocol was registered on March 8, 2025 with the Open Science Framework (doi:10.17605/OSF.IO/JYPUZ). ²⁷

Stage 1. Identifying the Research Question

Our scoping review aims to answer the following research question: What is known about professional grief across healthcare professions and specialties?

Stage 2. Identifying Relevant Studies

On January 5, 2022, we searched PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus with Full Text, and PsycINFO by titles and abstracts using the following sets of search terms: “disenfranchised grief,” “professional grief,” and “healthcare professional grief.” We also used combinations of “grief” and different professions (ie, “nurse,” “doctor,” “social worker,” “chaplain,” and “medical assistant”) as additional search terms. CINAHL and PsycINFO were searched using EBSCOHost. The detailed search strategy is provided in Supplemental Additional File 2. We selected these three databases based on their comprehensive coverage of relevant, peer-reviewed literature on the topic. While additional databases could expand coverage, we were focused on publications in the health care field and the combination chosen provided a robust balance between comprehensiveness and practical feasibility. On December 6, 2024, we updated the search by using the same search terms in the same three databases. A 20-year date range of 2004 to 2024 was imposed on the search. All identified publications were combined, and duplicate publications were excluded using Covidence, ²⁸ a web-based screening tool.

Stage 3. Study Selection

Next, the nonduplicate publications were screened by title and abstract using predetermined inclusion and exclusion criteria. Publications were divided among the five reviewers (CP, KT, DR, AV, SG), each reviewed independently by two reviewers, and any ambiguous publications were reviewed as a team to reach a consensus. The inclusion criteria for this scoping review were: (1) full text written in English, (2) focus on healthcare professionals (eg, doctors, nurses, social workers, chaplains, medical assistants), (3) primary outcome of professional or disenfranchised grief, and (4) examines the emotional experiences of HCWs coping with patient death and/or working in high-death contexts (eg, oncology, palliative care, hospice, and frontline roles during COVID-19). We defined HCWs as members of the healthcare team who play a vital role in the holistic care of patients, including addressing their spiritual and emotional needs.^29,30 Furthermore, our inclusion criteria included HCWs routinely involved in end-of-life situations—settings in which professional grief is most likely to arise. No limitations were placed on study design—qualitative, quantitative, and mixed methods designs were included. Publications were excluded if they (1) did not provide peer-reviewed empirical data (eg, letters, commentaries, editorials, dissertations, conference abstracts, case studies, systematic reviews, or book chapters) or (2) only discussed family or informal caregiver grief (ie, no HCWs grief). Grey literature was excluded due to our focus on peer-reviewed studies, considerations regarding methodological rigor, and to reduce bias. ³¹ The remaining publications were screened by full text using the same inclusion and exclusion criteria.

Stage 4. Charting the Data

All studies that met eligibility criteria were extracted and compiled in Supplemental Additional File 2, which includes the authors, year, country, purpose, methodology, demographics, and findings.

Stage 5. Collating, Summarizing, and Reporting the Results

A descriptive analysis of the included studies was conducted to summarize the key characteristics of the research, including study design, sample characteristics, and primary findings. Quantitative data were synthesized using narrative synthesis, a well-established approach for integrating findings across heterogeneous studies. ³² This method facilitated a comprehensive understanding of professional grief across healthcare disciplines and specialties while identifying methodological trends and gaps in the existing literature. Qualitative study findings were analyzed using Braun and Clarke’s ³³ thematic analysis process. Two reviewers (CP, KT) independently familiarized themselves with the qualitative data, reading and re-reading the findings to identify preliminary patterns and ideas. They then independently generated initial codes across the data set, marking segments of data relevant to the research question. Reliability was enhanced through regular meetings to compare interpretations, resolve discrepancies, and reach concensus on code definitions. Following initial coding, themes were developed by clustering similar codes into broader patterns. These themes were collaboratively reviewed and refined to ensure accuracy and comprehensiveness. To further enhance rigor, themes were continually cross-checked against the original data. No software was used during the analysis; all coding and theme development were conducted manually.

Results

Search and Screening

During stage 2, a total of 1,138 publications were identified. After removing 291 duplicates, 847 publications remained for title and abstract screening. During the screening of publications by title and abstract, a total of 655 publications were excluded. The remaining publications were sought for retrieval; however, two studies were not retrieved. A total of 190 publications proceeded to full-text screening. During the final phase of screening, 109 publications were excluded, for a total of 81 publications included in this scoping review. Figure 1 presents the full search and screening process.

Figure 1.

PRISMA flow diagram.

Descriptive Characteristics of Included Publications

The included 81 publications represent 80 unique studies and samples; 2 publications reported data from the sample study—one qualitative and the other quantitative findings from their intervention.^34,35 A summary of the 81 publications is presented in Supplemental Additional File 2. The studies were published between 2004 and 2024, with the majority (46/80; 58%) published since 2020, demonstrating a growing interest in this area of research. Ten studies were explicitly published in response to the COVID-19 pandemic. In total, the studies were conducted in 26 countries across North America, South America, Europe, Asia, Africa, and Oceania, with the largest proportion (28/80; 35%) published in the United States. Qualitative designs were most common (47/80; 59%); the remaining studies used cross-sectional (22/80; 28%), quasi-experimental (7/80; 9%), or mixed-methods (4/80; 5%) designs. Most of the included studies (46/80; 58%) did not mention a guiding philosophical or theoretical framework. Several theories were used, with Stroebe and Schut’s ¹⁰ dual process model of coping with bereavement,^34,36,37 Doka’s ³⁸ concept of disenfranchised grief,^39-41 and Papadatou’s ¹¹ model of health professionals’ grieving process^14,42 referenced the most frequently. Additionally, 10 of the qualitative studies adopted a phenomenological approach^43-52 and 10 used a grounded theory method.^14,53-61

Sample sizes across the studies ranged from 6 to 794, with an average of 87 HCWs per study. Most studies (47/80; 59%) had fewer than 50 participants. The largest proportion of studies focused on oncology (15/80; 19%), obstetrics and neonatal intensive care units (12/80; 15%), and pediatrics (12/80; 15%). Other specialties included inpatient and outpatient mental health (7/80; 9%), home health or long-term care facilities (7/80; 9%), palliative care or hospice (6/80; 8%), intensive care units (5/80; 6%), emergency medicine (1/80; 1%), podiatry (1/80; 1%), anesthesiology (1/80; 1%), and mixed acute care settings (12/80; 15%). One study did not specify specialty. ⁶² Regarding professions, nurses were the most frequently studied group (33/80; 41%), followed by physicians (10/80; 13%), healthcare aides (6/80; 8%), nurse midwives or obstetricians (4/80; 5%), and social workers (4/80; 5%). The remaining 17 studies included a diverse range of professionals, with nurses and physicians appearing in nearly all samples. Other professions represented included advanced practice registered nurses, psychologists, respiratory therapists, chaplains, and paramedics. Further details on study samples are available in Table 1.

Table 1.

Study characteristics.

Author, date (country)	Study population	Specialty	Study design	Objective	Demographics	Findings
Aase et al, 2008 (Norway)	10 physicians	Acute care (cardiology)	Qualitative	To understand how physicians experience existential aspects of their work.	Age: 33-66 30% female	Themes: not easy, but now I can live with death; vulnerable responsibility; the meaningful difference; fellowship of mutual understanding.
Adwan, 2014 (US)	120 nurses	Pediatrics	Quantitative	To investigate the relationships between grief, burnout, and job satisfaction.	Age: x̄ = 34 95% female Experience: ⩾1 year	Nurses experience grief, but less intensity than family caregivers. Grief positively correlated with burnout and negatively correlated with job satisfaction. Higher emotional exhaustion associated with death of primary patient and higher guilt associated with younger patients.
Agyei et al, 2022 (Ghana)	79 nurses	Mixed acute (medical, surgical, emergency, theatre, maternity, pediatric)	Quantitative	To explore grief and coping experiences.	Age: 84% <40 56% female Experience: 73% 1-10 years	63% reported grief following patient death. Of those that denied grief, 89% did not grieve due to fear or as a show of professionalism. Commonly reported impacts of grief: insomnia, loss of appetite, fatigue, depression, reduced functionality at work and home. Commonly reported coping strategies: exercise, spirituality, music, sharing with colleagues. 47% reported access to professional counseling.
Anderson and Gaugler, 2007 (US)	136 CNAs*	Nursing home	Quantitative	To explore whether grief contributes to burnout and turnover.	Age: x̄ = 35 93% female Experience: x̄ = 108 months	Complications from grief can contribute to burnout; however, positive reactions to grief can protect CNAs from burnout. Grief not a significant predictor of turnover.
Betriana and Kongsuwan, 2019 (Indonesia)	14 nurses	ICU*	Qualitative	To explore the lived experiences of Muslim nurses caring for patients who died.	Age: x̄ = 32 79% female Experience: x̄ = 9 years	Themes: lived other: empathetic understanding; lived body: balancing self; lived space: avoidance; lived time: anticipating the future of own death; lived things: relating technologies in bargaining.
Boerner et al, 2017 (US)	140 CNAs, 80 HHAs*	LTC* (nursing homes, homecare agencies)	Quantitative	To explore staff, institutional, patient, and grief factors as predictors of burnout among healthcare providers who had experienced a recent patient death.	CNA—age: x̄ = 51 89% female Experience: x̄ = 15 years HHA—age: x̄ = 43 96% female Experience: x̄ = 7 years	Grief factors accounted for greater variance in depersonalization, compared to staff, patient, or institutional factors. Supervisor support and caregiving benefits were associated with higher levels on burnout measures, while coworker support was associated with depersonalization and emotional exhaustion.
Breen et al, 2014 (Australia)	10 social workers, 7 chaplains, 6 nurses, 3 group facilitators, 1 physician, 11 psychologists	Oncology	Qualitative	To investigate the emotional consequences of supporting people affected by cancer.	84% female Experience: 4-33 years	Themes: the role of health professionals in supporting people who are experiencing cancer-related grief, ways of working with people who are affected by cancer, the unique qualities of cancer-related loss and grief experiences, emotional demands of the work and associated self-care.
Cardinalli et al, 2024 (US)	69 psychologists and mental health professionals	Mental health (78% clinical psychology, 44% private practice or group setting)	Quantitative	To examine mental health professionals’ trauma, grief, and resilience during the early stages of the COVID-19 pandemic.	Age: 29% 35-44, 26% ⩾65 81% female Experience: 46% ⩾13 years	48% met criteria for PTSD, 7% severe grief. Those first using virtual platforms during the pandemic reported less grief and PTSD symptoms. Those with children reported greater resilience, and resilience mediated relationship between children and grief. Resilience and PTSD symptoms independently predicted grief responses.
Cauldwell et al, 2015 (UK)	4 midwives, 5 doctors in training, 5 consultant obstetricians	Obstetrics	Qualitative	To explore the impact of maternal death on healthcare professionals and their related needs.	86% female Experience: 67% 1-2 years	Themes: professional culture, organizational culture and external expectation; personal blame and guilt; debriefing; professional training; shaping the training; support and counseling.
Chew et al, 2021 (Singapore)	12 nurses	Pediatrics (58% ICU, 17% oncology wards, and 25% high dependency wards)	Qualitative	To explore the experiences, challenges, and coping strategies of new pediatric nurses dealing with patient death.	Age: 75% 25-30 92% female Experience: <3 years	Themes: spectrum of emotions (emotionally scarred, overwhelmed and at loss, getting a grip), the “blame” game (responsibility and self-blame, blaming the difference between expectations and reality, blaming unpredictability), getting through the grief (importance of collegial support, reliance on spirituality, opportunity for personal growth), new nurses’ wish list (improved and earlier implementation of training, community sharing platform).
Curd and Hong, 2022 (US)	19 social workers	Hospice	Qualitative	To investigate the lived experiences of rural hospice social workers	84% female Experience: 16% 16-25, 21% ⩾26 years	Themes: meaning of hospice social work, role of hospice social workers, vulnerability and realness, self-care, rural culture.
Currin-McCulloch et al, 2022 (US; Canada)	246 social workers	Oncology (inpatient and outpatient) and palliative care	Mixed methods	To investigate how COVID-19 personal and professional grief impacted distress and resilience.	Age: 29% 35-44 98% female Experience: 31% ⩾20 years	A third of participants reported emotional distress and difficulty finding meaning related to pandemic losses. Participants reported lower level of resilience compared to US population. Themes: the hardest year of my career, the collective loss of our normal, we were built for this.
De Castro et al, 2018 (Brazil)	9 nurses	NICU	Qualitative	To investigate palliative care experiences of Brazilian NICU nurses.	Age: 34-57 78% female Experience: 18 months-20 years	Themes: living with the grief, identifying with the family, providing humane care, feeling unprepared.
Eagle et al, 2012 (US)	50 HCWs* (25 physicians, 6 nurses, 1 social worker, 1 respiratory therapist, 6 medical students)	PICU*	Quasi-experimental	To evaluate current rates of grief and burnout in PICU; to explore facilitated peer support sessions to reduce grief and burnout.	Experience: 27% 1-5 years	Low levels of grief and burnout among participants. No significant pretest/posttest changes.
Engler-Gross et al, 2020 (Israel)	33 social workers, 26 psychologists	Oncology	Quantitative	To examine the relationship between grief and compassion fatigue.	Age: x̄ = 41 87% female Experience: x̄ = 13 years	High levels of grief and compassion fatigue. Grief and compassion fatigue are positively correlated. Clusters: High Grief-Low Social Acknowledgment (secondary traumatic stress significantly higher in this group compared to each other cluster); Medium Grief-High Social Acknowledgment; Low Grief-Medium Social Acknowledgment.
Erami and Taghadosi, 2023 (Iran) Seminars in Oncology Nursing	18 nurses	Oncology	Qualitative	To investigate the contributing factors to grief experience among oncology nurses.	Age: 24-56 61% female Experience: 2-30 years	Categories: exposure to patients’ painful death (excessive exposure, unexpected deaths, critical conditions and imminent deaths, tragic deaths), depressing work atmosphere (sadness due to knowing imminent death, unpleasant work environments, exposure to request for patient death), knowing the heavy financial burden of cancer for patients (patients’ limited financial ability, heavy costs of treatment, patient problems/challenges due to finances), patients’ helplessness in the healthcare system (inadequate support for patients, patients’ familial problems).
Erami and Taghadosi, 2023 (Iran) Journal of Health Scope	20 nurses	Oncology	Qualitative	To examine the positive consequences following grief for oncology nurses.	Age: x̄ = 41 65% female Experience: x̄ = 14 years	Themes: promoting and practicing religious beliefs” (promoting religious beliefs, believing in prayers and miracles), feeling rewarded after experiencing grief (changing attitudes to death, rewards of patient care), promoting ethical virtues (promoting positive behaviors, decreasing attachment to the mundane world, taking advantage of life opportunities).
Esplen et al, 2022 (Canada) Current Oncology	189 HCWs (92% nurses)	Oncology	Quasi-experimental	To evaluate the impact of a continuing education program on knowledge and confidence among oncology staff with exposure to suffering and loss, compassion fatigue, and burnout.	Age: 16% <29, 49% 30-49, 32% ⩾50 93% female Experience: x̄ = 18 years	Intervention demonstrated significant improvements in confidence and knowledge related to managing grief and loss. High satisfaction.
Esplen et al, 2022 (Canada) Hospice and Palliative Care				To evaluate the qualitative themes from a continuing education program on managing grief and loss.		Themes: educational needs on compassion fatigue and strategies to support wellness and resilience, barriers to address compassion fatigue and burnout, health professional as a “person” and relevance of personal variables, self-skill practices to support well-being, team-related factors, organizational/institutional factors, need to incorporate self-care, resilience, and coping as topics in annual reviews.
Fallek et al, 2019 (US)	198 HCWs (34% nurses or APRNs*, 27% social workers, 14% case managers, 9% administrators, 6% physicians)	Mixed acute (62% oncology, palliative care, pediatrics, psychiatry, or surgery)	Quasi-experimental	To investigate the feasibility effectiveness of offering an intensive bereavement support program.	Age: x̄ = 49 Experience: x̄ = 17 years	Reported benefits included being able to grieve more effectively, accessing support, and learning new tools for healing and self-care; workshop was described as unique, cathartic, and life changing.
Funk et al, 2017 (US)	13 nurses, 12 aides	Palliative care	Qualitative	To explore how health care workers interpret personal grief related to patient death	Age: x̄ = 44 76% female Experience: x̄ = 12 years	Themes: death and dying work as a source of emotional distress, coping requires time and space, humor helps but must be used cautiously, grief suppression, emotional detachment, grief spillover and unfinished business, tension between professional ideals and caring identities.
Ghesquiere and Bagaajav, 2020 (US)	14 HHAs	Hospice	Qualitative	To explore HHAs’ reactions to patient death.	—	Hospice provider practices with family members (complicated grief or depression, relationships, support to family members), reactions and coping after patient death (emotional responses, coping through acceptance, coping through making meaning, coping through social support, barriers to coping), interest in support and training (training in working with family members, group support, self-care, organizational changes).
Giesbrecht et al, 2021 (Canada)	92 HCWs (12 administrators, 10 nurses, 15 LPNs*, 13 aides)	LTC	Qualitative	To explore the emotional geographies of providers caring for dying residents.	—	Identifying a resident as on a dying trajectory; Caring for actively dying residents; Following a resident’s death.
Gorbenko et al, 2021 (US)	6 physicians, 1 program manager, 3 APRNs, 3 social workers	Home care	Qualitative	To examine the psychological impact of the COVID-19 pandemic on home-based primary care providers.	Experience: Med = 12 years	Themes organized around two components of burnout. Depersonalization did not emerge in the data. Emotional exhaustion: “we’re used to patients passing but not like this”—the traumatic experience of losing many patients at once, grappling with and processing grief, pressure to adapt quickly. Reduced personal accomplishment: grappling with guilt about the care quality, rapid loss of confidence in one’s expertise, feeling useless.
Granek et al, 2012 (Canada)	20 physicians	Oncology	Qualitative	To gain understanding on what makes patient lost difficult for oncologists and to explore context for these losses.	Age: x̄ = 47 45% female Experience: x̄ = 13 years	Themes: difficult patient loss (relational factors—close patients and families, patient transference, young patients, long-term relationships, unexpected deaths; contextual factors—unrealistic expectations, excessive treatments, physician blame), physician culture (stigma around death and dying, affect as weakness, culture of cure, gendered).
Granek et al, 2015 (Israel)	21 physicians	Pediatrics (oncology	Qualitative	To explore pediatric oncologists’ grief reactions to patient death and the impact on their lives.	Age: x̄ = 43 52% female Experience: x̄ = 12 years	Themes: reactions to patient death (process of grieving, expressions of grief and reactions to death), impact of death (personal, professional, lifelong).
Granek et al, 2017 (Israel)	22 physicians	Oncology	Qualitative	To explore oncologists’ grief symptoms towards patient death and to identify factors impacting grief experiences.	Age: x̄ = 47 36% female Experience: x̄ = 14 years	Themes: grief over patient loss (behavioral, cognitive, physical, emotional symptoms), difficult patient loss (patient-related, family-related, disease-related factors).
Gray and Kim, 2017 (US)	60 aides	LTC (intellectual and developmental disabilities)	Qualitative	To explore direct care workers’ grief experiences, coping methods, and needs for support regarding client death.	Age: x̄ = 42 83% female Experience: x̄ = 12 years	Themes: factors affecting the loss experience (attachment, preparing for the loss); coping with loss (numbing to the loss, social supports, clearing the conscience); organizational issues (organizational grief supports, return-to-work policies, the need for respite, organizational communications).
Hawes et al, 2022 (US)	39 HCWs (7 nurses, 3 social workers, 5 respiratory therapists, 14 physicians, 3 APRNs)	NICU	Quasi-experimental	To evaluate formal bereavement debriefing sessions with NICU staff.	—	Stress levels significantly decreased; increased number of debriefing sessions attended associated with infant age at the time of death. Qualitative themes: family and provider relationships, evaluation of the death, team cohesion, caring for one another, and emotional impact.
Hayuni et al, 2019 (Israel)	71 physicians	Oncology	Quantitative	To investigate the mediating role of secondary traumatic stress and burnout in the relation between empathy and grief among oncologists.	Age: x̄ = 44 59% female Experience: x̄ = 13 years	Moderate grief and relatively high levels of secondary traumatic stress, burnout, and empathy. Mediators fully accounted for the relationship between two components of empathy (perspective taking, personal distress) and grief.
Holmes et al, 2021 (US)	181 social workers	—	Quantitative	To measure posttraumatic stress, grief, burnout, and secondary trauma experienced by social workers during COVID-19 pandemic.	Age: x̄ = 40 92% female Experience: x̄ = 12 years	26% met criteria for posttraumatic stress disorder, 16.6% severe grief symptoms. 99% reported average to high compassion satisfaction, 63% reported average burnout, 50% reported average secondary trauma.
Hong et al, 2023 (South Korea)	251 nurses	Acute care	Quantitative	To examine whether nurses’ psychological states affect their grief response to a patient’s death during COVID-19 pandemic.	—	34% suffered from depression. High grief scores predicted high scores on the different psychological state scores. Depression influenced pandemic grief response; work-related stress and viral anxiety, insomnia severity, and loneliness partially mediated this association.
Hung et al, 2023 (China)	10 social workers	Mental health (community)	Qualitative	To explore the grief experienced by social workers who have endured the loss of a client through suicide.	50% female Experience: 5-18 years	“Wounded helpers” experienced various forms of grief: guilt, shock, panic, anger, shame, loss, sadness, helplessness, regret, fear, anxiousness, debilitating flashbacks. Psychological pain lasts a long time.
Jit Singh et al, 2023 (Malaysia)	660 nurses	ICU	Quantitative	To explore the mediation effects of coping mechanism and grief support on the impact of burnout.	Age: x̄ = 27 91% female	Most participants had absence of grief, low burnout, and moderate to low grief support. Grief support significantly mediated relationship between grief and burnout.
Jonas-Simpson et al, 2013 (Canada)	6 nurses	Obstetrics (5), NICU (1)	Qualitative	To investigate obstetrical and NICU nurses’ experiences of grieving when caring for perinatal death.	Age: 20-51 Experience: x̄ = 17 years	Thematic patterns: growth and transformation emerging with the anguish of grief, personal and professional impact, giving-receiving meaningful help.
Kain, 2013 (Australia)	24 nurses	NICU	Qualitative	To investigate the grief reaction of neonatal nurses.	Experience: ⩾2 years	Constructs: acknowledgment of the loss, recognition of the relationship, inclusion of the griever.
Katti et al, 2024 (India)	18 medical students, 6 resident doctors	Mixed acute (general medicine, surgery, pediatrics, emergency medicine)	Qualitative	To explore the experience of patient deaths on the emotional health of young doctors.	Age: 22-28 42% female Experience: 1 month-3rd year resident	Themes: losing a patient—emotions behind the screen (initial response to patient loss, untimely deaths of the young, personal bonds with patients, death over suffering, identification), internal battles and external barriers (helplessness and feeling incompetent, barriers to processing the loss, coping strategies), intellectualization: death a realistic possibility (time heals, be brave), identifying lacunae and expressing unmet needs (emotional well-being, debriefing, skill development, healing emotions).
Kim et al, 2020 (Australia, New Zealand)	424 physicians	Anesthesiology	Quantitative	To investigate the attitudes of anesthesiologists towards attending a patient’s funeral.	Age: 38% 40-49 33% female Experience: 28% ⩾20 years	6% had previously attended a patient’s funeral, 86% rarely formed bonds with patients or families, 55% believed forming a bond would increase their likelihood of attending a funeral. Perceived benefits of attendance: respect, expression of grief and caring beyond life. Perceived barriers: families misinterpreting the purpose of or not expecting their attendance and time restraints.
Laor-Maayany et al, 2020 (Israel)	74 physicians	Oncology	Quantitative	To examine the associations of compassion fatigue and satisfaction with oncologists’ grief and sense of failure.	Age: x̄ = 45 56% female Experience: x̄ = 14 years	High levels of compassion fatigue and grief, moderate levels of sense of failure. Grief and sense of failure significantly predicted both aspects of compassion fatigue: secondary traumatic stress and burnout.
Liberati et al, 2021 (UK)	17 psychiatrists, 10 nurses, 5 psychotherapists, 3 psychologists	Mental health (inpatient and community)	Qualitative	To describe the experiences of mental health professionals during the first wave of the COVID-19 pandemic.	54% female	Changes in services and the nature of work; impacts of COVID-19-related service changes on staff; dilemmas and challenges; wellbeing and the use of support.
Lin et al, 2021 (Taiwan)	10 nurses	Obstetrics	Qualitative	To explore stillbirth care experiences of nurses.	Age: x̄ = 30 Experience: x̄ = 10 years	Themes: unfolding the suffering (shame and guilt, disenfranchised grief), engrossing in stillborn parents (perceiving the mother’s suppress sadness, empathizing with the father’s anger), demonstrating compassionate actions (fulfilling the parents’ needs to say goodbye to the stillbirth, saying a personal goodbye to the dead baby).
Lin et al, 2022 (China)	572 nurses	Mixed acute (213 surgery, 245 medicine, 28 ICU, 52 oncology, 34 emergency)	Quantitative	To explore the status and influencing factors of the death-coping self-efficacy of nurses.	Age: x̄ = 32 99% female Experience: 73% <10 years	Medium overall self-efficacy. Nurses who have attended a hospice care education course within the last year, accompanied the family members of the deceased, and have an open attitude towards death had higher self-efficacy.
Lindsay and Heliker, 2018 (US)	4 physicians, 3 nurses, 1 respiratory therapist	Pediatrics	Qualitative	To examine the lived experiences of emergency service personnel involved in an unsuccessful pediatric resuscitation.	Age: 29-40	Themes: lived time (what if?, dying before my eyes), lived other (team, what if it were my child?/being a parent), lived space (environment, being trapped), lived body (wounded healer, education, anger, coping).
MacDermott and Keenan, 2014 (Ireland)	8 nurses	Pediatrics	Qualitative	To explore nurses’ knowledge and personal experiences of grief related to caring for children with an intellectual disability who have died.	Age: 38% 31-40 100% female Experience: 38% 11-15 years	Themes: grief, relationship with child, end of life, support.
Macpherson, 2008 (US)	6 nurses	Pediatrics (oncology)	Quasi-experimental	To examine the impact of a peer-supported storytelling intervention.	Age: x̄ = 25 100% female Experience: x̄ = 3 years	Participants reported both providing and receiving support during sessions, which impacted their grief and meaning-making. The session focused on finding meaning and benefit in their experiences was especially helpful. Significant positive correlation between number of “special patient deaths” and sessions’ impact on grief. No significant change in grief score.
Maia de Sena et al, 2023 (Brazil)	23 HCWs (physicians, nurses, psychologists, social workers, dentists, physiotherapists, and educators)	Pediatrics (oncology, palliative care)	Qualitative	To explore how healthcare professionals experience grief in palliative care in pediatric oncology.	Age: 25-60	Classes: specificities of the treatment of children with cancer and other aspects related to chronic illness, health trainings do not prepare professionals to deal with death and these professionals have pre-concepts about palliative care, principles of palliative care, bonds formed by professionals and their grieving experiences.
Mander, 2004 (UK)	36 midwives	Obstetrics	Qualitative	To explore the experiences of midwives caring for a mother who died.	32 “experienced,” 4 “non-experienced”	Themes: career and practice, professional and personal grief, the professional experience and the midwife’s own childbearing, identification with the experience, coping strategies.
Martins et al, 2023 (Portugal)	16 nurses	Obstetrics	Qualitative	To explore the experiences of nurses involved in pregnancy loss care.	94% female Experience: 3-15 years	Themes: stressful work conditions (care management, institutional practices), personal characteristics (discomfort with loss, communication skills, work experience and empathy), the patient’s journey (partner’s ambiguous role, timing, respect for the patient’s individuality, viewing the fetus and facilitating grief rituals).
Mills et al, 2023 (Kenya, Uganda)	37 nurse midwives, 12 midwives, 10 physicians, 1 social worker, 1 reproductive counselor	Obstetrics	Qualitative	To explore the lived experiences of health professionals caring for women after a stillbirth in Kenya and Uganda.	75% female Experience: Med = 15 years	Themes: in the mud and you learn to swim in it (try to walk in their shoes, I don’t have the right words), it’s bad, it’s a sad experience (guilt, blame, and fear; what did I do wrong, what didn’t I do?), nobody asks “how are you doing?”
Morrissey and Higgins, 2021 (Ireland)	10 nurses	Mental health (inpatient and community)	Qualitative	To explore the impact and responses of mental health nurses to client suicide.	70% female Experience: 4-21 years	Themes: hearing the news, experiencing the impact of grief, grieving privately, searching for meaning, questioning practice.
O’Callaghan and Lambert, 2024 (Ireland)	15 HCWs (physicians, nurses, social workers)	Substance use disorders	Qualitative	To explore the impact of client drug deaths on healthcare providers.	53% female	Themes: grief beneath the surface (intrusive flashbacks, the clinical carer’s burden), the cost of caring (occupation and vocation, mutual learning and lost potential, shock to the system), finding closure (trepid last respects, balancing act).
Omran and Callis, 2021 (US)	10 nurses	ICU	Qualitative	To explore the needs of critical care nurses grieving the death of a patient; to explore nurses’ perceptions of their coping process.	Age: x̄ = 40 70% female Experience: x̄ = 11 years	Themes: emotional distress, empathy, personal distress, disconnection/nurse detachment, expectations, education, self-care and available resources.
Paul et al, 2023 (Mangalore)	50 nurses	Oncology	Mixed methods	To explore the chronic grief experiences and coping strategies of nurses caring for patients with end-stage cancer.	Age: x̄ = 30 88% female Experience: x̄ = 4 years	34% mild grief, 52% moderate grief, 14% severe grief. Interview themes: grief over circumstances, sense of powerlessness, physical and emotional exhaustion, engaging in self-controlling behaviors, self-nurturance, and compassion satisfaction.
Plante and Cyr, 2011 (Canada)	33 physicians, 46 nurses, 13 respiratory therapists, 9 others	Pediatrics	Quantitative	To explore the grief experienced by healthcare professionals after the death of a child, the factors associated with a memorable death, and needs of providers	Age: 34% 31-40 77% female Experience: 34% 0-5 years	Respiratory therapists had highest intensity of grief. Younger providers (20-25) reported higher early grief intensity than older ones (50+). No significant association between grief score and being a parent, receiving palliative care training, or length of relationship to child/family. 70% confided in colleagues, 48% with family and friends. 37% found social support most helpful.
Phillips and Volker, 2020 (US)	7 nurses	Oncology	Qualitative	To explore how nurses describe their emotions from first significant patient death to cumulative patient death.	Age: x̄ = 41 86% female Experience: x̄ = 14 years	Meta-theme: riding the roller coaster. Subthemes: all in and then, finding your way, impact on self.
Rahmani et al, 2023 (Iran)	375 nurses	Mixed acute (144 ICU)	Quantitative	To explore complicated grief and related factors among nurses during the COVID-19 pandemic.	Age: x̄ = 32 64% female Experience: 53% <10 years	58% suffering from complicated grief. Higher social support significantly associated with lower grief. Female, less educated, ICU, more experienced, floor nurses, and fixed shift had higher scores of grief—these variables explained 59% of the variance in grief scores.
Rao et al, 2021 (US)	22 physicians, 18 nurses, 4 paramedics, 2 respiratory therapists, 4 APRNs	Mixed acute (hospital medicine, pulmonary/critical care, emergency medicine, anesthesiology)	Qualitative	To examine the drivers of distress and motivations faced by clinicians during the COVID-19 pandemic.	Age: x̄ = 41 64% female Experience: x̄ = 13 years	Themes: depersonalization and barriers to care, powerless in uncertainty, overwhelmed and exhausted, bolstering morale and confidence, driven by moral duty.
Rice et al, 2014 (US)	9 nurses	Oncology (inpatient and outpatient)	Quasi-experimental	To explore the use of second life (virtual world technology) in facilitating peer storytelling for grieving oncology nurses.	Age: x̄ = 40 100% female Experience: x̄ = 12 years	Sessions were helpful for making sense and identifying benefit of grief. Difficulties related to technology were encountered. Themes: cognitive readiness to learn about death, death really takes death experience, emotional resilience.
Robalo Nunes et al, 2018 (Portugal)	66 nurses	Palliative care	Quantitative	To examine the relationship between humor and professional grief in palliative care nurses.	Age: x̄ = 34 80% female Experience: x̄ = 5 years	Low level of professional grief overload. No significant correlation between grief overload and sense of humor. Nurses with more negative attitudes toward humor had significantly more grief overload.
Robbins-Welty et al, 2024 (US)	57 psychiatry residents	Psychiatry	Quantitative	To investigate the prevalence and associations between burnout, depression, and grief.	Age: 44% 25-30 68% female Experience: 38% residency year 3	11 reported high levels of burnout, 8 met the criteria for moderate depressive symptoms, and 5 reported suicidal ideation. No participants met the criteria for pathologic grief. Grief was significantly correlated with burnout and depression.
Robson and Williams, 2017 (Australia)	15 physicians	Podiatry	Qualitative	To explore the impact of long-term patient death on podiatrists.	73% female Experience: Med = 15 years	Themes: acknowledging connections, willing to share and listen, creating support through starting the conversation.
Rodriguez et al, 2020 (US)	55 nurses	NICU	Quantitative	To explore the grief, coping mechanisms, and perceptions of grief support among NICU nurses.	Age: x̄ = 46 98% female Experience: 40% ⩾21 years	Mean grief score was 46.9. 60% disagreed on adequacy of grief support services and 81% reported staff could benefit from additional grief support such as debriefing and additional nurse staffing. Nurses’ past grief support included family, friends, and church. Future grief resources would include family, friends, and coworkers.
Sanford et al, 2021 (Australia)	130 professionals	Mental health	Mixed methods	To investigate the experience of professional exposure to suicide among behavioral and mental health professionals.	Age: x̄ = 47 75% female	Distress levels relatively low. Qualitative themes: impact on the individual, organization response to the death, lack of adequate resources and supports to prevent suicide.
Shi et al, 2022 (China)	794 nurses	Oncology	Quantitative	To examine the prevalence and correlation among empathy, grief, and compassion fatigue.	Age: x̄ = 32 98% female Experience: x̄ = 10 years	Moderate levels of empathy and grief, moderate to high levels of compassion fatigue. Perspective taking was negatively related to grief and secondary traumatic stress. Empathic concern was negatively related to burnout. Personal distress was positively related to grief, secondary traumatic stress, and burnout. Grief was positively related to secondary traumatic stress and burnout. Grief played a partial mediating role between empathy and secondary traumatic stress.
Shimoinaba et al, 2021 (Australia)	24 nurses	Pediatrics (emergency department)	Qualitative	To explore emergency department nurses’ experiences with children’s death, coping strategies, and support needs.	Age: 30-66 75% female Experience: 15 months-38 years	Themes: external strategies (peer-support, informal supervision), internal strategies (showing or hiding emotions, acceptance and meaning making), coping strategies.
Shorter and Stayt, 2010 (UK)	8 nurses	ICU	Qualitative	To explore the grief experiences of critical care nurses’ and coping mechanisms when a patient dies.	100% female Experience: 8 months-6 years	Themes: the death experience—expectedness, control and good nursing care, striking a chord, meaningful engagement; the death thereafter—formal and informal support, normalization of death, emotional disassociation.
Strote et al, 2011 (US)	145 physicians	Emergency medicine	Quantitative	To investigate the effects of patient death on emergency medicine physicians and their coping mechanisms.	Age: Med = 40 35% female Experience: 60% ⩽11 years	66% reported witnessing a death at least every month. 24% had received no training on coping with patient death and 64% had less than 6 hours. The most common coping mechanisms included talking with colleagues (78%) or friends/family (69%) and simply continuing to work (61%). 64% reported post death debriefings occurred rarely or never. Common physical responses included insomnia (37%) and fatigue (14%). Common emotional responses included sadness (70%) and disappointment (38%).
Treggalles and Lowrie, 2018 (Australia)	6 occupational therapists	Palliative care	Qualitative	To examine professional grief experiences of occupational therapists in palliative care.	Age: 29-56 100% female Experience: 8-35 years	Themes: knowledge of self, permission for connections and feelings, filtering experience, being present at work and home.
Tsui et al, 2019 (US)	26 aides	Home care	Qualitative	To investigate how home care workers navigate patient death.	Age: Med = 48 100% female Experience: Med = 10 years	Themes: relational factors shaping experiences of death; outcomes of client death (emotional and physical effects; financial effects; positive effects); core grief strategies and their limits (relying on personal strength; considering boundary-setting; expecting few agency supports, though sometimes requesting them; seeking emotional connection); supporting home care workers after a client death.
Turgut and Yildiz, 2023 (Turkey)	200 nurses	PICU	Quantitative	To investigate grief, posttraumatic growth, and related factors among PICU nurses.	Age: x̄ = 33 82% female Experience: 56% ⩾3 years	Mean grief = 49.43. Weak negative correlation between grief intensity and posttraumatic growth. Training, confidence, providing family with emotional support, and presence of supporting health professionals reduced grief. Being a woman, willingness to work in the unit, and sufficient time to accept the loss were correlated with higher posttraumatic growth. Nurses desired more time to recuperate after a loss and professional support.
Vázquez-Sánchez et al, 2023 (Spain)	25 nurses	Mix acute and outpatient (6 case managers, 7 family nurses, 8 ICU, 4 palliative care)	Qualitative	To explore the professional grief of nurses during the COVID-19 pandemic.	Age: 23-63 88% female Experience: 3-41 years	Themes: the impact on nurses of the COVID-19 pandemic (anguish as patients suffers a prolonged, painful death; communication difficulties; so many patients dying every day, each with their own personal characteristics; fear of dying; sensation of being overwhelmed and of insufficient resources, resulting in fatigue and guilt; fear of personal rejection), symptoms of professional grief (mental numbness; the need for points of reference; disorganization and despair; reorganization), cognitive reactions (personal protection; social behavior).
Vega et al, 2017 (Chile)	114 physicians, nurses, kinesiologists, psychologists, occupational therapists, nutritionists, social workers; 96 technicians	Pediatrics (130 oncology, 80 ICU)	Quantitative	To determine the prevalence of burnout and bereavement support of health professionals in pediatric oncology and critical care.	Age: x̄ = 39 89% female Experience: 4 months-40 years (53% <5 years)	4% with burnout, 71% at risk of burnout. 52% had high level of perception of bereavement support, especially women and oncology personnel. Recognition of the bond, as well as the loss after death of a patient, helps decrease depersonalization and improves personal fulfillment.
Wenzel et al, 2011 (US)	39 nurses	Oncology (inpatient and outpatient) (adult and pediatric)	Qualitative	To identify facilitators and barriers to managing patient loss among oncology nurses.	—	Themes: dimensions of work-related loss (losing life and hope, exacerbating job-related factors, outsider misunderstandings), working through bereavement (individual strongholds, team strength, renewal through patient and family relationships), recommendations for organizational support (creating time and space for self-care, counseling, quality time with patients and families, acknowledgment and reinforcement of nurses’ special efforts, work structures).
Wiesner et al, 2024 (Germany)	8 physicians, 3 midwives, 2 nurses, 2 counselors, 1 chaplain, 1 psychologist, 1 undertaker	Obstetrics	Qualitative	To explore the experiences and needs of professionals caring for parents continuing pregnancy after life-limiting prenatal diagnosis.	Age: x̄ = 48 89% female Experience: Med = 17	Main categories: framing the situation, management of perinatal palliative care, perception of families, collateral beauty (core concept).
Williams et al, 2024 (US)	24 nurses	Acute care	Mixed methods	To explore the grief of nurses working on the frontlines during the COVID-19 pandemic.	Age: x̄ = 35 88% female	5 reported indirect care of 80+ deceased patients, 1 reported direct care of 50+ deceased patients. Major concepts: facing a new reality, frustrations, stress and coping. Presents a conceptual definition of grief and a grounded theory of nurses’ experiences working during the pandemic.
Wilson, 2014 (UK)	8 nurses, 5 aides	Acute care (respiratory)	Qualitative	To investigate how ward staff experience patient death in acute medical settings.	Age: 22-55 92% female Experience: 2-10+ years	Themes: behavioral responses (behavior, thoughts); influences (pressure, life experiences, expectations, type of death); support (actual, desired).
Wladkowski et al, 2021 (US)	24 aides	LTC (hospice, palliative care, home health, skilled nursing facility)	Qualitative	To examine the experiences of direct care workers during care transitions.	Age: x̄ = 36 96% female Experience: ⩾3 months	Themes: managing experience of loss (anticipation and acceptance of loss, employing personal coping strategies, finding a process of saying good-bye); impact of relationship on grief experience (building and maintaining relationships, perceived connections and impact of loss).
Wlodarczyk, 2013 (US)	26 nurses, 9 HHAs, 3 chaplains, 3 aides, 12 music therapists, 11 social workers, 4 counselors	Hospice	Quasi-experimental	To examine the impact of a single-session group music intervention for grief resolution on feelings of disenfranchised grief with hospice workers.	Age: x̄ = 44 84% female Experience: x̄ = 6 years	Significant decline of personal sacrifice burden, and a non-significant reduction for feelings of burden. There was no significant impact on secondary measures of burnout, compassion fatigue, or perceived work environment. Qualitative themes: negative and positive aspects of hospice work.
Yenal et al, 2021 (Turkey)	10 midwives, 5 nurses	Obstetrics	Qualitative	To explore the experiences of Turkish midwives and nurses caring for patients with perinatal loss.	Age: 25-47 Experience: 2-19 years	Themes: emotional effect (emotion, helplessness, obstetric history, being a mother, experiencing perinatal loss), practice (compassionate care, consolation, consideration for religious views), ways of coping (sharing with colleagues, prayer, rationalization), difficulties (training/in-service education, the absence of a standard protocol for the woman or family to see, touch and hold the baby).
Yi, 2021 (South Korea)	11 nurses	Mixed acute (ICU, oncology, psychiatry, emergency, palliative care, geriatrics) and home care	Qualitative	To explore nurses’ experiences of accepting patient deaths.	Age: x̄ = 46 91% female Experience: x̄ = 17 years	Themes: causal conditions (facing forgotten death painfully, dying that became difficult, enduring from a step away), contextual conditions (wishing for well-dying), phenomenon (wholehearted care), intervening conditions (empathetic death experience), action/interaction strategies (acknowledging dying, lessening by sharing), consequences (reflecting upon death), core category (grieving over dying).
Zhang et al, 2024 (China)	18 nurses	ICU	Qualitative	To examine the coping experiences of ICU nurses following professional grief.	Age: x̄ = 30 50% female Experience: x̄ = 7 years	Themes: short-term dual coping with professional grief; long-term cumulative changes from professional grief.

Abbreviations: APRN, advanced practice registered nurse; CNA, certified nurse aide; HCWs, healthcare workers; HHA, home health aide; ICU, intensive care unit; LPN, licensed practical nurse; LTC, long-term care; PICU, pediatric intensive care unit.

Qualitative Findings

In this scoping literature review, we explored professional grief across healthcare disciplines and specialties. Our analysis identified key themes across individual, patient, and systemic factors, as well as coping strategies and the impact of patient death on HCWs. Finally, a sub-analysis of findings related to the COVID-19 pandemic are provided.

Individual Factors

Early Career Challenges

HCWs reported experiencing more difficulty in the early stages of their careers when confronted with patient death and that it becomes easier with more experience.^{37,48,50,56,57,61,63-68}

Lack of Education on Coping with Work-Related Emotions

Many HCWs feel unprepared to manage professional grief, particularly due to a lack of formal education on bereavement, grief processing, self-care, and communication with dying patients and their families.^{35,37,39,43,46,47,50,52,55,58,64,65,67-72} While on-the-job experience helps professionals learn to compartmentalize and set emotional boundaries, cope, and become more comfortable with difficult conversations,^{37,46,56,61,65,66,73} many desired more structured education on palliative care, self-care strategies, and interpersonal skills related to end-of-life care.^{35,39,43,46,52,56,67,69-71,74,75}

Personal Loss and Identification with Patients and Family

HCWs frequently experience stronger emotional responses when a patient or family member reminds them of themselves or their own loved ones.^{37,46,49,54,58,59,63,65,66,70,73-80} This identification can enhance empathy and improve patient care but also intensifies the grief response. Those with prior loss histories may find patient deaths especially triggering, while others develop coping strategies and bereavement skills informed by their past grief experiences.^{37,43,46,52,59,65,66,74}

Patient Factors

Patient Characteristics and Length of Relationship

Outside of pediatrics and the neonatal intensive care units, deaths of younger patients, pregnant individuals, and parents of young children are often described as particularly distressing, versus the death of older adults which is seen as natural.^{37,39,48,49,52,58,59,63,66,76,81-83} More intimate patient-care relationships foster stronger therapeutic bonds, which are beneficial for patient-centered care but can make death more emotionally challenging for HCWs.^{39,44,47-49,52,54,55,58,59,61,63-66,71,74,75,78,80-88}

Expectation and Prognosis of Death

Unexpected and sudden deaths, particularly in general wards, community settings, and cases involving COVID-19, are especially difficult for HCWs.^{14,43,46,48,49,54,56,58,59,61,63,67,69,73,76,78,80,82,83,85,86} Unlike chronic patients, such as in the ICU ⁴⁸ or pediatric oncology, ⁶¹ where there is time to process the prognosis and engage in anticipatory grieving, the sudden decline in a patient can be particularly distressing. ⁶⁷ These situations may also lead to heightened feelings of guilt and self-doubt among healthcare workers, as they question whether they did everything possible to prevent the outcome. ⁸⁶

Good Death Versus Bad Death

HCWs report that a “good death”—one in which suffering is minimized, patient wishes are fulfilled, unnecessary treatments are avoided, and occur in a home-like environment—provides emotional relief and a sense of meaning for HCWs.^{37,39,48,52,61,70,71,74,75,80,84} Conversely, “bad deaths,” characterized by prolonged suffering with no effective interventions to offer, often lead to feelings of guilt, powerlessness, and emotional burden.^{14,46,48,55,58,59,61,63,68,73,75-77,80,82,84,85,88} Managing family grief is an additional emotional burden for HCWs. Conflicts within families and difficulty accepting a prognosis are associated with a “bad death” and can complicate the professional’s experience of loss.^{37,58,59,72,75,82,83}

System Factors

Culture of Healthcare and Stigma Around Grief

The healthcare environment often discourages open expressions of grief, reinforcing a culture of emotional suppression.^{35,37,39,47,49,51,52,58,63-66,69,70,72,76,80,81,84,86,88} Grief expression, counseling, and debriefing are sometimes viewed as a weakness or lack of professionalism and inexperience,^{52,58,63,66,87} particularly in maternity settings where professionals fear blame and litigation.^43,69 Different healthcare professions believe other professions are better at processing and coping with patient death. Physicians often feel pressured to appear strong and believe it is more acceptable for nurses and midwives to express grief.^43,69,76 In contrast, nurses express a desire for a closer emotional connection with physicians, hoping for mutual support.^43,68 In palliative care, grief is more openly acknowledged and supported, but the work remains emotionally challenging.^35,63 Therapists believe their profession is more challenging because they are trained to display empathy, while physicians can focus more on the clinical aspects of care. ⁶⁰

Professionals must balance the expectation to remain composed and professional (repress grief) with the need to show compassion and build therapeutic relationships (express grief).^{37,39,49,56,57,60,61,63-65,70,72,73,81,84,87} Neonatal Intensive Care Unit (NICU) and pediatric HCWs often feel they lack the “right” to grieve since the deceased was not their child.^61,87 There is also uncertainty around funeral attendance, with concerns about colleague judgment, appropriateness, and whether the family would appreciate it.^{54,74,79,81,87} Gender norms, with male professionals more likely to compartmentalize their emotions, were only mentioned in one study. ⁵⁸

Lack of Time and Space to Grieve

HCWs often report that heavy workloads, understaffing, and the pressure to quickly transition to the next patient hinder their ability to process grief, leading to emotional strain.^{14,35,37,45,46,50,52,55,63,64,66,68,70,73,74,80,82,84-86} Additionally, a high volume of patient deaths can intensify emotional exhaustion.^{14,61,82,89,90} Participants express a desire for more time and space to engage in rituals and properly process their grief, as they feel they don’t have enough time to fully grieve or honor and respect the deceased patient.^{37,63,66,80,84}

Coping Strategies

Formal Support

Many professionals report a lack of formal institutional support for grief processing, representing a disconnect between those on the frontline and those in administrative and management roles.^{35,39,43,47,54,57,64,69,70,74-76,80,86-88,90} Desired resources include paid time off from work following difficult deaths,^39,55,74,86 designated time and space to grieve at work,^{63,64,66,80,86} structured debriefings and support groups,^{35,43,46,52,56,57,65,67,70,74,75,86} and professional grief counseling.^39,60,75,86 Unlike other professions, healthcare aides experienced additional financial stress related to patient deaths and coping. Home health aides, whose jobs are directly tied to their clients, face job insecurity when a client dies, making it difficult to take time off for their own wellbeing due to financial consequences. ³⁹ Other aides reported financial strain from attending memorial services, as this time is unpaid, ⁸⁶ and others reported not being able to take time off without it affecting their salary or vacation time. ⁷⁴ When formal support systems do exist, they are largely unsuccessful because they either occur too late, ⁸⁷ occur once (vs ongoing support),^46,70 lack structure or clear policies on when and how they should occur,^70,87 occur off-the-clock,^39,78,87 focus on clinical outcomes rather than emotional impact, ⁷⁰ or are led by an outsider. ⁸⁰ In psychiatry and community health settings, providers desire a better system for notifying staff of a patient’s death.^54,86

Informal Support

Colleagues provide the most meaningful support, particularly colleagues from the same unit where shared experiences foster understanding.^{37,39,43,46-51,53-57,61,63-68,70,73,74,76,77,80,81,83,86-89} Compared to formal support like professional counseling or support groups, some professionals reported that they prefer talking with colleagues during their shift because they do not want to bring work home and feel less inhibited when sharing with peers.^37,48 Nurse participants voiced the importance to support younger nurses.^56,65,68,70 Support from family and friends was also commonly discussed.^{35,39,46,47,50,51,53,54,65,77,80,83} However, compared to support from colleagues, family and friends are often less helpful due to a lack of understanding of the nature of professional grief and need to protect them from harsh reality of their work.^{39,46,61,65,68,87}

Personal Self-Care and Finding Meaning

Many HCWs use self-care strategies, such as spirituality, outdoor activities, spending time with pets, or relaxing through massages, baths, reading, or music, to process grief.^{37,39,44-46,49,51-53,55,60,64,67,70-73,76,78,80,83,91,92} Some also find comfort and closure in remembering deceased patients through personal rituals.^35,70,81,87 Additionally, qualities like inner strength, resilience, mindfulness, a positive attitude, and maintaining boundaries are seen as beneficial to grief management.^{39,44,63,64,68,78} HCWs often find meaning in their experiences by rationalizing the situation, using destiny-based explanations, believing they have fulfilled their caregiving responsibilities, or viewing their profession as a calling, with grief viewed as part of their professional responsiblity.^{37,39,45,47,50,54,57,61,63-65,70,73,76-78,89-91,93}

Emotional Avoidance

Some HCWs cope by suppressing or compartmentalizing their emotions.^{35,37,39,44,48-50,53,55,56,60,61,63,65,67,72-81,83,84,86-88} While this may help them fulfill their duties and maintain a task-oriented approach to patient care (versus whole person-oriented),^{37,52,53,61,63,72,79-81,83} it can have negative long-term effects due to not adequately processing grief, including loss of empathy^{37,50,77,81,84} and emotional shutdown both professionally and personally.^{50,55,60,63,74,81} Additionally, some HCWs engage in other forms of maladaptive coping, such as alcohol consumption or binge eating.^{35,37,46,52,53}

Impact of Death on Healthcare Professionals

Awareness of Mortality

Caring for dying patients often increases healthcare professionals’ awareness of their own mortality and prompts them to prepare and reflect on their personal priorities.^{37,44,48-51,55,57,61,64,65,67,68,79,91,92}

Psychological and Physical Impact

Grieving professionals often experience feelings of loneliness, stress, and burnout, along with sleep disturbances, increased blood pressure, chest pain, fatigue, anger, intrusive flashbacks, depression, and negative impacts on their personal relationships due to unprocessed grief.^{35,39,43,44,48,51-53,56,59,61,64-66,71,81,83,87,92} Some providers consider leaving or leave the profession partly due to professional grief,^60,61,64,79 while others become hypervigilant in their practice or peruse higher education to provider better quality care.^50,64,79,81 HCWs often feel responsible for a patient’s death, reflecting on what they could have done differently and reviewing whether everything was done correctly.^{39,43,49,51,52,54,58,59,61,63,66,67,69,72,76,81,83,85-87,90} For many, self-doubt and guilt become more overwhelming than the grief itself. In some cases, such as abortions ⁷² or the removal of ventilators, ⁶⁷ spiritual guilt is tied to the patient deaths.

Impact of COVID-19 on Professional Grief

The COVID-19 pandemic exacerbated professional grief in several ways. Many deaths occurred in isolation, depriving patients and families of meaningful goodbyes and leaving HCWs feeling powerless and guilty.^14,77,93 The responsibility of triaging limited resources, such as ventilators, placed immense ethical burdens on professionals, and providing substandard care.^77,89,93 A lack of preparation and constantly changing guidelines contributed to emotional fatigue.^14,53,93 Social support systems weakened as professionals worked remotely or in isolation.^89,93

Quantitative Findings

Grief Instruments

Thirteen valid and reliable instruments were used to measure grief (Table 2). However, most of these instruments have been validated for assessing grief in family caregivers or bereaved adults and have not been specifically tested or validated for use among healthcare workers. Only five of the instruments included in this review have been validated in healthcare worker populations.^36,83,94-97 Seven studies used non-validated, investigator developed surveys to measure various dimensions of grief among their participants.^68,90,98-102

Table 2.

Grief instruments used to measure grief among healthcare professionals.

Instrument (date developed)	Instrument purpose	Validated population	Used in studies reviewed
Adult Attitude in Grief Scale (2014)	To assess an individual’s vulnerability to grief by identifying the extent to which they exhibit “overwhelmed,” “controlled,” or “resilient” coping mechanisms.	Bereaved adults	Holmes et al, 2021 (US)
Bereavement Questionnaire (modified) (2017)	To assess the intensity of the impact of grief following loss.	Bereaved family caregivers	Williams et al, 2024 (US)
Death-coping Self-efficacy Scale (1992)	Measure the perceived ability to cope with death and dying, assessing confidence in managing the emotional and practical aspects of dealing with a dying patient or the death of a loved one. Developed to evaluate nurses’ confidence in providing physical and spiritual care of dying patients and their families.	Healthcare workers	Lin et al, 2022 (China)
Grief Support in Healthcare Scale (2010)	Measures grief support through three domains (recognition of the relationship, acknowledgment of the loss, and inclusion of the griever)	Healthcare workers	Jit Singh et al, 2023 (Malaysia) Vega et al, 2017 (Chile)
Hogan Grief Reaction Checklist (2001)	Multi-dimensional tool to assess the various emotional, cognitive, and behavioral aspects of grief experienced by bereaved adults after the loss of a loved one.	Bereaved family caregivers	Eagle et al, 2012 (US) Macpherson, 2008 (US)
Hospice Clinician Grief Inventory (2013)	The Hospice Clinician Grief Inventory was developed to measure grief resolution and adapted from the Marwit-Meuser Caregiver Grief Inventory that measures the grief experience of family caregivers of persons with progressive dementia.	Family caregivers	Wlodarczyk, 2013 (US)
Inventory of Complicated Grief (1995)	To measure the severity of symptoms associated with complicated grief, which is a maladaptive and persistent grief reaction following loss.	Bereaved Adults	Anderson and Gaugler, 2007 (US) Rahmani et al, 2023 (Iran)
Modified Grief Experience Inventory (2023)	Measures the emotional and behavioral experiences of grief to identify the specific areas of grief-related distress and the severity of these experiences.	Oncology nurses	Paul et al, 2023 (Mangalore)
Pandemic Grief Scale for Healthcare Workers (2023)	To identify individuals suffering from dysfunctional levels of grief due to COVID-19 deaths.	Frontline nurses	Hong et al, 2023 (South Korea)
Professional Grief Overload Scale (2011)	To assess the level of emotional distress experienced by healthcare workers who are regularly exposed to grief and loss in their work.	Healthcare workers	Robalo et al, 2018 (Portugal)
Revised Grief Experience Inventory (1993)	A multi-dimensional measure of grief which includes four subscales: existential tension, depression, guilt, and physical distress.	Family Caregivers	Adwan, 2014 (US) Esplen et al, 2022 (Canada) Rodriguez et al, 2020 (US)
Texas Revised Inventory of Grief (2010)	Measures grief intensity after the death of a loved one.	Family caregivers	Boerner et al, 2017 (US) Cardinalli et al, 2024 (US) Engler-Gross et al, 2020 (Israel) Hayuni et al, 2019 (Israel) Jit Singh et al, 2023 (Malaysia) Laor-Maayany et al, 2020 (Israel) Plante and Cyr, 2011 (Canada) Shi et al, 2022 (China) Turgut and Yildiz, 2023 (Turkey)
Traumatic Grief Inventory (2022)	A tool designed to measure the severity of symptoms related to “prolonged grief disorder” or “persistent complex bereavement disorder,” which are intense and debilitating grief reactions following loss.	Bereaved Adults	Robbins-Welty et al, 2024 (US)

Grief Intensity

Most of the studies that used validated family caregiver grief instruments, registered low to moderate levels of grief intensity upon measurement.^{9,34,41,42,94,103-109} Plant et al ¹¹⁰ found high levels of grief intensity among participants and notably highest among the respiratory therapists in their sample. Further, Rahmani et al ¹² found that nearly 60% of nurses in their study were suffering from complicated grief. The two studies^62,83 that used validated instruments for bereaved adults in general, showed a mixture of results. Paul et al ⁸³ found that 66% of nurses in their study had moderate to high levels of grief and Holmes et al ⁶² found that 16.22% of social workers in their study had severe grief symptoms. The instruments developed specifically for healthcare professionals measured a variety of grief factors, such as grief support, professional grief overload, death-coping self-efficacy, and pandemic grief intensity. Overall, these studies found that low to moderate levels of grief support,^94,95 low level of professional grief overload, ³⁶ and a medium level death-coping self-efficacy. ⁹⁶

Contextual Factors, Associations, and Predictors of Grief Intensity

Grief intensity was significantly and positive correlated with burnout,^{42,103,104,106,111,112} secondary traumatic stress or compassion fatigue,^{41,103,104,112} loneliness, ⁹⁷ insomnia, ⁹⁷ and depression.^97,111 Boerner et al ¹⁰⁶ found that grief factors accounted for unique variance in depersonalization (a component of burnout), over and above staff, patient, and institutional factors. Hong et al ⁹⁷ found that depression in nurses directly influenced pandemic grief reaction. Social support was the most consistent significant negative correlation,^12,40,41 meaning that greater social support was correlated with less grief intensity. Jit Singh et al ⁹⁴ found that grief support mediated the relationship between grief intensity and burnout through a significant indirect effect.

Other contextual factors that were associated with higher grief intensity were younger HCWs age, ¹¹⁰ gender, ¹² and working less time on a unit with high levels of patient death. ⁹ Anderson and Gaugler ⁴⁰ found that certified nursing assistants who reported higher levels of fear in their attitude toward death and who reported fewer deaths of residents in their facilities tended to experience higher levels of complicated grief. Lower levels of grief intensity were associated with having education in palliative or end-of-life care,^9,36,96 comfort caring for terminal patients and supporting the patient’s family,^9,96 and professional support from the hospital staff. ⁹ Notably, Agyei et al ⁹⁸ found that 89% of their participant did not grieve the loss of patients due to fear or as a show of professionalism. Alternatively, Plante and Cyr ¹¹⁰ found that 70% of participants spoke with colleagues, 48% with friends and families, and that 37% believed this was what helped them most. Similarly, Strote et al ¹⁰² found that talking with colleagues (78%) or friends and family (69%) and simply continuing to work (61%) were the most common coping strategies and that post-death debriefing rarely or never occurred for 64% of their participants.

Intervention Studies

There were six quasi-experimental (non-randomized) studies examining the effect of an intervention on grief (Table 3).^{34,68,99,100,107,108} Five of the six studies were conducted in the United States. The interventions consisted of educational modules, debriefing, and storytelling. Most of the interventions involved a component of peer-support and were implemented with pediatric healthcare professionals. There was a large range of intervention lengths ranging from 2 sessions to a 3-day retreat. Four of the six interventions were categorized as system-level interventions since they were implemented with teams within one institution. Only two studies^107,108 showed measured grief as a quantitative outcome of their study and neither study showed significant changes in grief intensity post-intervention.

Table 3.

Intervention characteristics.

First author, date (country)	Intervention description	Intervention level	Delivery location	Facilitator	Intervention length
Eagle et al, 2012 (US)	Two modules and peer support sessions. Module 1: coping and grief in relation to peer support; and Module 2: expressions of grief among health care providers and provision of palliative care to pediatric patients.	System	In-person, Health care system	Unclear	2 sessions
Esplen et al, 2022 (Canada)	An online educational series designed to enhance understanding and confidence in addressing the effects of exposure to suffering and loss, while also supporting the recognition of symptoms and various grief experiences.	Individual	Online	PhD-level practitioner/ educator with experience in grief/loss and psychotherapy	6 weekly group sessions (1.5 hours each)
Fallek et al, 2019 (US)	This workshop provides a structured space for participants to explore grief through teachings, personal sharing, and guided emotional work. It incorporates mindfulness, movement, and arts-based practices to support healing, with a focus on self-care, connection, and integrating the experience into daily life.	System	In-person, offsite	Palliative care physician (lead facilitator), trained physician, nurses, social workers, family therapists	3-day residential workshop
Hawes et al, 2022 (US)	Bereavement debriefing intervention within 72 hours after a death.	System	In-person, Health care system	Chaplain and psychiatric clinical nurse specialist	Not provided
Macpherson, 2008 (US)	Peer-supported storytelling with participant dyads. Each member takes a turn telling a story (about an experience of caring for a pediatric oncology patient, who died at any point in their career and whose death they grieve) and a turn listening at each session.	System	Not provided	None	Biweekly for 2 months
Rice et al, 2014 (US)	Peer-supported storytelling in a private 3-D outdoor virtual meeting space using avatars.	Individual	Online	Grief management expert	Biweekly for 5 sessions (1 hour each)

Discussion

This scoping review extensively explores professional grief experienced by HCWs across various disciplines and specialties. Professional grief, distinct from personal grief due to its recurring and occupational nature, is deeply influenced by individual, interpersonal, and systemic factors, emphasizing the complexity of grief experiences in healthcare settings. Our findings suggest multiple levels where professional grief is impacted and could be addressed with a systems-level approach. This contribution is unique because grief is often viewed as a personal experience. Therefore, it should be dealt with at a personal level. HCWs encounter death and dying, sometimes in traumatic ways, as part of their occupation. Therefore, professional grief should be situated as a potential outcome of occupational exposure, death, and dying, which may have differential effects based on individual, interpersonal, and systems-level factors.

At an individual level, certain personal characteristics and experiences can shape how HCWs experience and cope with professional grief. Early-career vulnerability is well documented, with novice HCWs often feeling unprepared for patient deaths and reporting more intense emotional impact.^113,114 Gender norms, personal loss history, and identification with patients or their families further influence the intensity of grief, highlighting the necessity of personalized support and educational interventions tailored to address these emotional complexities. Studies note that most HCWs enter the field without formal preparation for dealing with death, leading them to “learn by experience” and potentially struggle for years to find healthy coping methods^115,116 and with greater risk for burnout, secondary traumatic stress, and depression if healthy coping methods are not achieved.^97,106

Interpersonal factors also significantly shape healthcare professionals’ grief experiences. Patient-related factors such as age and circumstances of death can intensify grief. For instance, unexpected deaths or the death of a young patient often provoke stronger feelings of sorrow, guilt, or shattered expectations for HCWs. ¹⁵ Further, HCWs who develop a close therapeutic bond or care for a patient over a long period may experience the patient’s death as a significant personal loss.^106,112,116 Our findings reveal that younger patient deaths, unexpected deaths, and prolonged suffering contribute to heightened grief responses. The notion of a “good death” versus a “bad death” emerged qualitatively, with HCWs finding solace in fulfilling patient wishes and minimizing suffering. Quantitatively, social support correlated with lower grief intensity, suggesting that professional grief is mitigated when HCWs feel they have provided appropriate end-of-life care. ⁹⁴

Institutional culture can either mitigate or exacerbate professional grief. In some settings, there exists an unspoken expectation that “death is part of the job,” leading to a culture of silence where staff feel they must quickly “move on” without openly grieving. This lack of acknowledgment can make grief feelings more isolating. High workload and time pressures are other systemic factors—busy acute-care environments often allow little time for reflection or mourning, compelling clinicians to suppress grief and continue working. ¹⁵ Conversely, organizational support (or lack thereof) plays a critical role. Clinicians report better coping and less emotional exhaustion when healthcare institutions provide structured support—such as team debriefings, counseling services, or peer support. ⁸⁰ Unfortunately, most studies found that HCWs do not feel adequately supported by their organizations in managing grief.

Different professions and specialties exhibit variations in grief experiences, shaped by specific clinical cultures and professional expectations. For instance, nurses may form closer bedside connections with patients, witness death more directly, and experience grief more emotionally. ⁵⁹ Conversely, physicians tend to adopt a more transactional approach toward grief, focusing primarily on clinical outcomes. They may also be more prone to view patient death as a personal or professional failure, which can lead to feelings of guilt or suppressed grief.^15,114 Uniquely, home care aides show greater interest in formal grief support, highlighting possible disparities in how various medical cultures acknowledge and manage emotional distress.^39,74

The concept of a “good death” varies distinctly by specialty. For example, critical care providers prioritize control and predictability during end-of-life care, valuing structured clinical conditions. ⁴⁸ In contrast, oncology and palliative care professionals emphasize comfort, peace, and symptom management as core elements defining quality death. ¹¹⁷ Expressions of grief and coping mechanisms in settings where HCW-patient relationships are longer and foster deeper emotional connections potentially intensify the grieving process. Nurses in long-term care, palliative care, oncology, and community settings face heightened emotional demands, frequently tasked with balancing emotions within the HCW-patient dynamic, often experiencing significant emotional labor, underscoring the necessity for supportive organizational structures and interventions. ¹¹⁸

Changing Healthcare Culture: Educational, Clinical, and Policy Recommendations

Based on the findings from this review, there is an urgent need for cultural change within healthcare environments, explicitly addressing the pervasive issue of emotional suppression and stigma associated with professional grief. Healthcare professionals often feel pressured to repress emotional responses to maintain a professional image. This professional culture limits genuine emotional processing, intensifies isolation among HCWs, and contributes to emotional exhaustion.

Comprehensive educational, clinical, and policy-level interventions are necessary to transform healthcare culture effectively. Pre-licensure education is a critical starting point, yet current curricula significantly lack approaches to teach emotional resilience, grief management, and skills to cope with complex work-related emotions.^119-123 To address these gaps, educational institutions should incorporate structured grief education including personal coping assessment, emotional awareness, and boundary management strategies through simulation-based training.^{64,118,122,123}

Healthcare institutions must prioritize ongoing, structured grief interventions such as peer support groups, professional counseling services, and formalized grief-processing programs embedded within workplace culture.^11,17 But as this review shows, these programs are often underutilized by HCWs, likely because of cultural norms and systemic barriers. In embracing the framework of Total Worker Health, as proposed by the National Institute for Occupational Safety and Health (NIOSH), policy changes are necessary to create a work environment that addresses the safety, health, and well-being of health care professionals by acknowledging the workplace exposures of grief and loss.^124,125 While grief as a workplace exposure has not been fully recognized, it falls under the umbrella of psychosocial stressors. ¹²⁶ We propose that grief-related stress be formally recognized as a work-induced condition, thereby allowing affected workers to access mental health support, bereavement leave, and structured debriefing sessions. Additionally, updating workers’ compensation frameworks to cover the emotional toll of chronic exposure to loss could mitigate long-term mental health consequences and improve retention rates in the healthcare workforce. These changes validate healthcare professionals’ lived experiences and pave the way for a more supportive and sustainable work environment.

Research Implications

Future research should concentrate on developing and evaluating evidence-based interventions designed for the unique experiences of healthcare disciplines and specialties, recognizing distinct patterns in how grief manifests and is processed among individuals and professional roles. Additionally, research must systematically address institutional barriers—such as time constraints, stigma, and inadequate access to formal support—that currently limit healthcare professionals’ ability to cope with professional grief effectively. There is also a critical need for more precise measurement frameworks, as existing instruments primarily assess familial or informal grief, not capturing the unique nuances of professional contexts. Opportunities for future studies include refining professional grief measures to capture professional grief experiences better and to conceptually distinguish professional grief from other constructs such as burnout, compassion fatigue, moral distress, and moral injury.

Limitations

This review isn’t without limitations. First, we only included studies written in English, which may have resulted in the absence of literature published in other languages. Second, we acknowledge that limiting our search to three databases and excluding grey literature might have resulted in missing some relevant studies or emerging data. Future research could expand the scope by incorporating additional databases or including grey literature to further enhance comprehensiveness. Third, many studies had small sample sizes, potentially limiting generalizability. Additionally, most of the studies included utilized qualitative methodologies, though rich in depth, which may reflect subjective interpretations and limit broader application. The absence of longitudinal studies further restricts understanding of how professional grief evolves over time and in response to prolonged exposure.

Conclusion

This review highlights the significant and multifaceted nature of professional grief among healthcare professionals, underscoring the urgent need for systemic changes to better address emotional well-being. Integrating qualitative and quantitative research findings across professions and specialties reveals substantial gaps in education, institutional support, and effective grief interventions, emphasizing the complexity of professional grief within healthcare contexts. A shift in the healthcare culture from one that values stoicism and emotional suppression to one that normalizes emotional expression is imperative for any future strategies to be successful. By actively acknowledging grief as an inherent aspect of healthcare work and embedding supportive practices into the healthcare culture, institutions can significantly mitigate psychological distress among healthcare professionals, enhance their resilience, and ultimately elevate patient care outcomes and professional sustainability.