Institutional loss: an examination of a bereavement reaction in 22 mental nurses losing their institution and moving into the community

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Abstract
Grief has distinctive characteristics. Mental nurses working in a hospital due for closure in 15 months were assessed, and it was found that nurses with long service experienced an anticipatory bereavement in response to the expected loss of their hospital. This reaction is different from the uncomplicated grief which follows the death of a loved person, and is therefore called institutional loss. Twenty-two nurses were assessed, including 13 nurses who were still working in the hospital and nine ex-hospital nurses now working in the community. A sentence completion form was used, together with a measurement of feeling and observed emotion for each sentence. Participants had no prior knowledge about the study. Feelings identified included: initial disbelief; personal anxiety and anxiety about community care; physiological symptoms of anxiety; guilt; anger; feelings of internal loss; avoidance and searching behaviours; acknowledgement of grief; idealization; and identification phenomena. Institutional loss is characterized by: anticipatory grief; an acute stage of mourning in nurses who are physically distanced from the hospital; a refusal to accept closure as 'right'; and a strong identification with the old hospital. Institutional loss in nurses has important implications for the successful rehabilitation of large numbers of patients, and this research suggests that additional support and counselling should be offered.

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