When nurses witness the suffering patient's experience, it can provoke tears. Yet some nurses will declare: "Don't cry! If you can't handle it, get out of nursing." Indeed, for some, crying is taboo. It is as though crying brings to the surface distress that people would rather keep suppressed. Perhaps there is worry that if one cries, the distress will become incapacitating. Or tears may be thought to indicate weakness. Hence, when we cry, we may feel embarrassed and apologize for our tears.
Crying involves the sympathetic and parasympathetic nervous systems, allowing the body to be both aroused and soothed in response to distress. Crying involves facial muscles, engages a psychological state, and produces tears and vocalizations (Bylsma, Gracanin, & Vingerhoets, 2019). Although much is unknown about the neurobiology of crying, it is clear that crying communicates distress and functions to stimulate connection, support from others, and spiritual healing.
Although crying functions to establish human connection, criers and witnesses to crying will generally respond in at least one of these ways: a) offer socio-affective support that seeks to comfort and provide validation; b) share cognitive support that helps the distressed to create meaning; or c) act with disengagement that allows distraction from, or suppression of, the distress (Pauw, Sauter, van Kleef, & Fischer, 2019). The context of the distress and goals is associated with which response is used. For example, if crying interfered with a medical procedure, and the shared goal was to keep still, a nurse and patient would likely intuit that a form of disengagement was needed. Cognitive support, although infrequently used, is considered helpful for the long term.
Given that crying elicits social connections and may provide spiritual healing, and given that crying can be socially taboo and create discomfort for those around the crier, what principles can guide nursing care for those who cry? And what might guide the nurse who is crying? Here are some suggestions:
* When a patient cries, and circumstances do not necessitate disengagement, create space for crying to occur comfortably. Use nonverbal language to communicate that you will not emotionally or physically run away in response to seeing the tears. Pull up a chair, lean in, grab a box of tissues, avoid talk that tries to fix it, Don't be afraid to tear up, if that is your natural response. Loud nonverbal expression will likely erase any need to say, "It's okay to cry."
* Offer a reframing that affirms the value of tears. For example, briefly explain that scientists suggest tears play a healing function. Or for the theistic patient, observe that the tears might be "God's gentle kiss."
* If you as a nurse are prompted to cry, and the patient is not crying, or the context of caring dictates it may be inappropriate, ask yourself: What is prompting my tears? Is it a similar story I have, or my own need? Are my tears inappropriate self-disclosure? If that is likely, refrain from crying or take your leave. Take time to care for yourself. Determine a time and place where you can address the need after work and have a good cry.
* If, however, you honestly believe shedding some tears would be therapeutic for a patient (e.g., would show caring or model crying as acceptable), then respect and experience the grace of tears. If the nurse is providing emotional mirroring for the crying patient, then the nurse's tears will not be more intense than the patient's.
Psalm 31:9 poetically expresses the experience of many a patient-and nurse-who cries: "Be merciful to me, LORD, for I am in trouble; my eyes are tired from so much crying; I am completely worn out" (Good News Translation). Although crying typically gets a bad rap, respect crying for its function of provoking empathy and human connection. Indeed, seen in this way, we realize tears are a call to communion with another.