By Tami Wantola, BSN, RN and Sandra Zawalski, MSN, RN, CRRN, CCM, MSCC
Case managers meet people at the intersection of loss, change, uncertainty, and recovery. In hospital case management, we may support families after a new diagnosis, trauma, death, or difficult discharge plan. In workers’ compensation, we may work with injured employees grieving the loss of function, identity, income, or career direction. In managed care, we may speak with members navigating chronic illness, caregiving strain, or major life transitions. In community-based practice, we may see the long-term impact of bereavement, isolation, housing instability, or family disruption. In hospice, grief is often present before, during, and after death.
Across all these settings, one skill strengthens our work: grief literacy.
Grief literacy is the ability to recognize grief, understand how it may show up, and respond in ways that are compassionate, practical, and supportive. It includes knowing that grief is not only emotional. Grief is physical. It can affect the brain, nervous system, heart, immune system, digestion, sleep, energy, concentration, and daily functioning.
This matters in case management because many people do not identify themselves as grieving. They may not say, “I am grieving.” Instead, they may say:
“I can’t sleep.”
“I feel exhausted all the time.”
“My chest feels tight.”
“I keep forgetting things.”
“I can’t make decisions.”
“My stomach is a mess.”
“I know what I need to do, but I just can’t do it.”
Without grief literacy, these concerns may be misunderstood as noncompliance, lack of motivation, poor coping, or resistance. With grief literacy, we can recognize that the person’s body and nervous system may be responding to loss.
When someone experiences a significant loss, the brain may interpret that loss as a threat to safety. Stress hormones can rise, and the nervous system may move into survival mode. This can lead to anxiety, irritability, numbness, brain fog, difficulty concentrating, and trouble completing tasks that once felt routine. For a grieving person, scheduling an appointment, filling out forms, returning a call, arranging transportation, or remembering medications may feel overwhelming.
Grief may also affect the cardiovascular system. Some people experience increased heart rate, elevated blood pressure, palpitations, or chest tightness. A grief-informed approach does not dismiss these symptoms as “just grief.” Instead, it holds two truths at once: grief can create real physical symptoms, and new or concerning symptoms still deserve medical attention.
The immune and digestive systems may also be affected. People who are grieving may report frequent illness, inflammation, appetite changes, nausea, stomach pain, or bowel changes. Sleep is often disrupted. Some people cannot sleep; others sleep for long periods and still feel exhausted. These changes can affect participation in care plans, rehabilitation, work recovery, medical follow-up, and family responsibilities.
For case managers, grief literacy changes how we talk.
Instead of saying, “You need to follow the plan,” we might say, “This is a lot to manage while your body and mind are under stress. Let’s identify the next one or two steps that feel possible today.”
Instead of saying, “That is normal,” which can unintentionally minimize the person’s distress, we might say, “Many people are surprised by how physical grief can feel. What you are describing can happen during grief, and it is still important that we pay attention to it.”
Instead of asking only, “Do you have support?” we might ask, “Who feels safe to talk to right now?” or “Is there one person who can sit with you, help with a task, or check in this week?”
Helpful grief-informed communication is simple, direct, and validating. Case managers can use phrases such as:
“What has this loss changed for you day to day?”
“How is your body carrying this right now?”
“What feels hardest to manage this week?”
“Would it help if we broke this into smaller steps?”
“You do not have to do everything today. Let’s focus on what is most urgent.”
Grief-informed case management also includes practical support. Encourage the basics: hydration, nutrition, rest, medication adherence, movement as tolerated, and medical follow-up when symptoms are concerning. These are not quick fixes for grief. They are ways to help the body withstand the stress of grief.
Connection is also part of care. Safe connection can help calm the nervous system. Depending on the person, this may include family, friends, faith communities, peer support, grief groups, employee assistance programs, counseling, hospice bereavement services, community programs, or simply one trusted person who can be present without trying to fix the pain.
This work applies to us as professionals, too. Case managers repeatedly witness grief, trauma, decline, conflict, and loss. Over time, our own bodies may respond. Fatigue, headaches, irritability, poor sleep, emotional numbness, and difficulty concentrating may be signals that we also need support, rest, boundaries, and connection.
Grief literacy does not require case managers to become grief therapists. It asks us to become more skilled at recognizing grief, naming it gently, and responding with humanity. When we understand the physicality of grief, we are less likely to label people as difficult or disengaged. We are more likely to see them as human beings whose bodies are trying to adapt to loss.
That recognition can change the conversation. And sometimes, the conversation is where healing begins.
The flexibility to learn on your own schedule—and the variety of topics available—make this a valuable professional development opportunity for case managers at every career stage. Learn more: https://cmsa.societyconference.com/
Bios: Tami Wantola, BSN, RN is a nurse leader with more than three decades of experience across intensive care, cardiac catheterization, emergency medicine, utilization management, and case management. She is also an ATD Master Trainer and Master Instructional Designer with extensive experience developing practical, learner-centered education for healthcare professionals and adult learners.
Tami is known for creating clear, compassionate learning programs that help people apply complex information in real-world settings. Her work blends clinical expertise, instructional design, evidence-based practice, and collaboration to support stronger learning outcomes and better healthcare experiences.
Tami has presented on this topic at Camp Widow and the Newly Widowed Program for Soaring Spirits International.
Sandra Zawalski is an accomplished registered nurse with more than four decades of experience across a broad range of clinical specialties, including orthopedics, brain injury rehabilitation, and neonatal intensive care. She brings extensive expertise in both payer and provider case management, as well as in the design, development, and implementation of comprehensive case management programs across diverse healthcare settings.
Sandra holds a Master of Science in Nursing with a concentration in education and maintains multiple professional certifications, including Board-Certified Case Manager (CCMC), Certified Rehabilitation Registered Nurse, Medicare Set-Aside Certified Consultant, and ATD Master Trainer.
A recognized leader in the field, Sandra has authored numerous peer-reviewed articles and has presented at major national conferences, including the Case Management Society of America (CMSA) National Conference and the Commission’s New World Symposium. Her professional service includes roles as a former Chair and Commissioner for The Commission, former Vice President of the Cleveland CMSA Chapter, and current volunteer with the Commission and member of the CMSA editorial board.