1. When Grief Interferes with Academics: Advising Online Adult Learners
I have worked in higher education for a long time. I’ve been a recruiter, an admissions counselor, a registrar, an associate director of a degree completion program, an associate director of an MBA program, a director of student success, and so on. For the past seven years I have been the RN to BSN academic advisor at Linfield College, specifically with the School of Nursing. Linfield is a small, private liberal arts college, nestled in wine country. The School of Nursing is in Portland’s downtown Nob Hill district.
Linfield’s RN to BSN major is entirely online. My advisees are all Registered Nurses, seeking their bachelor’s degree in nursing. Nurses are a special population and I love working with them. They want answers now, not tomorrow. I meet some students in person when they are first getting started with us and if they live in the Portland metro area. I also have students who live in other states: New Jersey, Maryland, Alaska, Tennessee I rarely see those students in person. We connect via and phone. Even though I don’t know them in-person, I do get to know them personally. I’m sure many of you can identify with that!
I’m guessing that many of you are from larger institutions than Linfield and have counselors, both grief and academic, readily available to meet your student’s needs. Unfortunately, that isn’t the case for my online adult learners.
Where are you all from?
Presented by Joanne Swenson, MS Ed.
RN to BSN Academic Advisor
Linfield College, School of Nursing

2. Definition of Grief
Grief is a multifaceted response to loss, particularly to the loss of someone or something that has died, to which a bond or affection was formed. Although conventionally focused on the emotional response to loss, it also has physical, cognitive, behavioral, social, cultural, spiritual and philosophical dimensions. While the terms are often used interchangeably, bereavement refers to the state of loss, and grief is the reaction to that loss.
Grief is a natural response to loss. It is the emotional suffering one feels when something or someone the individual loves is taken away. The grief associated with death is familiar to most people, but individuals grieve in connection with a variety of losses throughout their lives, such as unemployment, ill health or the end of a relationship.
In thinking about grief and what it meant, I looked for a definition of grief and found this one in Wikipedia.
We know the impact that loss can have on a student, both physically and emotionally. We also know that a major part of an academic advisor’s role is to retain her students. The balancing act becomes whether to encourage the student to continue on with the semester’s classes or to take a term or two off. And, if they take an extended leave of absence, will they return?
When an on-campus student presents with grief, the advisor can comfort the student as appropriate and then walk the student to the campus counseling services.
When an online student calls or s with a crisis situation, academic advisors must be prepared to listen, to extend sympathy/empathy, and be ready with almost immediate advice on the student’s need to care for themselves and to offer suggestions to support the student academically.

3. Identifying and Addressing the Mental Health Needs of Online Students in Higher Education
“In a traditional classroom setting faculty have the ability to visually observe students, and interact face to face. This direct, experiential contact with students enables faculty to perceive mental health warning signs such as deterioration in hygiene, tardiness and absences, mood changes, bizarre behaviors, and altered levels of attention.
In online educational settings the direct sensory contact with students is missing and the student is often at a distant geographic location. Thus, online educators need strategies for identifying mental health problems in their students, resources available to offer the distance student, and institutional policies addressing mental health and student performance.”
In her article, Identifying and Addressing the Mental Health Needs of Online Students in Higher Education, Bonny Barr states:
In a traditional classroom setting faculty have the ability to visually observe students, and interact face to face. This direct, experiential contact with students enables faculty to perceive mental health warning signs such as deterioration in hygiene, tardiness and absences, mood changes, bizarre behaviors, and altered levels of attention.
In online educational settings the direct sensory contact with students is missing and the student is often at a distant geographic location. Thus, online educators need strategies for identifying mental health problems in their students, resources available to offer the distance student, and institutional policies addressing mental health and student performance. (Barr, 2014).
I’m sure we all get s from students saying that they just can’t do this anymore and we ask why and we get replies that say something like:
Well there's not one specific reason, just life in general. Working full time, working lots of overtime, chasing a toddler, being pregnant, and trying to keep the house afloat ... not really one good reason just a lot of things that come up.
Do you hear those same types of reasons why they just can’t go on?

4. Why me? Some of the events that led to this presentation.
A man with testicular cancer who went into great detail about it until I stopped him and reminded him that I am not a nurse and I was turning a bit green listening to the gory details. (He is now cancer free.)
A nurse who was a whistleblower at her place of work, was fired, and is still in litigation more than a year later.
A nurse who was severely accosted but survived and did complete her BSN.
A nurse who discovered her husband was a drug addict. (He is in rehab now.)
A nurse who has to move across the country to help his mother care for his ailing father.
The impetus for this presentation came about from several distressing situations I have encountered within the last few years – with online only adult learners. I am not including school shootings or other national traumatic events.
Some of the events that impacted me include:
A man with testicular cancer who went into great detail about it (awkward!) until I stopped him and reminded him that I am not a nurse and I was turning a bit green listening to the gory details. (He is now cancer free.)
A nurse who was a whistleblower at her place of work, was fired, and is still in litigation more than a year later.
A nurse who was severely accosted but survived and did complete her BSN.
A nurse who discovered her husband was a drug addict. (He is in rehab now.)
A nurse who has to move across the country to help his mother care for his ailing father.
But wait – there’s more . . .

5. But wait there’s more . . .
A young woman who is a dreamer (DACA) and terrified of what will happen next to her and her family.
The nurse who has a son in kindergarten. She got a call from a friend who had seen her son standing on a sidewalk looking lost. He was -- the school bus dropped him off on the wrong street.
A nurse whose husband was a crew leader for Portland’s Department of Public Works and fell from the top of a department truck into a 12-foot hole that had had been dug for sewer work. They had to reinforce the walls of the hole and then use a rope-and-pully system to rescue him. I recently received an update from her.
“He is still at home but doing as well as expected. Unfortunately, he is permanently disabled and will not be able to return to the job.”
This student did complete her BSN and is now in the last term of a
Nurse Practioner degree.
A young woman who is a dreamer (DACA) and terrified of what will happen next to her and her family.
The nurse who has a son in kindergarten. She got a call from a friend who had seen her 5-year-old son standing on a sidewalk looking lost. He was lost -- the school bus dropped him off on the wrong street.
A nurse whose husband was a crew leader for Portland’s Department of Public Works and fell from the top of a department truck into a 12-foot hole that had had been dug for sewer work. They had to reinforce the walls of the hole and then use a rope-and-pully system to rescue him. I recently received an update from her.
“He is still at home but doing as well as expected. Unfortunately, he is permanently disabled and will not be able to return to the job.”
She did complete her BSN and is now in the last term of a Nurse Practioner degree.

6. When you get that phone call or an email, where do you start?
Ask a few clarifying questions . . .
How are you doing right now?
Does the student have family support?
Does it feel like the student can confide in you? Do they trust you?
Do you think the student is disclosing the entire situation? Do you need to probe a bit further for details?
Does the student need to continue with classes and complete this term or take a leave of absence?
Does the student need to be referred to a professional counselor/therapist? How do you know when to make that referral?
When you do get that phone call or , where do you start? This is when your active listening skills are most relevant. It is essential to ask clarifying questions.
How are you doing right now?
Does the student have family support?
Does it feel like the student can confide in you? Do they trust you?
Do you think the student is disclosing the entire situation? Do you need to probe a bit further for details?
Does the student need to continue with classes and complete this term or take a leave of absence?
Does the student need to be referred to a professional counselor/therapist? How do you know when to make that referral?

7. How do you know when it is time to refer the student?
When to refer a student
When a student presents a problem or a request for information which is beyond your level of competency - refer the student.
When you feel that personality differences (which cannot be resolved) between you and the student will interfere with his or her effective progress - refer the student.
If the problem is personal and you are uncomfortable discussing it because you know the student too well on another basis (friend, neighbor, grad assistant, etc.) - refer the student.
If the student is reluctant to discuss his or her problem with you for some reason - refer the student.
If, after a period of time, you do not believe your work and communication with a student has been effective - refer the student.
Texas A&M Student Counseling Services handbook
In the Texas A&M student counseling services handbook I found these suggestions on when to refer a student to outside help.
WHEN to Refer
When a student presents a problem or a request for information which is beyond your level of competency - refer the student.
When you feel that personality differences (which cannot be resolved) between you and the student will interfere with his or her effective progress - refer the student.
If the problem is personal and you are uncomfortable discussing it because you know the student too well on another basis (friend, neighbor, grad assistant, etc.) - refer the student.
If the student is reluctant to discuss his or her problem with you for some reason - refer the student.
If, after a period of time, you do not believe your work and communication with a student has been effective - refer the student.
Does this make sense to you? Have you found yourself in these kinds of situations? How has the referral gone? Was the student OK with being referred?

8. Alice
Joanne, 
I just wanted to update you on the issues I have been having with my health.   Unfortunately I found out Monday that I have progressed to metastatic breast cancer with metastases to my lung.  As you can imagine, this has been a difficult few days.  I hope to continue working toward my goal of obtaining my BSN while I fight this battle...again.  Should I need to miss a term for treatment is this a possibility?  What options do I have?  My hope is to continue on with the program, but I need to know my options should that not be possible.
Thanks for your support during all of this, it is greatly appreciated. I will continue to keep you updated so that we can work together to get me through to the end of the program.
I named several situations earlier but those are not the ones I want to focus on today. I want to tell you about three students who will forever remain in my heart. Alice was a 40-year-old nurse and mother of 3. While she was in RN to BSN classes her breast cancer returned. I received this from her. 
Joanne, 
I just wanted to update you on the issues I have been having with my health. Unfortunately I found out Monday that I have progressed to metastatic breast cancer with metastases to my lung.  As you can imagine, this has been a difficult few days.  I hope to continue working toward my goal of obtaining my BSN while I fight this battle...again.  Should I need to miss a term for treatment is this a possibility?  What options do I have?  My hope is to continue on with the program, but I need to know my options should that not be possible.
Thanks for your support during all of this, it is greatly appreciated. I will continue to keep you updated so that we can work together to get me through to the end of the program.
Alice was determined to complete her BSN, to be a role model for her three sons. She kept in touch with me and with her instructors throughout chemo and all of her ups and downs. Alice did complete her degree and passed away four months later.

9. Amanda’s
On our vacation my 15 year old daughter had an accidental drowning. She is at OHSU and not expected to make it. I am devastated, sad, and can't imagine how life will be without her. I do want to finish this term and am asking to possibly have extra time for this week’s assignments. I am partly done with my paper and have looked at the information for this week’s post prior to leaving on my trip. This is a lot of information. In the next 48 hours we will be leaving after her organs have been donated. I feel like being able to finish these classes will help me so that I have something to focus on and to give my mind a break. I will be off work for a month so I should be able to stay up with the classes once I get home. Thank you and I will stay in touch if something changes.
Another nursing student in the program ed me.
On our vacation my 15 year old daughter had an accidental drowning. She is at OHSU and not expected to make it. I am devastated, sad, and can't imagine how life will be without her. I do want to finish this term and am asking to possibly have extra time for this week’s assignments. I am partly done with my paper and have looked at the information for this week’s post prior to leaving on my trip. This is a lot of information. In the next 48 hours we will be leaving after her organs have been donated. I feel like being able to finish these classes will help me so that I have something to focus on and to give my mind a break. I will be off work for a month so I should be able to stay up with the classes once I get home. Thank you and I will stay in touch if something changes.
Amanda and I talked a lot during this time. I still do not know how she was able to go on and complete her degree, but she did.
One of the things that I learned during both of these women’s situations was how resilient people can be

10. Brenda This one has a happy ending!
Brenda went into labor 12+ weeks early. She literally called me from her hospital bed where they were working to deter the baby from entering the world so early. They were unsuccessful and suddenly this recently divorced, single mother had a son. She called me often to keep me updated on his progress. Naturally, she had trouble keeping up with her assignments as she focused all of her energy on keeping this little guy alive. He endured several surgeries in his first three months.
My last one has a happy ending!
Brenda went into labor 12+ weeks early. She literally called me from her hospital bed where they were working to deter the baby from entering the world so early. They were unsuccessful and suddenly this recently divorced, single mother had a son. She called me often to keep me updated on his progress.
Naturally, she had trouble keeping up with her assignments as she focused all of her energy on keeping this little guy alive. He endured several surgeries in his first three months.
Our RN to BSN nursing instructors rarely give Incompletes. But when Brenda sent me this photo of her baby with tubes every where and I ed it to her two instructors with details of what was happening, they each consented to grant her an Incomplete.

11. Brenda completed both classes the following term and earned her BSN
Brenda completed both classes the following term and earned her BSN. Today this adorable child is 19 months old and thriving, but still has several therapist and specialist appointments each week.
Brenda completed both classes the following term and earned her BSN. Today this adorable child is 19 months old and thriving, but still has several therapist and specialist appointments each week.
Was it my job to continue to be a support person for Brenda?
Our conversations went way beyond academic advising and became almost like a mother/daughter relationship.
Did I cross the line by going to the instructors for her? What would you have done?
Was I equipped to cope with the emotional toll these situations took on me? Not so much. Were there things that I could have done, other than listen and intervene with instructors if needed?  

12. As I was preparing for this presentation and reliving the distress I went through during these pivotal times, I realized what a toll this type of advising/grief counseling, can take on someone who has not been trained to deal with it. I mean – I’m old!
I’ve been through a lot of my own grief/bereavement situations. I raised teenagers and lived to tell about it! I went back to school as an adult, first in the classroom and later earned my master’s degree online. But I have never had specific grief counseling training.
When I look back on those times, I remember months on end when I went home from work, curled up on the couch in the fetal position with my colored pencils and coloring books, and a glass of wine, followed up by a carton of ice cream. Not great self-care!
One of my recently hired young colleagues asked me about my presentation and when I told her those three stories, she asked me how I knew what to say? How did I learn to say the right things, how to react?

13. Crisis Intervention & Training
Guidelines for Creating Student Services Online: Lessons Learned
The same array of services that exist for on-campus students should also be available to distance students. Comprehensive student services for online students need to be accessible via the internet from any geographic location, and include self-service capabilities, as well as assistance and/or information abilities.
Guidelines for creating student services online: Lessons learned.
Shea, P. and Armitage, S. (2000b).
That realization made me eager to explore the need for crisis intervention for online students and also, the need for training for online academic advisors.
Have you been trained to deal with student crises? Do you know what to say?
I found this statement in the article, Guidelines for Creating Student Services Online: Lessons Learned applicable.
The same array of services that exist for on-campus students should also be available to distance students. Comprehensive student services for online students need to be accessible via the internet from any geographic location, and include self-service capabilities, as well as assistance and/or information abilities.

14. Discussion questions
Does your campus have a procedure in place for dealing with online student crises?
Have you have grief counseling as part of your advisor training?
Do you feel comfortable talking with students about grief and loss?
Do you feel confident that you are aware of cultural differences when it comes to loss and mourning practices?
Do you have a student/faculty/staff handbook online detailing the institution’s policies and procedures?
Are the same approaches available to both campus and online students?
Are there resources for you through your Employee Assistance Plan?
If you found yourself needing help with a crisis situation, do you know who you should turn to?
I’m guessing that many of you have more than one academic advisor, right? Do your advisors debrief situations like my examples? I am the only online RN to BSN advisor for about 250 students. I work with a fabulous team, they just aren’t next door to go talk to during a stressful day. Of course my supervisor and colleagues in McMinnville are always there for me but they are an hour away and sometimes a phone call just isn’t enough.
I would like us to discuss the following questions and see if we can come up with some solutions for creating a more effective way of dealing with online student crises. I’m hoping that those of you who already have plans in place will share your knowledge with us.
Does your campus have a procedure in place for dealing with online student crises?
Have you have grief counseling as part of your advisor training?
Do you feel comfortable talking with students about grief and loss?
Do you feel confident that you are aware of cultural differences when it comes to loss and mourning practices?
Do you have a student/faculty/staff handbook online detailing the institution’s policies and procedures?
Are the same approaches available to both campus and online students?
Are there resources for you through your Employee Assistance Plan?
If you found yourself needing help with a crisis situation, do you know who you should turn to?

15. References An Overview of Online Counseling
Advising Online Students: Replicating Best Practices of Face-to-Face Advising
Coping with Loss: Bereavement and Grief, Mental Health America
Experiencing Grief in College & Meeting Your Immediate Needs
How to help
Identifying and Addressing the Mental Health Needs of Online Students in Higher Education.
Barr, B.(2014). Online Journal of Distance Learning Administration, Volume XVII, Number II, Summer 2014 University of West Georgia, Distance Education Center
Guidelines for creating student services online: Lessons learned. Shea, P. and Armitage, S. (2000b).
Telephone Hotlines & Helplines
Thank you all so much for being here today and sharing your thoughts.
I noticed that one of the presentations following this one is on self-care for advisors so I am heading that way!