A pioneer in bereavement care

Rana Limbo, PhD, RN, CPLC, FAAN, began her career at Gundersen in 1979 as a postpartum and labor and delivery nurse. Through that work, she developed a passion for perinatal bereavement care, a passion that became the focal point of her highly successful career. Her work at Gundersen followed her early work as a nurse caring for new mothers and babies and, subsequently, teaching maternal/child nursing at a major university.

Not only was Dr. Limbo involved in the early design and implementation of Resolve Through Sharing® (RTS), Gundersen Medical Foundation’s innovative bereavement education program for healthcare professionals, she was—and still is—instrumental in the program’s success. In addition to her
continued support for the RTS program, Dr. Limbo is an advocate for Gundersen Medical Foundation, especially in the area of medical education.

Though she retired in 2018, Dr. Limbo continues to support RTS as the program’s Director Emerita—and there is no question that her work as a nurse, a researcher, an educator and a leader has changed countless lives.

A career in caregiving

As a young girl growing up on a farm in Nebraska, Dr. Limbo remembers being struck by the compassion and empathy her father and paternal grandmother showed to others. 

“Daddy was always genuinely interested in other people and their experiences,” remembers Dr. Limbo, “and grandma was the same. They showed care in the way they talked and listened to people; they made sure others felt heard.”

Looking back, Dr. Limbo believes these role models inspired her to become a caregiver, too. After high school, she attended St. Olaf College in Northfield, Minn., where she earned a Bachelor of Science in Nursing. In the years that followed, she would go on to receive a Master’s Degree in Maternal/Child
Nursing from the University of Colorado, a Master’s Degree in Adult Psychiatric and Mental Health Nursing from Indiana University, and a Doctor of Philosophy in Nursing from the University of Wisconsin–Madison.

In 1979, Dr. Limbo, a maternal/infant nurse, moved to La Crosse and began working at Gundersen. While she had always been interested in mental health, Dr. Limbo soon developed an interest in perinatal bereavement care.

“The delivery room is not always a happy place,” said Dr. Limbo, who observed the trauma in patients experiencing a miscarriage, stillbirth, ectopic pregnancy or the death of an infant shortly after birth. “I found myself wanting to shine a light on people who I felt were being overlooked. At the time, there were few—if any—standards for this type of care.” 

In 1981, Dr. Limbo worked with several colleagues to develop a bereavement education program called Resolve Through Sharing (RTS), with the initial goal to positively impact the quality of patient care at Gundersen. The program received so much internal support that Dr. Limbo was hired as a bereavement
coordinator, the first such position at Gundersen, and—perhaps—the first position of its kind in the nation.

Some of her early research on perinatal bereavement focused on miscarriage, a topic that was not well understood at the time.

“Research showed that up to 75 percent of women experiencing a miscarriage grieved the loss,” said Dr. Limbo. “Therefore, the choice of language—personal language vs. medical language—used by healthcare professionals is an extremely important part of providing comfort and care.”

By 1983, the model was developed enough for Dr. Limbo and a colleague to present on the subject at two national healthcare conferences. The topic was so popular, she remembers, that at one of the conferences, an entire ballroom full of nurses attended their workshop to learn about the approach being used at
Gundersen.

Seeing the potential, Dr. Limbo returned to Gundersen and submitted a proposal to grow and develop the healthcare education program. 

“I have always felt blessed to have begun this work here—at Gundersen,” Dr. Limbo said. “Leaders need to have support at the organizational level in order to make a big impact, and Gundersen is that kind of place.”

Today, more than 60,000 healthcare professionals throughout the U.S. and beyond have received RTS training. The program is considered to be the gold standard in industry—and Dr. Limbo is viewed as a pioneer and leader in this field of study.

A transformational experience 

Even though Dr. Limbo loved the work she was doing and feared she may never find another role more suited to her passion she left RTS in 1990 to work in behavioral health as a psychotherapist until enrolling in a PhD program in nursing at the University of Wisconsin–Madison in the fall of 1993.

There, she had what she calls a “transformative experience,” thanks in part to Karen Pridham, PhD, the advisor for her doctoral program. At the time, Dr. Pridham was conducting a randomized clinical trial that applied the teaching and learning theory called Guided Participation (GP), which focuses on helping
individuals become more competent in a practice by working alongside a guide.

As a research assistant, Dr. Limbo worked closely with the participants in the study, all of whom had pre-term babies. 

“I will never forget the families and the babies I worked with during that study,” said Dr. Limbo, “or the impact of what I learned.”

Two articles by Drs. Pridham and Limbo about GP are accepted for publication in a major nursing journal.

In 2004, Dr. Limbo was invited back to Gundersen to serve as the director of Resolve Through Sharing, and she brought the theory of Guided Participation with her. The tenets of Guided Participation were integrated into care practices at Gundersen, and this relationship-based intervention is a core part of all
RTS trainings.

A career of highlights

Dr. Limbo retired from Gundersen in 2018, but she continues to volunteer in support of RTS, serving as the Director Emerita. In addition to her work with RTS, Dr. Limbo has co-edited or coauthored six books including three named as American Journal of Nursing Books of the Year: Perinatal and Pediatric Bereavement (2016), Guided Participation in Pediatric Nursing Practice (2018) and Handbook of Perinatal and Neonatal Palliative Care (2020). She has
also authored numerous journal articles and textbook chapters.

Having experienced first-hand the impact of investments in medical education, Dr. Limbo has supported Gundersen Medical Foundation for the past 27 years. 

“I feel so fortunate to have ended up at Gundersen, in a place so committed to high-quality patient care—and a place that values and supports medical education and research,” said Dr. Limbo. “My gifts to the Foundation are one way I can give back for what they have given to me.”

One very personal gift to the Foundation occurred in 2010 when Dr. Limbo and her sister sponsored a bereavement room in honor of their grandmother, Christena Estrem Limbo. The bereavement room allows patients to spend time in a warm, comfortable environment with their loved one who has died.

In 2012, Dr. Limbo was recognized for her RTS work by being inducted as a fellow into the American Academy of Nursing. Of the 4.2 million nurses in the U.S., only about 2,900 have been named fellows—and Dr. Limbo is the only person at Gundersen to have received this honor.

“It is the highlight of my nursing career because it places me within a group of esteemed nursing leaders,” said Dr. Limbo, “and I’m also especially proud because of the recognition it brings to Gundersen and the Foundation.”

The gold standard in bereavement care

Resolve Through Sharing (RTS) is an evidence- and relationship based bereavement education program for healthcare professionals. RTS trains clinicians providing bereavement care and support (e.g., nurses, chaplains, physicians, social workers) at Gundersen facilities, across the country and around the world.

The innovative program was created at Gundersen in 1981 and has since become the gold standard in bereavement education. To date, bereavement trainings has been provided to more than 60,000 caregivers. While the program initially focused on bereavement training for those supporting perinatal loss, programming has since expanded to include bereavement education across the lifespan.

The program’s core two-day courses focusing on perinatal, neonatal and pediatric, and adult death experiences were delivered in-person until the COVID-19 pandemic imposed the need for a virtual transformation. Today, these RTS education sessions are offered live on Zoom.

Additional programming offered by RTS includes online modules, a webinar series featuring renowned bereavement experts, training for genetic counseling students, a protocol for emergency responders, resources for veterinary professionals, and a complete catalog of bereavement resources.

Director Mary Beth Hensel reflects, “Every time we deliver an RTS training, comments from attendees identify the experience as the best training these healthcare professionals have received. This Foundation program serves as an example of how investments in medical education not only raise the quality of care locally, but position Gundersen as an industry leader.” 

Visit Resolve Through Sharing to learn how our bereavement training and resources can help your staff.