Support for grief and bereavement among nurses in the ambulatory oncology setting

Deaths of patients can result in significant personal stress among nurses that may be reflected in behavior changes and possible burnout. This may be especially true among staff in the ambulatory oncology setting, where patients who are often known for years die in other locations and there is inconsistent notification of these deaths, and no formal opportunities for staff bereavement exist, according to a presentation during the Oncology Nursing Society 36th Annual Congress.

To assist professional staff in the identification of solutions to address death notification and to support staff grief, a leadership project at Monter Cancer Center, a suburban ambulatory center that serves adult oncology patients, addressed the impact of patient death on staff, particularly nurses in the ambulatory setting, reported Karen Gleason, RN, BSN, OCN®, North Shore LIJ HealthSystem Monter Cancer Center, Lake Success, New York, and colleagues. The faculty practice and treatment center experiences an average of 3,900 patient visits monthly and employs 180 professional and support staff. At the time the abstract was submitted in 2010, 300 patients had died from their disease.

A literature review revealed few studies have reported research on staff grief in the ambulatory oncology setting, noted Gleason.. Themes included in the literature that did address the professional caregiver experience in settings other than ambulatory included the need for increased support from supervisors, the need for bereavement-related education, and obstacles to grief expression of patient loss.

Project outcomes included provision of identified bereavement tools and an environment conducive to expression of grief. A formal survey weighted by a Likert scale was utilized to draw insight from the ambulatory oncology nurse's grief experience. Analysis resulted in a multidisciplinary interventional approach to support the staff. Interventions included educational presentations on professional grief led by a social worker, development of an “expressive bereavement group,” implementation of a formal patient memorial book, and a journal club meeting dedicated to staff grief.

Pre- and postintervention bereavement surveys and informal staff interviews conducted with project participants revealed the interventions were well-received by those who chose to participate in support measures. For example, presurvey, 78% of respondents agreed or strongly agreed with the statement, “Does the loss of a patient affect you on a personal level?” and 78% agreed or strongly agreed with, “does the loss of a patient affecdt you on a professional level.” Thirty-two percent also reported loss of, or change in, sleep related to the death or pending death of a patient, and 39% believed they had adequate time to communicate feelings of loss with their colleagues.

Postsurvey, 70% reported benefitting from the supportive expressive bereavement group. Comments included, “It's good to know others feel the same way I do,” and “We are so busy that we put death on a shelf—out of the way. The group gives me a place to express the feelings I might otherwise not been open to express.” In addition, 84% agreed or strongly agreed that the new, formalized notification of a patient's death, the memorial book, was effective. Comments included, “If helps to reflect on those we have lost,” and It helps reconcile those we have missed in the center.”

Staff members were encouraged to identify their own needs and participate in the activities available to address grief and bereavement in the work setting, Gleason concluded.
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