DISCUSSION

There are many books written about grief, there are grief support groups, there is talk of burnout and compassion fatigue, yet my struggle was anxiety that I might say or do the wrong thing. Dealing with expressions of grief can be complicated. My uncertainty about saying the “right thing” held me back. What if Kate started to cry again? What if Tracy felt threatened or scrutinized by me? Was it my place to check on her when I am not her manager?

There are certain things that are dangerous to leave unattended. A baby should not be left unattended in a bath. A campfire should not be left unattended in the forest. Grief is another thing that should not be left unattended. Stoicism in the face of grief and hiding our grief from others are ways of failing to attend to grief. The trio of deaths and especially Susanna dying triggered awareness that those of us working together needed a mechanism for addressing grief, that leaving grief unattended was not healthy. In the article, “Working Through Grief and Loss: Oncology Nurses’ Perspectives on Professional Bereavement,” Wenzel and colleagues describe a qualitative research project that helped identify the challenges of work-related bereavement. One consistent report from the nurses in the study was that giving staff the opportunity to debrief and dialogue about their grief had a positive impact on managing work-related bereavement.


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On our unit, the loss of three patients in a short period of time made it clear that we needed to address the feelings of grief and loss. After several discussions with the palliative care team, the physician member approached management about offering a grief workshop. In a surprisingly short period of time, we were able to organize a pilot program. Rather than a presentation about what grief is and the kinds of grief there are, this program followed a workshop format with an emphasis on the shared experience of grief and loss. One workshop cannot address the ongoing grief experienced on the oncology unit, but it opened up the dialogue. By validating grief, the workshop allowed those of us who participated to acknowledge the impact those patient losses made. It encouraged us to develop a team approach to dealing with the losses. It helped Kate and others feel less inclined to hide in the med room to cry.

One communication challenge in oncology is how to address the toll grief takes on our practice. Frequently checking in with staff creates the environment that allows for expression of grief. Becoming desensitized to death is easy; yet doing so is unhealthy for us and for those in our care. I was anxious about my conversations with Tracy and with Kate, worried about saying the wrong thing. But in both cases asking was as important as what I asked because it started a conversation. The workshop helped us continue the conversation. One legacy of Susanna’s death is that it opened the doors to expressing grief and the need for support. I think that would make her happy.


Ann Brady is the symptom management care coordinator at the Cancer Center, Huntington Hospital, Pasadena, California.  


REFERENCES

1. Achenbach S. A time to grieve. Johns Hopkins Nursing Magazine. 2010;8(1):44-46. http://magazine.nursing.jhu.edu/2011/11/a-time-to-grieve/. Accessed March 5, 2014.

2. Wenzel J, Shaha M, Klimmick R, Krumm S. Working through grief and loss: oncology nurses’ perspectives on professional bereavement. Oncol Nurs Forum. 2011;38(4):E272-E282.

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