Providing Grief Resolution as an Oncology Nurse Retention Strategy

An Integrative Review of "The Pause" After Patient Death

Background: Healthcare providers are engrossed in high-stakes, high-stress situations during their daily work with patient death being a potential negative outcome of work-related stress. Many interventions exist to combat work-related stress among nurses. The Pause, an intervention to offer a moment of silence for the healthcare team after a patient death, is one example. Objective: An integrative review of The Pause was conducted to investigate its use and how it impacts healthcare providers and their work environments. Methods: The integrative review methodology by Whittemore and Knafl was used to guide this study. Steps included were problem identification, literature search, data evaluation, data analysis, and presentation. Content analysis was used to identify themes. Results: Seven databases were searched in 2022 and seven studies were identified for inclusion in this review. Two themes were identified: personal benefits and professional benefits. Findings reveal benefits from self-care and grief processing to a better work environment. Conclusions: The Pause is a low-cost, low-risk intervention that can be implemented at an organizational level to help reduce burnout, unresolved grief, increase resilience, increase retention, and improve patient outcomes. Future research should include an examination of how The Pause may affect patient outcomes and workplace culture.

An Exploratory Study of ICU Pediatric Nurses' Feelings and Coping Strategies after Experiencing Children Death

BACKGROUND

This study aims to explore the feelings and experiences of nursing staff when faced with the death of a pediatric patient in the ICU.

METHODOLOGY

A qualitative study based on hermeneutic phenomenology was conducted through semi-structured interviews. Ten nurses (30% of staff) from the Pediatric Intensive Care Unit of a referral hospital were interviewed in April 2022. Text transcripts were analysed using latent content analysis.

RESULTS

Content analysis indicated that the interviewees had feelings of sadness and grief; they had a misconception of empathy. They had no structured coping strategies, and those they practiced were learned through personal experience, not by specific training; they reported coping strategies such as peer support, physical exercise, or strengthening ties with close family members, especially their children. The lack of skills to cope with the death and the absence of support from personnel management departments were acknowledged. This can lead to the presence of compassion fatigue.

CONCLUSIONS

The feelings that PICU nurses have when a child they care for die are negative feelings and sadness, and they possess coping strategies focused on emotions learned from their own experience and without institutional training support. This situation should not be underestimated as they are a source of compassion fatigue and burnout.

"You gotta have your cry": Administrator and direct care worker experiences of death in assisted living

Assisted living (AL) is increasingly a site of end-of-life care and a long-term care location where growing numbers of people are aging in place and dying. Despite these trends, limited research focuses on how death and grief impact the work environment in AL. This grounded theory analysis examined qualitative data collected from 27 administrators and 38 direct care workers (DCWs) in 7 diverse settings. As assisted living administrators and DCWs experienced resident death, they engaged in a dynamic and individualized process of "managing the normalization of death," which refers to the balance of self-identity and workplace identity. The process of reconciling these opposing contexts in AL involved several individual- and community-level conditions. Administrators and DCWs would benefit from additional resources and training around death. Increasing collaboration with hospice and clarifying policies about death communication would better prepare the workforce to acknowledge the end of life in assisted living.

Psychometric Properties of Grief Traits and State Scale for Nurses to Measure Levels of Grief

Frequent exposure to patient deaths prompts nurses to experience grief. Unresolved grief leads to harmful consequences of nurses' mental health and quality of nursing care. A cross-sectional study using an online survey was conducted to determine the psychometric properties of the Grief traits and State Scale for Nurses. Exploratory factor analysis revealed two factors measuring the level of nurses' grief traits (Cronbach's alpha: 0.84) and two factors in grief state (Cronbach's alpha: 0.86). Nurses' feelings of unable to provide good care were associated with a higher risk of grief (odds ratio (OR): 4.30, 95% confidence interval (CI): 1.45-12.75), uncomfortable feeling toward deaths (OR: 11.29, 95%CI: 1.48-85.91), and emotional exhaustion (OR: 7.12, 95%CI: 1.63-30.99). Results indicated that the scale was reliable in determining the levels of their grief. Nurse managers can use the scale to identify their nurses' levels of grief, creating opportunities to influence the resolution of the grief experiences.

Fatiga por compasión y agotamiento profesional en personal de salud ante el duelo y muerte en contextos hospitalarios

Resumen Este artículo pretende identificar y analizar en la literatura la producción relacionada con la fatiga por compasión y el agotamiento psicológico presente en el personal sanitario que brinda atención y cuidado a personas durante los procesos de muerte y duelo de pacientes y sus familiares, respectivamente. Esta es una revisión integradora en las bases de datos JSTOR, ProQuest, Medline (vía PubMed), LILACS y Google Scholar en el periodo 2005-2018. La revisión permitió la identificación de tres cuerpos importantes de producción académica: trabajos de corte cualitativo que describen el fenómeno; los que desarrollan escalas y herramientas de medición del problema; y los que describen estrategias desarrolladas frente al mismo. En los contextos hospitalarios al personal de salud que acompaña a persona durante el proceso de muerte se le impide demostrar sentimientos y vivir el duelo por la pérdida de sus pacientes. Los trámites administrativos, la despersonalización sanitaria, el número de pacientes a cargo y la baja conciencia en relación con la muerte regulan de cierta forma lo acontecido, impidiendo que exista por parte del personal de salud descarga de sentimientos, llevándolos a presentar agotamiento psicológico y fatiga por compasión.

Nurses' Experiences of Establishing Meaningful and Effective Relationships With American Indian Patients in the Cancer Care Setting

Introduction

The establishment of caring relationships with racial and ethnic minority populations is challenging for many cancer care nurses. Nurses serving American Indian (AI) patients frequently encounter population-specific issues, yet their experiences are largely unknown.

Objective

The purpose of this study was to describe the meaning of the AI patient-cancer care nurse relationship from nurses' perspectives. The study included three objectives: (a) to describe the immediate experiences of nurses that have engaged in cancer care relationships with AI patients, (b) to identify the underlying structures of the AI patient-cancer care nurse relationship as described by nurses, and (c) to interpret the meaning of the patient-nurse relationship within the context of AI cancer care experiences.

Methods

This was an interpretive phenomenological study using a hermeneutical process for data collection and analysis of multiple, exploratory interviews. Thematic reduction was completed to explicate the fundamental structures of this particular relationship. Reduction of individually situated themes resulted in seven shared meta-themes including from task to connection; unnerving messaging; we are one; the freedom of unconditional acceptance; attuning and opening; atoning for the past, one moment at a time; and humanizing the inhumane.

Results

Nine cancer care nurses participated. Reconstitution of data and reflective writing suggested that the essential meaning of the AI patient-cancer care nurse relationship was expressed in contradictory yet simultaneous patterns for nurses. Nurses sought synchronicity with their AI patients despite their contextual differences and similarities, yet most lacked adequate cultural safety training. Being in relationship provided nurses great purpose within the universal human context of caring.

Conclusions

Results contribute to the development of interventions designed to improve both the AI cancer care experience and the support and training of nurses. The mutually dependent nature of the patient-nurse relationship implies that strengthening and improving support for one entity may in turn positively impact the other.

Case Study of Nurses' Experiences Related to the Deaths of Their Patients

A qualitative case study methodology was applied to explore how nurses cope when their patients die. The study utilized a sample of 16 participants at a rural 123-bed community hospital. Nine themes regarding nurses dealing with grief emerged: (a) family issues, (b) patient alone at death, (c) knowing the community, (d) never-forgotten experiences, (e) first experiences, (f) time issues, (g) responses to unexpected deaths, (h) role of nurses, and (i) nurses' response to death itself. It is concluded that nurses need to grieve. If nurses do not know how to cope with deaths of their patients, it may lead to personal health issues. There is a need for further research to evaluate whether improved end-of-life education and counseling address the needs of the nurses who deal with deaths of their patients. Globally, nurses cope with death and need to grieve when their patients die. Knowledge introduced from this research adds to the knowledge of the skills and coping of nurses everywhere.

Reflections on the Emotional Hazards of Pediatric Oncology Nursing: Four Decades of Perspectives and Potential

THEORETICAL PRINCIPLES

Pediatric oncology nurses are particularly vulnerable to emotional distress. Responsible for the oversight of a child's care, these nurses sustain close interactions with multiple patients and families over time, many of whom are coping with life-limiting diagnoses. The world of pediatric oncology nurses is one where tragedy is routinely witnessed thus demanding self-care and healing across a continuum.

PHENOMENON ADDRESSED

The aim of this article is to outline and review the emotional sequelae of pediatric oncology nurses' work and to suggest interventions to support well-being in light of prolonged caregiving. Three major categories that are addressed include the aspects of clinical practice that influence caregiving, the risks of burnout, compassion fatigue, moral distress and grief, and interventions to counteract these phenomena.

RESEARCH LINKAGES

Future-nursing research should focus upon the development of validated, psychometrically sound measurement tools to assess nurse-specific variants of burnout, compassion fatigue, moral distress, and nurse grief. Qualitative research should investigate the relationship between personal variables, workplace and team characteristics, age and experience, and their influence on the predominance of burnout, compassion fatigue, moral distress, and nurse grief. Lastly, the phenomena of resiliency demands further study.

Stress Levels of Nurses in Oncology Outpatient Units

BACKGROUND

Oncology nursing is often a source of substantial stress for nurses. Many nurses, particularly novice nurses, have inadequate preparation to care for patients at the end of life and their families. Unless nurses prevent or manage work-related stress by using effective coping strategies, oncology nursing staff will continue to suffer from burnout and compassion fatigue.

OBJECTIVES

The purpose of this article is to identify stress levels and stressful factors of nurses working in oncology outpatient units and to explore coping behaviors for work-related stress of oncology staff nurses in outpatient units.

METHODS

A descriptive, cross-sectional design was used to identify stress levels and stressful factors for outpatient oncology nurses, investigate differences in stress levels among nurses' demographic characteristics, and explore coping behaviors of the nurses. Study participants (N = 40) included RNs and licensed practical nurses who completed the Nursing Stress Scale, three open-ended questions, and a demographic questionnaire.

FINDINGS

The highest sources of stress were workload and patient death and dying. Demographic variables of age and work experience in nursing showed a significant positive relationship to work-related stress scores. The three most frequently used coping behaviors were verbalizing, exercising or relaxing, and taking time for self. Continuing education programs on stress management are highly recommended. Outpatient oncology nurses should be nurtured and supported through tailored interventions at multiple levels to help them find effective coping strategies and develop self-care competencies. Although younger and less experienced nurses had lower mean stress scores than older and more experienced nurses, the continuing education programs and tailored interventions would be helpful for all oncology nursing staff.

Care of the body after death

Care of the body after death is an important nursing function that occurs in a wide variety of contexts. After a patient dies, nursing care continues as physical care of the body as well as care of the family members. In this descriptive, qualitative study, the authors explored nurse perceptions of what it means to care for the body after death. Narratives describing this care were collected and analyzed. The descriptions were coded and two overarching themes emerged: giving respectful and dignified after-death care (ADC) that is sensitive to the needs of the family and ADC providing nurses with a mechanism for coping with care of dying patients. To ensure patient and family ADC needs are not superseded by nurses' own coping needs, comprehensive patient and family-centered ADC planning is recommend. Grief resolution opportunities, end-of-life education, and mentoring should be available to support nurses with post-death experiences.

Relationships among structural empowerment, psychological empowerment, intent to stay and burnout in nursing field in mainland China-based on a cross-sectional questionnaire research

The aim of the study was to explore the relationship among perceived structural empowerment, psychological empowerment, burnout and intent to stay by nurses in mainland China.With the shortage of nurses in many countries, including China, intent to stay is a dominant factor to influence the quality of care. Also, burnout is identified to negatively affect the quality of care. Empowered clinical nurse practical environment is related to intent to stay and burnout. In the current literature, there is a lack of data based on empowering environment discussing the relationship between burnout and intent to stay. The study used an anonymous questionnaire, filled voluntarily by 219 nurses from different sections in a city in mainland China, 2012.Structural equation modelling (SEM) was used to test the proposed hypotheses. Based on the SEM model, structural empowerment and psychological empowerment had significant positive effects on intent to stay of nurses and negative effects on burnout. Burnout had a significant negative effect on intent to stay. The final modified models yielded χ(2)  = 58.580, P > 0.05, χ(2) /df = 1.046, root mean square error of approximation = 0.015, Tucker-Lewis Index = 0.996, comparative fit index = 0.998,which indicated good fit indices. Creating a positive empowering workplace can encourage nurses to stay long and prevent burnout. Therefore, higher level of empowering environment is required.