A Continuing Educational Program Supporting Health Professionals to Manage Grief and Loss

Grief Training in Palliative Care Fellowships

INTRODUCTION

No prior study has assessed grief and bereavement curriculum in Hospice and Palliative Medicine (HPM) fellowship programs in the United States.

METHODS

A 14-item survey was created and distributed to Accreditation Council for Graduate Medical Education (ACGME)-accredited HPM fellowship Program Directors to assess program demographics, curriculum emphasis, grief and bereavement programming, and attitudes toward grief and bereavement training for HPM fellows.

RESULTS

The overall survey response rate was 63%. Most palliative care programs were academic (74%) and had four or fewer fellows (85%). 90% devoted a minority (0%-10%) of their curriculum to grief and bereavement training. Most programs reported at least some program-led grief and bereavement programming (69%); however, 53% endorsed that fellows are not very or not at all involved in this programming. Almost half of programs only have a small amount of programming related to supporting families after loss (49%). The majority endorsed having a great deal of programming for debriefing or supporting fellows through professional grief (55%), and the most common modalities were debriefing sessions (62%) and ensuring access to mental health resources (41%). The most common ways of teaching grief and bereavement were through bedside/anecdotal teaching and lectures/case conferences. Most program directors felt that palliative care fellowships should provide grief and bereavement training (81%) and consider it important or very important for fellows to learn how to process grief and bereavement (92%).

DISCUSSION

It was widely reported by program directors that grief and bereavement training are important curricular components for HPM fellows. Acknowledging professional grief remains an underrecognized need in palliative care training and practice. Our study suggests that for grief and bereavement curricula in HPM fellowships, the time dedicated, specific types, and amount of fellow involvement was highly variable. It will be critical for programs to disseminate best practices to help move toward a more uniform approach for ensuring basic competency in grief and bereavement training in HPM fellowship programs in the United States.

An integrative review of strategies to prevent and treat compassion fatigue in oncology nurses

Compassion fatigue is understood as the combination of secondary traumatic stress and cumulative burnout caused by reduced ability to cope with one's environment. As such, compassion fatigue can be a significant workplace hazard for nurses in oncology. Findings from this integrative review reveal a lack of awareness and understanding of compassion fatigue among oncology nurses even if this group has been identified as high risk for experiencing compassion fatigue. Strategies such as self-care, mindfulness, and resiliency-based interventions to cope with compassion fatigue are reviewed herein along with related effectiveness. Some studies underscore that prevention-focused rather than treatment-focused interventions for compassion fatigue may be more effective. The responsibility for promoting and protecting oncology nurses' well-being is essential and must be spearheaded by organizations, administration, educational institutions, care teams, and individual nurses.

Revue intégrative des stratégies de prévention et de traitement de la fatigue de compassion chez les infirmières en oncologie

La fatigue (ou usure) de compassion est un mélange de traumatisme secondaire et d’épuisement professionnel cumulatif résultant d’une difficulté à composer avec son environnement. De par la nature de leurs fonctions, les infirmières en oncologie sont particulièrement sujettes à la fatigue de compassion. Les conclusions de la présente revue intégrative révèlent un manque de sensibilité et de compréhension envers les infirmières en oncologie qui éprouvent de la fatigue de compassion, et ce, même s’il s’agit d’un groupe à haut risque. Il sera ici question de l’efficacité des stratégies d’autosoins, de pleine conscience et d’interventions visant à renforcer la résilience pour surmonter la fatigue de compassion. Certaines études suggèrent que les interventions préventives seraient plus efficaces que les interventions curatives. Il est essentiel de promouvoir et de protéger le bien-être des infirmières en oncologie; c’est aux organisations, aux administrations, aux établissements d’enseignement, aux équipes soignantes et à chaque infirmière d’y voir.

Factors Contributing to Grief Experience Among Oncology Nurses: A Qualitative Study

OBJECTIVES

Care provision to patients with cancer can cause varying levels of grief for oncology nurses. Grief in turn significantly affects nurses' personal and professional life. However, there is limited information about the contributing factors to grief experience among oncology nurses. The aim of this study was to explore the contributing factors to grief experience among oncology nurses.

DATA SOURCES

This qualitative study was conducted in Iran from May 2020 to October 2021. Participants were 18 oncology nurses purposively selected from several hospitals in Iran. Data were gathered via in-depth semistructured interviews and analyzed via the conventional content analysis method proposed by Graneheim and Lundman. Lincoln and Guba's criteria were used to ensure trustworthiness.

CONCLUSION

The four categories of the contributing factors to oncology nurses' grief experience were exposure to patients' painful death, depressing work atmosphere, knowing the heavy financial burden of cancer for patients, and patients' helplessness in the healthcare system. Oncology nurses experience deep grief due to a wide range of personal, professional, environmental, and sociocultural factors.

IMPLICATIONS FOR NURSING PRACTICE

The findings of this study can be used to better understand the contributing factors to grief experience among oncology nurses, determine their needs, and develop strategies to strongly support them.

Professional grief among nurses in Spanish public health centers after caring for COVID-19 patients

AIMS AND OBJECTIVES

The aim of the present study is to investigate the professional grief suffered by nurses in various medical units, after coping with the COVID-19 pandemic for the last 18 months.

BACKGROUND

Addressing and acknowledging the reality of professional grief is of fundamental importance to nurses' mental health, as this condition has both professional and personal consequences.

DESIGN

A qualitative, content analysis approach was taken.

METHODS

Based on 25 interviews with nursing professionals working in different health centers units were performed. The following sampling schemes were used: first, convenience sampling, then nominated sampling, and finally theoretical sampling.

RESULTS

From our analysis of the data obtained, three main themes were identified: the impact on nurses of COVID-19 outcomes; the symptoms of professional grief; and cognitive reactions. These core elements interacted with 12 subtopics, including symptoms of grief and the cognitive impact produced.

CONCLUSIONS

A large proportion of the nurses consulted in this study have suffered and suffered professional grief and report many related symptoms. In response to the present pandemic and any future occurrence, the question of professional grief needs to be addressed.

RELEVANCE TO CLINICAL PRACTICE

To help them cope better with this type of situation, nurses should receive appropriate training. Moreover, healthcare institutions should be made aware of the problem and be encouraged to offer assistance to address the impact produced on nurses by the deaths of their patients.

CLINICAL RELEVANCE

This study shows the impact of professional grief on nurses in the context of the COVID-19 pandemic. Nurses are affected personally by the deaths of patients and by alterations to their working conditions. In many cases, this grief remains unresolved and its various symptoms persist.

S. V. Supporting Resilience and the Management of Grief and Loss among Nurses: Qualitative Themes from a Continuing Education Program

Caring for patients with cancer is highly stimulating and rewarding, attracting health professionals to the field who enjoy the challenge of managing a complex illness. Health professionals often form close bonds with their patients as they confront ongoing disease or treatment impacts, which may be associated with multiple losses involving function and/or eventual loss of life. Ongoing exposure to patient loss, along with a challenging work setting, may pose significant stress and impact health professionals' well-being. The prevalence rates of burnout and compassion fatigue (CF) are significant, yet health professionals have little knowledge on these topics. A 6-week continuing education program consisting of weekly small-group video-conferencing sessions, case-based learning, and an online community of practice was delivered to health care providers providing oncology care. Program content included personal, organization and team-related risk and protective factors associated with CF, grief models, and strategies to mitigate against CF. Content analysis was completed as part of the program evaluation. In total, 189 participants (93% nurses) completed the program, which was associated with significant improvements in confidence and knowledge of CF and strategies to support self and team resilience. Qualitative themes and vignettes from experiences with the program are presented. Key themes included knowledge gaps, a lack of support related to CF and strategies to support resilience, organization- and team-based factors that can inhibit expression about the impacts of clinical work, the health professional as a "person" in caregiving, and the role of personal variables, self-skill practices, and recommendations for education and support for self and teams.