Within the context of end-of-life care, where relationships have been formed and nurses have been witness to intimate aspects of the patient's family life, a profound emotional response frequently occurs (Bush & Boyle, 2012; Gray 2009).
Hence, having the opportunity to process the personal and professional responses to a patient's death is an important aspect of nurse mourning and grief. Yet due to the absence of such support in the clinical setting, nurses are frequently disenfranchised grievers.
Interventions that change the current paradigm are needed for many reasons. Some of these include reducing the negative consequences of cumulative and complicated grief. Enduring feelings of guilt and remorse may lead to turnover or decisions to leave nursing. Having a formal opportunity to respond to a patient death may also promote learning and skill building specific to care of the dying patient, a competency rarely taught in undergraduate nursing programs. Of note is the finding by Gerow and colleagues (2010) that significant death experiences early in nurses' careers sets the stage for how they care for dying patients in their future.
Keene and colleagues (2010) at Johns Hopkins Children's Center described one of their palliative care interventions to support healthcare professionals in their care of dying children -- bereavement debriefing. Planned by the bereavement coordinator, sessions are offered after all patient deaths. Via email, verbal invitations, and posted signs on units, key healthcare professionals involved in the patient's care are invited. While they are modeled after Critical Incident Stress Debriefing (CISD) sessions, these offerings differ in several ways.
First, rather than focus on the details of the traumatic incident, bereavement debriefing sessions focus on the emotional response of the healthcare provider, namely within the wider context of the relationship with the patient and family. Second, these sessions are usually held within a week of the death (often after the funeral) rather than within hours, which is the case with CISD offerings. This fosters staff the chance to hear about the funeral as well as describe personal grief reactions.
The format and structure of bereavement debriefing is outlined in the article (Keene, Hutton, Hall & Rushton, 2010). Sample questions are listed that are asked of staff. Many of these are appropriate for individual oncology nurses to ponder in their grief responses:
- "What was it like taking care of this patient?"
- "What will you remember most about this patient and family?"
- "What have you experienced since the death?"
Very importantly, the group is also queried, "What lessons did we learn from caring for this patient and family?"
Learning to manage personal grief, a critically important affective component of oncology nursing practice, is an under-emphasized skill for nurses (Boyle, 2000). Requesting help with this needed support is step one in its provision. Nursing leadership advocacy is also crucial to see this type of intervention actualized in practice. I would be interested in hearing from readers about offerings in their places of employment that address the psychosocial aspect of our intense care.
Boyle DA (2000). Pathos in practice: Exploring the affective domain of cancer nursing. Oncology Nursing Forum, 27(6): 915-919.
Bush NJ & Boyle DA (2012). Nurse grief. Self-Healing Through Reflection: A Workbook for Nurses. Hygeia Media: Pittsburgh, pp. 57-75.
Gerow L, Conejo P, Alonzo A, Davis N, Rodgers S & Domain EW (2010). Creating a curtain of protection: Nurses' experiences of grief following a patient death. Journal of Nursing Scholarship, 42(2): 122-129.
Gray B (2009). The emotional labour of nursing – defining and managing emotions in nursing work. Nurse Education Today, 29, 168-175.
Keene EA, Hutton N, Hall B & Rushton C (2010). Bereavement debriefing sessions: An intervention to support health care professionals in managing their grief after the death of a patient. Pediatric Nursing, 36(4): 185-189.