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Working Through Grief and Loss: Oncology Nurses' Perspectives on Professional Bereavement

Jennifer Wenzel

Maya Shaha

Rachel Klimmek

Sharon Krumm

nurse's grief
ONF 2011, 38(4), E272-E282. DOI: 10.1188/11.ONF.E272-E282

Purpose/Objectives: To determine facilitators and barriers to managing patient loss from the combined perspectives of oncology nurses and to extract essential components of a supportive intervention.

Research Approach: Qualitative, descriptive.

Setting: The comprehensive National Cancer Institute-designated cancer center of a mid-Atlantic university teaching hospital.

Participants: 34 nurses from inpatient and outpatient adult and pediatric oncology units.

Methodologic Approach: Focus groups were held with oncology staff nurses to identify challenges regarding work-related bereavement, current support for managing grief and loss, and how to support interpersonal functioning and resiliency.

Main Research Variables: Work-related bereavement, bereavement support, and interventions and management strategies for bereavement and loss.

Findings: Two primary themes emerged: dimensions of work-related loss and working through bereavement. Participants also provided many concrete suggestions for the creation of a supportive self-care environment. Conclusions: Support issues were numerous, multilevel, and varied. However, addressing those concerns can improve job satisfaction and decrease compassion fatigue. The findings lay the foundation for appropriate interventions to assist nurses in managing those situations.

Interpretation: Administrators, managers, and individuals interested in furthering the multifaceted goals of oncology care, including nurses themselves, are challenged to create and maintain mutually supportive environments for providing optimal care to patients and families.

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    References

    Abendroth, M., & Flannery, J. (2006). Predicting the risk of compassion fatigue: A study of hospice nurses. Journal of Hospice and Palliative Nursing, 8, 346-356. doi:10.1097/00129191-200611000-00007
    AbuAlRub, R.F. (2004). Job stress, job performance, and social support among hospital nurses. Journal of Nursing Scholarship, 31, 73-78. doi:10.1111/j.1547-5069.2004.04016.x
    Agar, M. (1999). How to ask for a study in qualitatisch. Qualitative Health Research, 9, 684-697. doi:10.1177/104973299129122162
    Aycock, N., & Boyle, D. (2009). Interventions to manage compassion fatigue in oncology nursing. Clinical Journal of Oncology Nursing, 13, 183-191. doi:10.1188/09.CJON.183-191
    Bakitas, M., Lyons, K.D., Hegel, M.T., Balan, S., Brokaw, F.C., Seville, J., … Ahles, T.A. (2009). Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: The Project ENABLE II randomized controlled trial. JAMA, 302, 741-749. doi:10.1001/jama.2009.1198
    Barbour, R.S. (2005). Making sense of focus groups. Medical Education, 39, 742-750. doi:10.1111/j.1365-2929.2005.02200.x
    Boelen, P.A., & Huntjens, R.J. (2008). Intrusive images in grief: An exploratory study. Clinical Psychology and Psychotherapy, 15, 217-226. doi:10.1002/cpp.568
    Buerhaus, P., Donelan, K., DesRoches, C., Lamkin, L., & Mallory, G. (2001). State of the oncology nursing workforce: Problems and implications for strengthening the future. Nursing Economics, 19, 198-208.
    Burns, N., & Grove, S.K. (2005). The practice of nursing research: Conduct, critique, and utilization (5th ed.). St. Louis, MO: Elsevier/Saunders.
    Byrne, D., & McMurray, A. (1997). Caring for the dying: Nurses' experiences in hospice care. Australian Journal of Advanced Nursing, 15, 4-11.
    Curtis, E., & Redmond, R. (2007). Focus groups in nursing research. Nurse Researcher, 14, 25-37.
    Cutcliffe, J., & McFeely, S. (2001). Practice nurses and their "lived experience" of clinical supervision. British Journal of Nursing, 10, 312-323.
    Dorz, S., Novara, C., Sica, C., & Sanavio, E. (2003). Predicting burnout among HIV/AIDS and oncology healthcare workers. Psychology and Health, 18, 677-684. doi:10.1080/0887044031000141180
    Ferrucci, L., Guralnik, J.M., Cavazzini, C., Bandinelli, S., Laurentani, F., Bartali, B., … Longo, D.L. (2003). The frailty syndrome: A critical issue in geriatric oncology. Critical Reviews in Oncology/Hematology, 46, 127-137. doi:10.1016/S1040-8428(02)00177-4
    Figley, C.R. (Ed.). (1995). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. New York, NY: Brunner-Routledge.
    Gerow, L., Conego, P., Alonzo, A., Davis, N., Rodgers, S., & Domian, E.W. (2010). Creating a curtain of protection: Nurses' experiences of grief following patient death. Journal of Nursing Scholarship, 42, 122-129. doi:10.1111/j.1547-5069.2010.01343.x
    Given, B., & Sherwood, P.R. (2006). Family care of the older person with cancer. Seminars in Oncology Nursing, 22, 43-50. doi:10.1016/j.soncn.2005.10.006
    Goelz, T., Wuensch, A., Stubenrauch, S., Bertz, H., Wirsching, M., & Fritzsche, K. (2010). Addressing the transition from curative to palliative care: Concept and acceptance of a specific communication skills training for physicians in oncology—COMM-ON-p. Onkologie, 33, 65-69.
    Hellgren, J., Naswall, K., Sverke, M., & Soderfelt, M. (2003). New organizational challenges for human service work. Munich, Germany: Rainer Hampp.
    Institute of Medicine. (2009). Ensuring quality cancer care through the oncology workforce: Sustaining care in the 21st century (workshop summary). Washington, DC: National Academies Press.
    Kean, S. (2000). Focus group interviews: A qualitative research approach to nursing [In German]. Pflege, 13, 145-151. doi:10.1024/1012-5302.13.3.145
    Kearney, M.K., Weininger, R.B., Vachon, M.L., Harrison, R.L., & Mount, B.M. (2009). Self-care of physicians caring for patients at the end of life: "Being connected … a key to my survival." JAMA, 301, 1155-1164. doi:10.1001/jama.2009.352
    Lee, V., Cohen, R.S., Edgar, L., Laizner, A.M., & Gagnon, A.J. (2006). Meaning-making intervention during breast or colorectal cancer treatment improves self-esteem, optimism, and self-efficacy. Social Science and Medicine, 62, 3133-3145. doi:10.1016/j.socscimed.2005.11.041
    Lerias, D., & Byrne, M. (2003). Vicarious traumatization: Symptoms and predictors. Stress and Health, 19, 129-138. doi:10.1002/smi.969
    Madriz, E. (2000). Focus groups in feminist research. In N.K. Denzin & Y.S. Lincoln (Eds.), Handbook of qualitative research (2nd ed., pp. 835-850). Thousand Oaks, CA: Sage.
    Mansell, I., Bennett, G., Northway, R., Mead, D., & Moseley, L. (2004). The learning curve: The advantages and disadvantages in the use of focus groups as a method of data collection. Nurse Researcher, 11, 79-88.
    Maree, J.E., & Wright, S.C. (2008). Palliative care: A positive outcome for cancer patients? Curationis, 31(2), 43-49.
    Maslach, C., Shaufeli, W.B., & Leiter, M.P. (2001). Job burnout. Annual Review of Psychology, 52, 397-422. doi:10.1146/annurev.psych.52.1.397
    Mayring, P. (2002). Einfuhrung in die qualitative sozialforschung: Eine anleitung zu qualitativem denken [Introduction to qualitative social research: A guide to qualitative thinking] (revised 5th ed.). Weinheim, Germany: Beltz.
    Mayring, P. (2007). Qualitative inhaltsanalyse: Grundlagen und techniken [Qualitative content analysis: Bases and techniques] (9th ed.). Weinhem, Germany: Beltz.
    Medland, J., Howard-Ruben, J., & Whitaker, E. (2004). Fostering pyschosocial wellness in oncology nurses: Addressing burnout and social support in the workplace. Oncology Nursing Forum, 31, 47-54. doi:10.1188/04.ONF.47-54
    Mukherjee, S., Beresford, B., Glaser, A., & Sloper, P. (2009). Burnout, psychiatric morbidity, and work-related sources of stress in paediatric oncology staff: A review of the literature. Psycho-Oncology, 18, 1019-1028. doi:10.1002/pon.1534
    Quinal, L., Harford, S., & Rutledge, D.N. (2009). Secondary traumatic stress in oncology staff. Cancer Nursing, 32, E1-E7. doi:10.1097/NCC.0b013e31819ca65a
    Rabenschlag, F., & Shaha, M. (2007). Analysis of team specific situations of burden in everyday nursing and development of tailored interventions: An action research project nurses [In German]. Pflege, 20, 35-40. doi:10.1024/1012-5302.20.1.35
    Rodrigues, A.B. & Chaves, E.C. (2008). Stressing factors and coping strategies used by oncology nurses. Revista Latino-Americana de Enfermagem, 16, 24-28. doi:10.1590/S0104-11692008000100004
    Rohan, E., & Bausch, J. (2009). Climbing Everest: Oncology work as an expedition in caring. Journal of Psychosocial Oncology, 27, 84-118. doi:10.1080/07347330802616043
    Sabo, B.M. (2006). Compassion fatigue and nursing work: Can we accurately capture the consequences of caring work? International Journal of Nursing Practice, 12, 136-142. doi:10.1111/j.1440-172X.2006.00562.x
    Sabo, B.M. (2008). Adverse psychosocial consequences: Compassion fatigue, burnout, and vicarious traumatization: Are nurses who provide palliative and hematological cancer care vulnerable? Indiana Journal of Palliative Care, 14, 23-29. doi:10.4103/0973-1075.41929
    Sehlen, S., Vordermark, D., Schafer, C., Herschbach, P., Bayerl, A., Pigorsch, S., … Geinitz, H. (2009). Job stress and job satisfaction of physicians, radiographers, nurses, and physicists working in radiotherapy: A multicenter analysis by the DEGRO Quality of Life Work Group. Radiation Oncology, 4, 6. doi:10.1186/1748-717X-4-6
    Shaha, M., & Rabenschlag, F. (2007). Burdensome situations in everyday nursing: An explorative qualitative action research on a medical ward. Nursing Administration Quarterly, 31, 134-145.
    Shaha, M., Wenzel, J., & Hill, E.E. (2011). Planning and conducting focus group research with nurses. Nurse Researcher, 18(2), 77-87.
    Showalter, S.E. (2010). Compassion fatigue: What is it? Why does it matter? American Journal of Hospice and Palliative Medicine, 27, 239-242.
    Sinclair, H.A., & Hamill, C. (2007). Does vicarious traumatization affect oncology nurses? A literature review. European Journal of Oncology Nursing, 11, 348-356. doi:10.1016/j.ejon.2007.02.007
    Turner, J., Clavarino, A., Butow, P., Yates, P., Hargraves, M., Connors, V., & Hausmann, S. (2009). Enhancing the capacity of oncology nurses to provide supportive care for parents with advanced cancer: Evaluation of an educational intervention. European Journal of Cancer, 45, 1798-1806. doi:10.1016/j.ejca.2009.02.023
    Turner, J., Clavarino, A., Yates, P., Hargraves, M., Connors, V., & Hausmann, S. (2007a). Development of a resource for parents with advanced cancer: What do parents want? Palliative and Supportive Care, 5, 135-145. doi:10.1017/S1478951507070204
    Turner, J., Clavarino, A., Yates, P., Hargraves, M., Connors, V., & Hausmann, S. (2007b). Oncology nurses' perceptions of their supportive care for parents with advanced cancer: Challenges and educational needs. Psycho-Oncology, 16, 149-157. doi:10.1002/pon.1106
    Turner, J., Clavarino, A., Yates, P., Hargraves, M., Connors, V., & Hausmann, S. (2008). Enhancing the supportive care of parents with advanced cancer: Development of a self-directed educational manual. European Journal of Cancer, 44, 1625-1631. doi:10.1016/j.ejca.2008.02.045
    Vincent, G.K., & Velkoff, V.A. (2010). The older population in the United States: 2010-2050. Retrieved from http://www.census.gov/prod/2010pubs/p25-1138.pdf
    Walton, A.M. & Alvarez, M. (2010). Imagine: Compassion fatigue training for nurses. Clinical Journal of Oncology Nursing, 14, 399-401. doi: 10.1188/10.CJON.399-400
    Williamson, T.S. (2008). The shift of oncology inpatient care to outpatient care: The challenge of retaining expert oncology nurses. Clinical Journal of Oncology Nursing, 12, 186-189. doi:10.1188/08.CJON.186-189
    Yoder, E.A. (2010). Compassion fatigue in nurses. Applied Nursing Research, 23, 191-197.