As a career, oncology nursing is rewarding, but it involves frequent care of patients at the end of life. Such frequent exposure to death leads to high rates of grief and stress in oncology nurses, which, if left unaddressed, can result in nurses experiencing burnout, depression, anxiety, compassion fatigue, chronic compounded grief, and other negative symptoms, and, ultimately, nurses leaving the specialty or profession.

Key Definitions

Burnout: exhaustion arising from a cumulative, prolonged increase in stress. Symptoms include withdrawing from emotional scenarios at work, anger, and decreased empathy. Bereavement: the state of experiencing a loss Chronic compounded grief: an accumulation of unresolved grief; symptoms are similar to that of burnout. Compassion fatigue: exhaustion in healthcare providers arising from becoming too emotionally attached to patients and families Grief: emotion experienced as a consequence to a loss or in anticipation of a loss

In her article in the December 2012 issue of the Clinical Journal of Oncology Nursing, Hildebrandt shared the results of a literature review looking at grief resolution coping strategies for oncology nurses. Hildebrandt specifically looked at Saunders and Valente’s bereavement task model.

The Bereavement Task Model

Hildebrandt used the Saunders and Valente model because it is the only one that isolates the unique characteristics of the oncology role in grief and bereavement. In their model, Saunders and Valente postulated that oncology nurses take the following four actions when grieving the loss of a patient.

  1. Finding meaning in a patient’s death or questioning whether different actions would have resulted in a different outcome
  2. Maintaining and restoring integrity, if the nurse felt conflicted or helpless about a patient’s death
  3. Managing affect by expressing emotions and feelings related to the death
  4. Redefining relationships that may have been impacted by a patient’s death

Grief Resolution Strategies

Hildebrandt found a variety of strategies in her literature search that would help oncology nurses to complete Saunders and Valente’s Bereavement Task Model. The strategies fell within four common themes that, when used together, enable nurses to address all the steps of the Bereavement Task Model.

Create a positive work environment: Mutually supportive work environments that integrate grief resolution strategies directly in the workplace can optimize patient care, improve oncology nurses’ job satisfaction, and reduce the risk and incidence of compassion fatigue. The most supportive workplaces in the literature provided accessible, variable grief resolution strategies to their nurses on a regular basis. Oncology nurses also stressed the importance of workplaces supporting outward displays of grief and mourning by nurses.

Encourage nurses to debrief with colleagues: Sharing their experiences with colleagues, who may have had similar experiences, helps nurses cope with their grief. In contrast, bringing those experiences home to loved ones is not as helpful, because nurses’ family members may not be able to relate in the same way. The studies in Hildebrandt’s review reported that activities such as peer-supported storytelling, workplace psychosocial wellness retreats, and listening to others’ stories of grief experiences all had a cathartic effect on oncology nurses.

Offer end-of-life education and grief training: End-of-life training that incorporates components of managing grief, in addition to the usual foci of patient and family care, pain management, and other symptom management, helps prepare nurses to attend to their own needs during patient death. Hildebrandt found that for this kind of training to be effective, it must be provided prior to a nurse’s first exposure to patient death and grief.

Alter patient care assignments: Because repeated exposure to death can compound a nurse’s grief experience, altering patient care assignments may give nurses an emotional break so they can complete the steps of bereavement. Efforts should be made to ensure that nurses do not provide end-of-life care to multiple patients simultaneously, and nurses should be allowed time off the unit following a patient’s death so they can grieve appropriately.

Several of the studies in Hildebrandt’s review also found that improving work-life balance helped nurses prevent or limit grief. This includes engaging in physical activity, asking for help when needed, sustaining adequate sleep and nutrition, and engaging in enjoyable activities.

For more information on grief in oncology nurses or Saunders and Valente’s Bereavement Task Model, refer to the full article by Hildebrandt.

Five-Minute In-Service is a monthly feature that offers readers a concise recap of full-length articles published in the Clinical Journal of Oncology Nursing (CJON) or Oncology Nursing Forum. This edition summarizes “Providing Grief Resolution as an Oncology Nurse Retention Strategy: A Literature Review,” by Lori Hildebrandt, RN, BN, MN, CON(c), which will be featured in the December 2012 issue of CJON. Questions regarding the information presented in this Five-Minute In-Service should be directed to the CJON editor at CJONEditor@ons.org. Photocopying of this article for educational purposes and group discussion is permitted.