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Frontline Grief: The Workplace Support Needs of Community Palliative Care Nurses After the Death of a Patient

Lobb, Elizabeth A. PhD, MAppSci, BAdEd; Oldham, Lynn PhD, BN, RN; Vojkovic, Susie BN, RN; Kristjanson, Linda J. PhD, MN, BN, RN; Smith, Joanna BPsych; Brown, Jane M. RN; Dwyer, Victor W. J. MCouns

Journal of Hospice & Palliative Nursing: July-August 2010 - Volume 12 - Issue 4 - p 225-233
doi: 10.1097/NJH.0b013e3181dceadc
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This study describes the impact of multiple deaths on nursing staff who work exclusively with palliative care patients in the community and identifies the types of workplace support required after the death of a patient. A self-report questionnaire was mailed to community palliative care nursing staff (n = 101). Fifty-nine questionnaires were returned (58% response rate). Requesting workplace support following the death of a patient was associated with higher levels of emotional exhaustion (P =.001) and depersonalization (P =.04). Registered nurses with less than 10 years community care experience reported higher levels of depersonalization (P =.01) and lower levels of personal accomplishment (P =.03). A reported lack of training in grief responses was associated with depression (P =.02), guilt (P =.03), and physical distress (P =.02). Peer debriefing was identified as the most appropriate workplace support; however, most respondents reported they lacked debriefing skills, and this was associated with lower levels of personal accomplishment (P =.01). Staff working in this community palliative care service were not adversely affected by the deaths of their patients. It appears that training in grief responses is psychologically protective. Key recommendations for workplace support include training in debriefing, communication skills around death and dying, grief responses, and access to workplace-based complementary therapies.

Author Affiliations: Elizabeth A. Lobb, PhD, MAppSci, BAdEd, is Adjunct Associate Professor, Calvary Health Care Sydney, WA Centre for Cancer & Palliative Care, Curtin University of Technology; and School of Nursing, Midwifery & Postgraduate Medicine, Edith Cowan University, Perth, Western Australia.

Lynn Oldham, PhD, BN, RN, is Associate Professor and Deputy Director, WA Centre for Cancer & Palliative Care, Curtin University of Technology, Perth, Western Australia.

Susie Vojkovic, BN, RN, is Clinical Nurse Consultant, Silver Chain Hospice Care Service, Perth, Western Australia.

Linda J. Kristjanson, PhD, MN, BN, RN, is Pro Vice Chancellor Research & Development, Curtin University of Technology, Perth, Western Australia.

Joanna Smith, BPsych, is Senior Research Officer, Silver Chain Nursing Association, Perth, Western Australia.

Jane M. Brown, RN, is Case Coordinator, Silver Chain Hospice Care Service, Perth, Western Australia. Victor W. J. Dwyer, MCouns, Counseling Coordinator, Silver Chain Hospice Care Service, Perth, Western Australia.

This project was funded by an Edith Cowan University Industry Collaborative Grant with the Silver Chain Hospice Care Service.

Dr Lobb was supported by an NH&MRC Australian Clinical Research Fellowship, and Dr Kristjanson was supported by the Cancer Council WA as the Chair in Palliative Care at the WA Centre for Cancer & Palliative Care, Edith Cowan University.

Address correspondence to Elizabeth A. Lobb, PhD, MAppSci, BAdEd, Calvary Health Care Sydney, Kogarah, New South Wales 2217, Australia (Liz.Lobb@sesiahs.health.nsw.gov.au).

The authors declare no conflict of interest.

© 2010 The Hospice and Palliative Nurses Association