Journal of Hospice and Palliative Care

  • 제25권2호
  • /
  • Pages.55-65
  • /
  • 2022
  • /
  • 2765-3072(pISSN)
  • /
  • 2765-3080(eISSN)
한국호스피스완화의료학회 (Korean Society for Hospice and Palliative Care)
권호 표지
DOI QR코드

DOI QR Code

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

  • Esplen, Mary Jane (Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto) ;
  • Wong, Jiahui (Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto) ;
  • Vachon, Mary L.S. (Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto)
  • 투고 : 2022.05.14
  • 심사 : 2022.05.18
  • 발행 : 2022.06.01
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

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.

키워드

과제정보

We would like to acknowledge contributions by health care professionals who participated in this program and shared their experiences of managing grief and loss while delivering outstanding care to patients and families, to Allan Holtzman who assisted in the delivery of the online sessions, and to funding provided by the Ontario Ministry of Health and Long-Term Care.

참고문헌

  1. Vachon M, Fillion L. Staff stress and burnout in palliative care. In: Bruera E, Higginson I, von Gunten CF, Morita T, eds. Textbook of palliative medicine and supportive care. 2nd ed. Boca Raton:CRC Press;2015. p. 1033-46.
  2. Bussing A, Falkenberg Z, Schoppe C, Recchia DR, Poier D. Work stress associated cool down reactions among nurses and hospital physicians and their relation to burnout symptoms. BMC Health Serv Res 2017;17:551. https://doi.org/10.1186/s12913-017-2445-3
  3. Shanafelt TD, Mungo M, Schmitgen J, Storz KA, Reeves D, Hayes SN, et al. Longitudinal study evaluating the association between physician burnout and changes in professional work effort. Mayo Clin Proc 2016;91:422-31. https://doi.org/10.1016/j.mayocp.2016.02.001
  4. Esplen MJ, Wong J, Vachon MLS, Leung Y. A continuing educational program supporting health professionals to manage grief and loss. Curr Oncol 2022;29:1461-74. https://doi.org/10.3390/curroncol29030123
  5. Medland J, Howard-Ruben J, Whitaker E. Fostering psychosocial wellness in oncology nurses: addressing burnout and social support in the workplace. Oncol Nurs Forum 2004;31:47-54. https://doi.org/10.1188/04.ONF.47-54
  6. Maslach C, Leiter MP. Understanding the burnout experience: recent research and its implications for psychiatry. World Psychiatry 2016;15:103-11. https://doi.org/10.1002/wps.20311
  7. Figley CR. Treating compassion fatigue. New York:Brunner-Routledge;2002.
  8. Vachon MLS, Harris D. The liberating capacity of compassion. In: Harris D, Bordere TC, eds. Handbook of social justice in loss and grief. New York:Routledge;2016. p. 265-81.
  9. Turner J, Kelly B, Girgis A. Supporting oncology health professionals: a review. Psycho-Oncologie 2011;5:77-82. https://doi.org/10.1007/s11839-011-0320-8
  10. Baranowsky A, Schmidt D. Overcopers: medical doctor vulnerability to compassion fatigue. In: Figley C, Huggard P, Rees CE, eds. First, do no self-harm : understanding and promoting physician stress resilience. New York:Oxford University Press;2013. p. 203-15.
  11. Vachon M. Attachment, empathy and compassion in the care of the bereaved. Grief Matters 2016;19:20-5.
  12. Bowlby J. The making and breaking of affectional bonds: I. The making and breaking of affectional bonds. I. Aetiology and psychopathology in the light of attachment theory. An expanded version of the Fiftieth Maudsley Lecture, delivered before the Royal College of Psychiatrists, 19 November 1976. Br J Psych 1977;130:201-10. https://doi.org/10.1192/bjp.130.3.201
  13. Adshead G. Becoming a caregiver: attachment theory and poorly performing doctors. Med Educ 2010;44:125-31. https://doi.org/10.1111/j.1365-2923.2009.03556.x
  14. Hawkins AC, Howard RA, Oyebode JR. Stress and coping in hospice nursing staff. The impact of attachment styles. Psychooncology 2007;16:563-72. https://doi.org/10.1002/pon.1064
  15. Vachon MLS, Huggard PK, Huggard J. Reflections on occupational stress in palliative care nursing: Is it changing? In: Ferrell BR, Coyle N, Paice JA, eds. Oxford textbook of palliative nursing. 4th ed. New York:Oxford University Press;2015. p. 969-86.
  16. Zhang YY, Han WL, Qin W, Yin HX, Zhang CF, Kong C, et al. Extent of compassion satisfaction, compassion fatigue and burnout in nursing: a meta-analysis. J Nurs Manag 2018;26:810-9. https://doi.org/10.1111/jonm.12589
  17. West CP, Dyrbye LN, Erwin PJ, Shanafelt TD. Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. Lancet 2016;388:2272-81. https://doi.org/10.1016/S0140-6736(16)31279-X
  18. Wentzel D, Brysiewicz P. Integrative review of facility interventions to manage compassion fatigue in oncology nurses. Oncol Nurs Forum 2017;44:E124-40. https://doi.org/10.1188/17.ONF.E124-E140
  19. Ghawadra SF, Abdullah KL, Choo WY, Phang CK. Mindfulness-based stress reduction for psychological distress among nurses: a systematic review. J Clin Nurs 2019;28:3747-58. https://doi.org/10.1111/jocn.14987
  20. Halifax J. A heuristic model of enactive compassion. Curr Opin Support Palliat Care 2012;6:228-35. https://doi.org/10.1097/SPC.0b013e3283530fbe
  21. Kuhl D, Cave D, Pearson H, Whitehead P. Treatment and prevention work: center for practitioner renewal. In: Figley CR, Huggard P, Rees CE, eds. First, do no self-harm : understanding and promoting physician stress resilience. New York:Oxford University Press;2013. p. 247-64.
  22. Esplen MJ, Hunter J, Maheu C, Rosberger Z, Wong J, McGillicuddy P, et al. de Souza interprofessional practice cancer competency framework. Support Care Cancer 2020;28:797-808. https://doi.org/10.1007/s00520-019-04823-z
  23. Lev E, Munro BH, McCorkle R. A shortened version of an instrument measuring bereavement. Int J Nurs Stud 1993;30:213-26. https://doi.org/10.1016/0020-7489(93)90032-P
  24. Adwan JZ. Pediatric nurses' grief experience, burnout and job satisfaction. J Pediatr Nurs 2014;29:329-36. https://doi.org/10.1016/j.pedn.2014.01.011
  25. Burnard P. A method of analysing interview transcripts in qualitative research. Nurse Educ Today 1991;11:461-6. https://doi.org/10.1016/0260-6917(91)90009-Y
  26. Mealer M, Jones J. Posttraumatic stress disorder in the nursing population: a concept analysis. Nurs Forum 2013;48:279-88. https://doi.org/10.1111/nuf.12045
  27. Granek L, Barbera L, Nakash O, Cohen M, Krzyzanowska MK. Experiences of Canadian oncologists with difficult patient deaths and coping strategies used. Curr Oncol 2017;24:e277-e284.
  28. Perez GK, Haime V, Jackson V, Chittenden E, Mehta DH, Park ER. Promoting resiliency among palliative care clinicians: stressors, coping strategies, and training needs. J Palliat Med 2015;18:332-7. https://doi.org/10.1089/jpm.2014.0221
  29. Badenoch B. Being a brain-wise therapist : a practical guide to interpersonal neurobiology. New York:W.W. Norton & Co.;2008.
  30. Barnard D, Towers A, Boston P, Lambrinidou Y. Crossing over : narratives of palliative care. New York;Oxford:Oxford University Press;2000.