Completed Research Project
A study to assess the grief experienced by Registered Nurses and Care Aides who work in community palliative care and to identify suitable strategies for support
Investigators: Lobb EA, Oldham
L, Vojkovic S,
Smith J, Brown J. Dwyer V, Husain M.
Funding: Edith Cowan University Industry Collaborative
Scheme and Silver chain Inc ($52,349)
Administering Institution: Edith Cowan University
Abstract: Stage 2 of this study described the impact of multiple deaths on Registered Nurses and Care-aides working in community palliative care. Currently, there are no evidence-based grief and bereavement support protocols available for use by palliative care health professionals in the community setting in Australia. A questionnaire was designed from themes identified in interviews conducted in Stage 1. All Registered Nurses and Care Aides working with Silver Chain Hospice Care Service were mailed a self report questionnaire. The majority of participants did not report clinically significant levels of anxiety. However, approximately 1/3 had moderate levels of anxiety. The process of resolving grief over time as measured by existential tension, depression, guilt and physical distress was assessed in this study. Participants who scored lower on existential tension were significantly more likely to want debriefing the day after the death of a client. Less than half of those who responded to the survey had undertaken any formal learning in grief and bereavement. Lack of formal training in grief and bereavement was significantly associated with above average scores in depression, guilt and physical distress. The majority of community palliative care nurses with Silver Chain did not report significant levels of burn-out as measured by emotional exhaustion, a sense of depersonalisation or lack of personal accomplishment. Those who wanted workplace-based complementary therapies reported significantly higher levels of emotional exhaustion and depersonalisation. Nurses with less than 10 years of experience in community care were significantly more likely to suffer from depersonalisation and to report lower levels of personal accomplishment. The majority of staff wanted both formal and informal debriefing. However, less than half of respondents reported that they had the skills and knowledge to provide colleagues with adequate de-briefing. Those who reported that they did not have de-briefing skills were significantly more likely to report lacking a sense of personal accomplishment. This study concluded that the majority of nurses working in community palliative care with Silver Chain are not adversely affected by the multiple deaths that they experience in their daily work. It appears that formal learning in grief and bereavement is psychologically protective. Nurses with less than 10 years of experience in community nursing appear to have higher levels of psychological distress. Debriefing was found to be the most appropriate form of workplace support following the death of a client; however, the majority of respondents reported that they did not possess such skills. There is some evidence that de-briefing soon after the death of a client assists the process of grieving. The need for self-care was noted, with the majority of participants responding favourably to the introduction of workplace-based complementary therapies. A formal protocol is being prepared for Silver Chain with recommendations for workplace support for community palliative care nurses.