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Keywords

COPING MECHANISMS, GRIEF SUPPORT, STAFF SUPPORT, SUPPORT GROUPS

 

Authors

  1. Lenart, Sylvia B. MSN, RN, CCRN
  2. Bauer, Charise G. BA, RN
  3. Brighton, Diane D. BSN, RN
  4. Johnson, Jacqueline J. MA, RN
  5. Stringer, Tia M. BA, RN, CCRN

Abstract

Patient death is a stressful experience for the patient, family, and the healthcare team. Nurses often have only informal resources for coping with the sadness and grief they might experience. Realizing the need for nursing grief support, a group of staff nurses from the intensive care unit formed a grief support group. Using information from the literature and critical incident stress debriefing, the group developed support interventions to aid intensive care unit staff after patient death.

 

The intensive care unit (ICU) at Mayo Medical Center is a combined medical, surgical, and transplant unit. According to Acute Physiology Age and Chronic Health Evaluation (APACHE) III data collected by our institution, 40% of patients are unexpected admissions from general care units. The mean mortality rate is 6-8% per month, similar to national statistics and other large teaching institutions. Nurses, physicians, and respiratory therapists are responsible for covering all emergency code calls in the inpatient and outpatient areas. As in all ICUs, nurses deal with crisis situations and end-of-life decision making on a daily basis. For some nurses, professionalism may include concealing personal grief in an effort to be strong for patients and families. Nurses are seldom able to share the grief that follows a patient's death. Although informal peer support is available, many nurses believe this is insufficient. Situations involving nurses' experience with grief, without adequate support or defusing time, prompted some nurses to initiate a group to assess the issue.

 

The Grief Support Group (GSG) initially discussed areas of staff nursing needs surrounding patient death including code debriefing, knowledge deficits, ethical decision making, death and dying, nurse and family support, coping mechanisms, and resource support personnel to assist as needed. After some discussion, the GSG decided to focus on the nurse's grief following a patient death. Three basic priorities were developed to guide future interventions. These priorities were:

 

* availability of grief support services to all staff;

 

* educating staff about coping mechanisms for dealing with grief; and

 

* providing staff with communication skills and tools when supporting families.