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multiple deaths, palliative care, staff grief, support needs



  1. Lobb, Elizabeth A. PhD, MAppSci, BAdEd
  2. Oldham, Lynn PhD, BN, RN
  3. Vojkovic, Susie BN, RN
  4. Kristjanson, Linda J. PhD, MN, BN, RN
  5. Smith, Joanna BPsych
  6. Brown, Jane M. RN
  7. Dwyer, Victor W. J. MCouns


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.