While this chapter has mainly focused on the family who is grieving the loss of a loved one, it is also important to recognize the health of the nurse who cares for patients at the end of life. Much of what has been written in this text focuses on the importance of establishing an effective nurse-patient-family relationship which will foster effective communication. In Chapter 10, we discussed the various components that can enable the nurse to enter into this type of strong relationship. While these tips will help to make the patient and family feel connected to their nurse, it can also make the nurse feel connected with the patient. In end-of-life care, with each connection will come a subsequent loss as patients die. Over time, multiple losses that are not well-supported could take their toll on the nurse. Nurses witness much pain, suffering, and distress in patients and families alike. They also can expe- rience distress related to ethical or moral issues that are encountered as a result of the var- ious health care decisions that occur at the end of life. Hospice nurses in particular can be
vulnerable to “cumulative loss.” Cumulative loss is when nurses experience multiple succes- sions of losses, often on a daily basis, without adequate time for resolution before the next loss (ELNEC, 2010). Over time, this can lead to emotional distress in the nurse.
Factors that can affect the way nurses who care for dying patients adapt to the losses experienced in the workplace include: nurse’s educational level, personal death history, life changes, and support systems (ELNEC, 2010). Nurses who work with this population have to find a way to balance the losses they experience through healthy expressions of their feel- ings. In hospice care, nurses usually have formal team debriefing meetings following the death of patients, as well as memorial ceremonies they can attend to help them find closure. These are formal types of support that are available to nurses, depending on their setting. Informal support systems, such as talking with co-workers or peers, can also help provide a supportive environment for the nurse. The nurse may find solace from spiritual or religious services or support from their own clergy. Engaging in self-care activities, such as mas- sage or vacations, can also help the nurse cope with the effects of their role. Finally, nurses who work in end-of-life care should continue to engage in continuing education activities which can help provide knowledge and skills about ways to effectively cope with the effects of their role (ELENC, 2010).
What You Should Know
• Grief is the process by which individuals cope with loss.
• Individual factors and circumstances surrounding the loss can affect the grief response and extend or complicate the grief experience.
• Both formal and informal support mechanisms can be effective in helping the bereaved cope with their loss and find closure.
Corless, I. B. (2010). Bereavement. In B.R. Ferrell & N. Coyle (Eds.),Oxford Textbook of Palliative Nursing(pp. 597-611). New York: Oxford University Press.
End of Life Nursing Education Consortium (2010).ELNEC – core curriculum training pro- gram.City of Hope and American Association of Colleges of Nursing. Retrieved from http://www.aacn.nche.edu/ELNEC
Lowey, S. E. (2008). Letting go before a death: A concept analysis.Journal of Advanced Nursing, 63(2), 208-215.
Life is not measured by the breaths we take but by the moments that take our breath away.
• Evaluate one’s own attitudes and beliefs about death and dying.
• Describe the writer’s perspectives about the realm of nursing care at the end of life using lessons learned from clinical experiences.
One of the reasons I decided to write this book was because I wanted to share my knowl- edge and experiences of end-of-life care with nursing students and novice nurses. The majority of what I have learned throughout my career was learned through experience and the clinical setting. If there was a patient with a diagnosis that was unfamiliar, I would read about it. If there was a new procedure that a patient had undergone, I would research it. If there was a symptom that was not responding to a particular medication, I would explore possible reasons. End-of-life care, by its very nature, enabled me to gain a vast amount of knowledge, not only about various disease states and treatments, but about everything one can imagine is related to concerns and needs of those who are dying. There have been many improvements with medical and palliative interventions for cancer, heart disease, COPD and dementia during the past 15 years that have impacted the progression of end of life nursing care. It has grown in response to all the new research and evidence based practice. This research can show us what is effective in nursing interventions. Additionally, stud- ies that asked patients to describe their experiences with healthcare have spurred further improvements in end of life.
This afterword is presented in question and answer format so the reader can use my own
self-reflections to begin to contemplate what they have read and what it means to them. Self-reflection is essential in providing end-of-life care because the nurse will witness the full circle of human emotions and: happiness, joy, laughter, wisdom, forgiveness, anger, sorrow, pain, silence, and peace.