Some patients with cancer will not survive. Death may be a reality, but that does not make it any easier for oncology healthcare professionals. We work hard alongside patients and their caregivers to fight this ugly disease. We witness each patient’s extraordinary courage and determination, especially in areas like phase I/II clinical trial centers or hematopoietic cell transplant (HCT) programs. Oncology nurses, in particular, develop close personal relationships with their patients. We genuinely care, which makes us very good at our jobs. Yet, these same feelings cause many of us to truly grieve a loss.
After a patient’s death, some nurses consider attending their viewing, memorial service, or celebration of life. There aren’t black-and-white answers or hard rules about this; each situation is unique. But before attending, ask these critical questions:
- What is my motivation to attend?
- Is this in the family’s best interest?
- Will I go to services for all of my patients or just those with whom I formed a special bond?
- Does management support attendance?
WHAT WOULD THE FAMILY WANT?
ONE NURSE'S EXPERIENCE
I vividly recall the only funeral I attended in my 33-year career as an oncology nurse. The patient had a difficult death. She had been on a ventilator for days before finally losing her 7-year battle with chronic graft-versus-host disease resulting from an unrelated allogeneic HCT. We met when she was admitted for her transplant. Over the years, I helped her during her numerous hospitalizations and outpatient clinic visits. I even helped train her homecare nurses. I had a special bond from the long-term relationship with her and husband. I drove to her funeral alone, but soon found other transplant team members. I didn’t think about why I wanted to be there; I simply went. Maybe I looked for a way to say goodbye or have closure. Perhaps I needed to let the family know that I cared and grieved, too. But I was not able to communicate anything. I emotionally fell apart. Her oncologist ended up comforting me, instead of me being able to offer condolences. –ED
The death of a patient can be very emotional, and yes, oncology nurses need to grieve. But a patient’s funeral is often not the best place to process personal feelings or to debrief. It’s also important to remember that confidentiality laws apply even after a patient’s death.
While some family members may welcome attendance, others may find it a reminder of unhappier times. Nurses should not place the family in a situation of feeling that they need to care for the nurse.
Some institutions offer onsite memorial services, especially for families of international patients. This can be tricky, as someone needs to provide patient care, but what if there is a service and no one goes except for the family?
DOES YOUR INSTITUTION HAVE A POLICY?
Certain managers may view attending services as “crossing the line” of professional behavior. While others may not encourage it, they recognize that it is an employee’s choice of how to use their personal time. Some hospice services support, even require, staff attendance at funerals or memorial services as part of bereavement care. Be sure to not only check the manager’s philosophy but employer policies, too.
NURSE SELF-CARE IN A TIME OF GRIEF
Think about attending work-sponsored grief support. Sharing with co-workers who are in your same situation can be very helpful. Some facilities provide staff the opportunity to attend scheduled remembrance services (monthly, quarterly, or annually). Others offer debriefing sessions or moments of silence to come together to reflect on patient deaths. A bereavement coordinator may be designated to ensure the session occurs in a timely manner, often that very same day or the day after a patient’s death.
Consider having team discussions, in advance, of how your work setting will best handle a patient’s death; these must be in line with organizational policy. Suggest to leadership, social work, and spiritual leaders ideas or strategies that would be most helpful for patients’ families and staff. A healthy supportive work environment is critical to nurses’ health and well-being.
Being equipped with the tools and resources to deal with grief may lead to decreased compassion fatigue and burnout.
In order to be sustainable in the field of oncology, nurses need to focus on self-care and make maintaining physical, emotional, and spiritual health a priority. Every nurse must decide whether that includes going to a patient’s funeral or memorial service. Think about attending the memorial service, if there is one, instead of the funeral. It is often more informal, where people come and go at any time. Try to find a colleague and share a ride.
OTHER WAYS TO HONOR A PATIENT’S MEMORY
There are other ways to honor a patient’s memory besides attending the funeral. I often donate to a cancer charity that fits the patient’s diagnosis or personality. I recently contributed to an organization that uses musical events to raise cancer awareness and funding to honor the loss of someone who loved music and sang in the choir. I typically send a card to the family or post on the online funeral home memorial site.
Some nurses may journal what they learned or will remember most from this patient. Others choose to meet to share memories with other staff and each other, either formally or informally.