Survey Examines Burnout of Nurses Caring for Actively Dying Patients

In the summer of 2016, Smilow Cancer Hospital at Yale New Haven Health, a large, National Cancer Institute—designated comprehensive cancer center, introduced 4 inpatient virtual hospice beds—and oncology nursing leadership identified an opportunity to evaluate the coping needs of staff who care for actively dying patients. The beds, implemented in partnership with a regional hospice service, were placed on the medical oncology and gynecologic oncology units.

With a goal of decreasing staff burnout and subsequent turnover, 3 nurses representing the 2 inpatient units participating in the 2015-2016 University HealthSystem Consortium (UHC)/American Association of Colleges of Nursing (ACCN) Nurse Residency Program evaluated the impact of a meditation intervention on staff perception of stress.

The evaluation was performed using a 3-step process: an initial survey to gather demographic information about the nursing and support staff, a Likert scale to determine baseline subjective stress levels, and another Likert scale to measure levels after the intervention using guided imagery, a form of meditation.

Thirty-four staff members from the medical oncology and gynecologic oncology units participated, including registered nurses, nurse educators, and patient care associates. The initial survey consisted of 10 questions to identify participants’ perceptions of stress at work and related to actively dying patient care, years of experience, and coping mechanisms for dealing with work-related stress. The participants then completed a Likert scale survey associated with the statement “I feel stressed,” with responses ranging from 1 (strongly disagree) to 10 (strongly agree). Next, all participants listened to a guided relaxation audio provided by Smilow Cancer Center’s Integrative Medicine Department. The 10-minute exercise and survey took place in a conference room during a change of shift or when convenient during staff time.

Afterward, participants were asked to again respond to the “I feel stressed” statement on the scale of 1 to 10. Evaluation of the pre- and post-intervention data revealed that the majority of nursing staff experienced a decrease in perceived stress level after using guided imagery.

The remaining minority of nurses attributed their unchanged stress level to the responsibility of a patient assignment during the evaluation and intervention, timing of the evaluation (eg, during a shift change), and the voice on the audio.

Interestingly, none of the 4 participating patient care associates identified caring for actively dying patients as a stressful event; therefore, there was no change in evaluation of stress after guided imagery.

Further exploration into differences in nursing and support staff stress levels is warranted, and monitoring of turnover post-intervention is in progress. A standardized tool to evaluate stress and perception of burnout, as well as a list of standardized definitions of words and phrases frequently used in the survey and discussion (eg, “comfort measures only,” “actively dying patient,” and “compassion fatigue”) would help provide a concrete reference for participants. For example, nurses and nursing support staff define “actively dying patient” differently: While one nurse might use that term to describe the majority of patients on the medical oncology or gynecologic oncology units, another staff member might consider only a patient with agonal breathing or “comfort measures only” code status as actively dying.

This gray area of definition may have affected perception of stress in the overall results. Another area for further study may be use of the Professional Quality of Life (ProQOL R-IV) scale, a standardized tool for evaluating perception of stress. Overall, the project provided a great foundation for further examination into the areas of self-care for nurses. Guided imagery offers an easy, feasible, and effective coping strategy that staff who take care of actively dying patients can use while on duty.

This project invites discussion into promoting wellness and mental health of the staff—specifically, those who care for patients transitioning to hospice.

The author acknowledges Mercy Asomaning, RN, and Kelsey Osinski, RN, for their help in the implementation of the project.

Samantha Herlihy, RN, BSN, graduated from the University of Connecticut in 2015. She now works as a clinical nurse II at Smilow Cancer Hospital at Yale New Haven.