coping up of medical professionals

1. Review of Related
Literature
Agcaoili, Medetrina
Group 7
11- B
Far Eastern University – Nicanor Reyes Medical Foundation

2. How doctors are taught to deal with death
Author/s: Eleanor Flynn and Jennifer Philip
Date: October 23, 2017
As a society we’re pretty removed from death. We don’t really talk about it. Yet when
medical students start their training, it suddenly becomes something they’re
intimately acquainted with. So how are young doctors taught to deal with death?
The teaching of medicine has traditionally been one of apprenticeship. A student is
equipped with basic knowledge and then, through experience in “the clinic”, is guided
by a trusted senior into a medical career. The teaching of students around one of the
key skills they will require in their career, care of the dying, requires specific skills
that the student may not encounter in their ordinary clinical teaching.
So it’s necessary to ensure all aspects of this vital topic are covered in the
curriculum, and any extra clinical experience is a bonus to help cement the
knowledge and understanding for the students.
What medical schools teach students about death
The most important skills medical schools need to teach students is to develop an
understanding of the broad impact of chronic illness on patients and their
communities; to understand patients’ (and their families’) responses and priorities; to
understand their own emotions; and to be able to do all of this while ensuring the
patient has all of the relevant medical information.
Most medical students, like many young Australians, have had no personal
experience with death. They are part of a “death-free generation” that may not
encounter the death of a close family member until later in life.
In many medical degrees, death is introduced in a theoretical way in the first year of
study, with lectures on the ethics of body donation for anatomy dissection, and
deaths of hypothetical patients. Some universities even have commemorative
services to thank those who donated their bodies to be used in anatomy classes.
Using these methods, the moral and social dimensions of dying and death are
explicitly highlighted alongside the physical dimensions.
In addition to visiting patients on wards during clinical experience, students spend
time following one patient through in-hospital care and to their follow-up
appointments with different health care providers. This gives them unique insights

3. into the patient experience, communication exchanges, decision-making, and the
dynamics of receiving care in the setting of serious illness
How physicians cope with patient death
Author/s: Ashley Altus
Date: November 28, 2017
Janice Knebl, DO, once saw 10 patients die in a single 24-hour shift. As a
geriatrician and palliative care specialist, she notes that seeing the end of patients’
lives is a significant part of her job, but the experience is still jarring every time.
After each patient death, Dr. Knebl processes her grief by saying a prayer and
pausing for a few moments of quiet time before moving on to the next patient.
Physicians often develop close relationships with their patients, and may eventually
lose one. Grief-related job stress may become job-related burnout, which can affect
up to 50 percent of physicians treating terminally ill patients. It’s important for
physicians affected by the loss of a patient to find a healthy way to cope.
“Patient death is what wears on you the most,” says Lisa Kopp, DO, a pediatric and
adolescent oncologist.
Below, several DOs share the coping mechanisms that they’ve found to be most
helpful in processing patient death and moving forward afterwards.
Express emotions
Kelly Dinnan, DO
It’s healthy to let yourself feel loss.
“Let emotions happen, it makes you human and empathetic. It takes time to get over
a death, and it is okay to remember those that have died,” says trauma and general
surgeon Kelly Dinnan, DO.
Showing emotion in front of the patient’s family is okay, but having a breakdown can
make the patient’s loved ones feel that they need to be comforting you.

4. Take time to reflect
Every physician will process a patient death in their own personal way.
Lisa Kopp, DO
Dr. Kopp prefers to take a moment to reflect on her time spent caring for the patient,
remembering positive interactions between herself and the patient. “Each of us have
our own internal coping mechanisms, “ Dr. Knebl says. “Find what’s going to work for
you to handle that loss and to continue to be effective for your patients and families.”
.
Embrace “We”
To help combat the negative thoughts after patients die, when Dr. Kopp speaks to
family, she frames everything using “we”. Phrases like, “I can’t cure your child,” or “I
failed you,” place too much of a burden on physicians, she says. She also reminds
herself that there are limits of what she can do to help patients.
“It’s not just me who can’t cure the child, it’s modern medicine,” Dr. Kopp says.
“Great physicians are self-aware and willing to speak up about uncomfortable
topics,” she says.
Dispel the feeling of failure
While there’s nothing you can change about a patient having cancer or another life-
ending illness, it’s natural to feel a sense of failure after a patient dies, Dr. Kopp
says.
However, it’s also important to combat this feeling. Dr. Kopp does so by conducting
research, supporting patients and participating in community service projects. She
uses every patient experience as a way to reflect on how she can move the field of
pediatric oncology forward—a practice she has credited with helping her avoid
burnout.
Dr. Dinnan combats feelings of failure by remembering successful outcomes she’s
had with other patients. She also relies on her senior partner and father for
encouragement.
Define your role
Society thinks of physicians as healers, and it’s easy to fall into the trap of viewing
your role–and worth–solely in terms of being able to cure patients, says Dr. Knebl.

5. Dr. Knebl prefers to view the role of the physician as always providing comfort, and
healing when they can.
“If you look at your role to cure always, you will always feel like you’ve never done
enough, “ she says.
For patients who can’t be cured, Dr. Knebl recommends physicians strive to give
them the best passing possible by helping them get their affairs in order and making
sure they experience minimal pain.
Patient loss: Surgeons describe how they cope
Author/s: Devin Rose
Date: February 1, 2015
Losing a patient is an experience that all surgeons are likely to face at some point in
their careers. The circumstances surrounding these deaths differ—one patient’s life
might have been in the process of ending for years due to a terminal illness, while
another might suffer complications during what should be a routine procedure. These
events can be devastating for everyone involved, and with that in mind, several
Fellows of the American College of Surgeons (ACS) are sharing strategies they’ve
learned that ease the difficulty of patient loss, as well as advice they would offer to
people considering careers in surgery.
Telling the truth
Geoffrey P. Dunn, MD, FACS, general surgeon, department of surgery, and medical
director, palliative care consultation service, University of Pittsburgh Medical Center
(UPMC) Hamot, Erie, PA, said he has seen a change in the way that death is
perceived in the surgical world. Dr. Dunn said that when he started his career 30
years ago, surgeons were not inclined to see death as a natural occurrence. The
main question was, “Is my treatment of the patient working?” Recently, however, Dr.
Dunn has noticed the focus shift from the single event of the death to improving the
surgeon’s ability to anticipate it and to enhance the patient’s comfort level during this
time.

6. Dr. Dunn said he felt a great sense of responsibility to his patients and their loved
ones. Recently, he treated a 102-year-old man on whom his grandfather also had
operated.
Having that connection can be helpful, Dr. Dunn said, but it can also make it more
painful if something happens to the patient. Even in those circumstances, though,
staying in touch with the patient’s family has helped him to cope. One of the first
losses Dr. Dunn experienced was with a patient on whom his father had operated
years before. After the funeral, the family invited him to dinner, where he heard them
talk about the man’s life. He and the family kept in touch for years.
Dr. Dunn said he also became an early believer in the value of a condolence letter,
which serves as a tribute to the patient and a source of comfort to the survivors. In
those letters, he makes sure to recall qualities of the patient and offers a way to keep
in touch. “Death is not a final, defining point for the individual or the relationship that
occurred around it,” Dr. Dunn said.
Developing a relationship with a patient’s family also helped Danielle Saunders
Walsh, MD, FACS, get through the loss of a patient. Dr. Walsh, a pediatric surgeon
who has been practicing for approximately 10 years, is an associate professor at
Brody School of Medicine, East Carolina University, Greenville, NC.
Dr. Walsh said the death of every child affects her, regardless of how well she knows
the family. “Children bring a different perspective in dealing with death. In general,
we view them as innocent. We see it as a loss of an opportunity for someone to
experience a full life,” she said.
Dr. Walsh said that losing this patient was extremely difficult, and she contemplated
whether a career in surgery was right for her. “If this is so painful, why am I doing it?”
she wondered. But at the funeral, the girl’s mother could tell she was hurting. “She
said, ‘I hope you don’t give up,’” which reassured Dr. Walsh that she should continue
in her chosen career.
Dr. Walsh said that in her experience, many conversations with patients and families
would be easier if Americans could view death as a natural part of life—no matter
how brief or lengthy that life may be. But we are not quite there yet as a society, she
said, because people tend to think there is always more, medically, that can be
done.
Dr. Numann said she would always try to go to the family’s calling hours after the
death of a patient in order to cope. Doing that shows families that “you did truly do
your best, and you did truly care about the person,” she said. Dr. Numann added that
many people don’t realize how much surgeons miss some of the patients they have
treated. “[Some patients] become like part of your extended family,” she said,
because, as part of a trusted relationship, they would get to know what was going on
in each other’s’ lives.

7. Returning to the OR
For Dr. Dunn, it’s important to get in touch with peers and not become
psychologically isolated after losing a patient. When that happens, he said, you tend
to lose perspective. “You’ve got to have a place to put all the negative energy that
can occur because of losses. Share your thoughts with someone you trust,” he said.
Dr. Walsh said she turns to people she cares about who can provide the words and
guidance necessary to help ease the pain.
Dr. Santry said there have been times when she has cried with the families of
patients after a loss. But surgeons need to have a laser-like focus, she said. They
have to be so fully engaged with the next patient that they simply have to shut down
lingering feelings, if only temporarily.
Tyler G. Hughes, MD, FACS, ACS Governor and Chair, ACS Advisory Council for
Rural Surgery, general surgeon, McPherson Hospital, KS, agreed that sharing the
experience with someone else is helpful. For him, that means talking to another
physician or someone other than his wife or friends.
Dr. Hughes cautioned against returning to surgery too quickly after a loss. The event
might cloud your judgment, he said, and you don’t realize that you’re not listening to
your current patient because your head is still back in the operating room with the
last one. Surgeons of his generation were trained to be “bulletproof,” he said, but
he’s learned that it’s not a sign of weakness to ask for help. It can also be comforting
to know that every surgeon has most likely gone through the same thing.
No matter the circumstances that lead to the death of a patient, the surgeons agreed
it’s always difficult for all involved. Some surgeons said it was important to keep in
contact with the patient’s family because interaction with the family helped to show
how much these physicians cared about the patient, while another surgeon found the
reassurance she needed to continue practicing surgery from these personal
exchanges. Many surgeons said it was important to talk to someone they trust after a
loss, whether it be a family member or fellow physicians who help them see these
situations objectively. No matter how sad they may feel, however, it’s essential for
surgeons to be able to put their full focus on the next patient.

8. Death Anxiety among Nurses and Health Care
Professionals: A Review Article
Author/s: Hamid Sharif Nia, PhD, Rebecca H. Lehto, PhD, Abbas Ebadi, PhD, and
Hamid Peyrovi, PhD
Date: January 2016
Abstract
Death anxiety, a negative affective state that is incited by mortality salience, may be
experienced by nurses and other health care workers who are exposed to sickness,
trauma, and violence. This paper examines death anxiety and management
strategies among health providers in different health settings across cultures. A
literature review of the research published since 2000 in the English language was
conducted using PubMed, Science direct, CINAHL, and Psych Info databases.
Death anxiety is commonly experienced and is associated with more negative
attitudes about caring for dying patients and their families. Performing educational
and psychological interventions to help nurses build strong coping strategies for
managing death anxiety are recommended to offset negative consequences such as
leaving positions, poor communication, and decrements in personal health and
quality of life.
KEYWORDS: Anxiety, Attitude to death, Delivery of health care, Fear, Nurses,
Thanatology

9. Nurses attitudes towards death, dying patients
and euthanasia: A descriptive study
Author/s: Fatma Öz and Melike Ayça Ay
Date: March 1, 2018
Abstract
Background:
Attitudes of nurses towards death and related concepts influence end-of-life care.
Determining nurses’ views and attitudes towards these concepts and the factors that
affect them are necessary to ensure quality end-of-life care.
Objectives: The purpose of this study was to determine nurses’ views and attitudes
about death, dying patient, euthanasia and the relationships between nurses’
characteristics.
Methods: Participants consist of the nurses who volunteered to take part in this
descriptive study from 25 hospitals (n = 340) which has a paediatric or adult
intensive care unit and located within the boundaries of Ankara, Turkey. ‘Nurse
Information Form’ and ‘Attitude Scale about Euthanasia, Death and Dying Patients
(DAS)’ were used as data collection tool.
Ethical consideration: Written permissions were received from the ‘Non
interventional Clinical Researches Ethics Board’ of authors’ university and education
councils of each hospital. Informed consent was obtained from participants.
Findings: It is found that there are statistically significant difference among the
factors of marital status, having a child, years of experience, bereavement
experience, affected by working with dying patient, definition of euthanasia, views
about patients who are appropriate for euthanasia, views about patients who desire
to die and feeling need for counselling on these concepts according to the mean total
score of nurses’ attitudes about euthanasia, death and dying patient (p < 0.05).
Conclusion:The results indicate that nurses are negatively affected to face the
concepts of death, euthanasia and work with dying patient. This is reflected in their
attitude. In order to gain positive attitude towards death, dying patient and
euthanasia, the implementation of training and consulting services to nurses at
appropriate intervals during both education and professional life are required.

10. A review of the effect of occupational
experienceof patient death and death
situations on Nurses
Author/s: Rhoda Suubi Muliira and Joshua Kanaabi Muliira
Date: January 2016
Abstract
Background: Impacts of regular occupational exposure and experience of patient
death on nurses’ professional quality of life and well-being. Despite the impacts, it
has not yet been adequately addressed by professional training, research and by
employers of nurses.
Purpose: To analyze the impacts of occupational exposure, experience of patient
death and death situations on nurses’ professional quality of life and recommend
strategies to curtail them.
Methods: Studies were retrieved from three databases CINAHL, SCOPUS,
MEDLINE and reference lists of relevant journal publications.
Results: The findings show that the impact of experience of patient death on nurses
positively or negatively depending on the way patient death is perceived (good or
bad). The positive outcomes include increased professionalism, devotion to patient
care, bonding with deceased patient’s family members and individualized patient
care. The negative impact may be short-term emotional reactions such as fear,
severe grief, and self-doubt. The short-term adverse outcomes can initiate long-term
consequences such as compassionate fatigue, burnout, and withdrawal from
practice among nurses with inappropriate coping.
Conclusion: Occupational exposure to death situations can adversely influence
patient care and nurse’s professional quality of life. Nurse educators, employers, and
researchers should play a proactive role in enhancing nurse’s knowledge, skills, and
coping.
Keywords: death, emotional support, grief, nurses, occupational exposure,
professional quality of life

11. Effects of Working at the Pediatric Oncology
Unit on Personal and Professional Lives of
Nurses
Author/s: Dilek Konukbay, RN, PhD
Dilek Yildiz, RN, PhD
Derya Suluhan, RN, PhD
Correspondence: Konukbay Dilek, RN, PhD
Date: August 2019
Abstract
Background: Cancer is a universal problem that increases day by day and that has
negative effects on patients from all age groups. Oncology nurses and other health
professionals, who serve children with cancer, witness the suffering or death of these
children.
Methodology: This study is a qualitative study that aims to analyze the effects of
working at the pediatric oncology units on personal and professional lives of the
nurses. For this aim, we used semi-structured in-depth interview method.
Results: Participant nurses were in a close relationship with the children with cancer
and their parents. They developed empathy towards the children and their parents
and sympathized with them. Although the participants expressed that working at the
pediatric oncology unit, which may sometimes be mentally exhausting, required
special skills and attention, they were satisfied with their jobs. Finally, loss of the
children led the participants to question their attitudes towards life. They stated that
all patients are individually unique, nothing is worse than the death of a child,
enjoying your life to the full is important and every breath you take is valuable.
Conclusions: The participants expressed that working with children with cancer is a
valuable experience for their personal and professional lives. They are satisfied with
their jobs. Finally, lessons, which they derive from the experiences with the children
with cancer and their parents, have a positive effect on the attitudes of the
participants towards their lives.
Keywords: Child, nurse, cancer, patient care

12. Coping strategies used by nurses in dealing
with patient death and dying
Author/s: Akuroma Roseline, Curran Tasner and Eye Aichetou
Date: October 24, 2016
Absract:
Nurses are affected by patient death and dying on a regular basis. Nurses, however,
encounter challenges to cope with it. Education is one way of preparing nurses to
face these challenges. The aim of this study is to present the coping strategies used
by nurses in dealing with patient death and dying and to determine which are
found most helpful. The purpose of this study is to provide information that can be
used as a resource for nursing students at Jyväskylä University of Applied
Sciences and that might help facilitate the improvement of the subject in the
curriculum.
A literature review was chosen as the method of analysis in this study. The following
databases were used to search for and obtain data: Cinahl, Elite, Pubmed and
Science Direct in addition to manual search. The sixteen articles which were found
were analyzed thematically. Three themes emerged from the reviewed articles: the
factors affecting death perception, coping process and examined educational
models. Work settings, previous experience and culture were the factors influencing
death perception. Distancing was found to be the first strategy sought by nurses,
while seeking support from colleagues was the most used. EOLc education that
adapted to nursing students’ individual needs and their anticipated future work
settings was emphasized to be the solution for better preparing these students to
deal and cope with patient death and dying.

13. Complicated Grief: Risk Factors, Interventions,
and Resources for Oncology Nurses
Author/s: Cindy S. Tofthagen, Kevin Kip, Ann Witt and Susan C. McMillan
Date: June 2017
Background: When a loved one dies of cancer, complicated grief (CG) may occur
because of the trauma associated with family caregivers’ perceptions of their loved
one’s suffering, either from advanced cancer or from side effects of cancer
treatment.
Objectives: This article provides an overview of CG and existing interventions for
family caregivers who may be at risk for CG following the loss of a loved one and the
implications for oncology nurses who provide emotional support and guidance.
Methods: Current evidence related to the treatment of CG and information to assist
with identification of individuals at risk for CG are presented, as well as resources for
oncology nurses who encounter individuals who are at high risk for, or who are
experiencing, CG.
Findings: Although therapy interventions for CG have been shown to be effective
forms of treatment, these therapies are not widely available and often require an
extended treatment period to yield results. Oncology nurses can provide early
interventions, such as referrals to supportive care services and mental health
professionals to facilitate effective treatment.

14. Nurses’ bereavement needs and attitudes towards
patient death: A qualitative descriptive study of
nurses in a dialysis unit
Author/s: Shelley Tranter, Elizabeth Josland and Kylie Turner
Date: January 08, 2016
Background
Dialysis nurses have a unique relationship with their patients and often require
bereavement support should a patient death occur. This study was conducted in
2014 and aimed to explore the attitudes of dialysis nurses to death and dying and to
identify suitable bereavement strategies following a death of a patient.
Methods
A purposeful, convenience sample of all nurses employed in the dialysis service
completed a demographic profile and The Death Attitudes Profile Revisited (DAP_R)
survey.
Results
There were 52 responses to the survey (98% response rate). The mean age of the
participants was 45 years ± 8.0 years; 87% had >10 years nursing experience.
Nurses suggest that debriefing and the use of a counsellor would support them in
their grieving process while new graduate nurses appear to require extra support
following a patient death. Analysis of the death attitude profile‐revised (DAP‐R)
showed significant relationships between fear of death/death avoidance as well as
fear of death/neutral acceptance. Spirituality and religion correlate strongly with
‘Approach Acceptance’ in this study group. Forty‐four percent people who ‘approach
acceptance’ of death can be explained by the strength of religious beliefs.
Conclusions
Many dialysis nurses appear to have strong religious or spiritual belief systems and
this contributes to their acceptance of death, although there also appears to be a
degree of death avoidance. The study has highlighted the need to provide adequate
bereavement support for dialysis nurses.

15. How nurses cope with death in the Paediatric
Intensive Care Unit
Author/s: Á.M.Henao-CastañoRNC, MSc, PhD
M.A.Quiñonez-MoraRNC, MSNb
Date: December 2019
Abstract
The death of a child in the Paediatric Intensive Care Unit (PICU) is difficult, the loss
generates feelings of sadness and pain; this study highlights the different coping
strategies used by nurses to manage this situation and find the strength to provide
care at the end of life.
Objective
Explore the strategies used by nurses in the PICU in coping with death.
Methods
Study conducted in the city of Manizales, Colombia, during the months of October,
November and December. A qualitative, hermeneutical phenomenological approach
was used. The method of intentional sampling for the selection of participating
nurses (n = 10) working in PICU, in-depth interviews were conducted for the
construction of the information and the data were analyzed according to the
procedures proposed by Cohen, Kahn and Steeves.
Results
Nurses use coping strategies focused on emotions: they inhibit their feelings towards
the patient and their family; they use communication and prayer with the patient, as
well as accompaniment to alleviate the suffering of the family.
Conclusion
UCIP nurses develop coping strategies for end-of-life care using spiritual resources
and communication with the family who require ongoing support, reflecting on death
and accompanying the child in its transcendence.

16. How social support affects the ability of clinical
nursing personnel to cope with death
Author/s: Wen P.Chang PhD, RN1
Date: December 2018
Abstract
Aim
The aim of this study was to explore how social support has an impact on nursing
personnel's coping ability when they are faced with a death in a clinical situation.
Background
The amount of social support may have an impact on nursing personnel's ability to
cope with patient deaths.
Methods
Overall, 323 effective questionnaires were returned. Their respective scores
calculated according to the Death Coping Self-Efficacy Scale and Social Support
Scale, using hierarchical regression for a statistical test.
Results
With regard to identification of coping with grief, the length of service of nurses (3–
4.9 years vs 1–2.9 years) (β = −0.15, p = .020) and unit type (oncology ward vs
general medicine ward) (β = 0.15, p = .009) reached significance. Following the
control of basic attributes, social support can effectively influence their preparation
for death, of which peer support reached significance (β = 0.27, p < .001). Moreover,
social support can also affect one's ability to cope with death; specifically, peer
support reached significance (β = 0.23, p < .001).
Conclusions
Support provided by supervisors and peers have a positive impact on the nursing
personnel when nurses are providing hospice care for the terminally ill. Furthermore,
sufficient support from colleagues can be an important source of comfort for clinical
nursing personnel to manage their preparation for and overall strategies to cope with
the death of patients.

17. Pediatric oncologists' coping strategiesfor
dealing with patient death
Author/s: Leeat Granek, PhD, Maru Barrera, PhD, Katrin Scheinemann, MD
and Ute Bartels , PhD
Date: February 11, 2016
ABSTRACT
This research examined pediatric oncologists coping strategies when their patients
died of cancer. Twenty-one pediatric oncologists at 2 Canadian pediatric academic
hospitals were interviewed about their coping strategies when patients died or were
in the process of dying. The grounded theory method of data collection and data
analysis were used. Line-by-line coding was used to establish codes and themes
and constant comparison was used to establish relations among emerging codes
and themes. Pediatric oncologists used engagement coping strategies with primary
and secondary responses including emotional regulation (social support and
religion), problem solving (supporting families at end of life), cognitive restructuring
(making a difference and research), and distraction (breaks, physical activity,
hobbies and entertainment, spending time with own children). They also used
disengagement coping strategies that included voluntary avoidance
(compartmentalization and withdrawing from families at end of life). Given the
chronic nature of patient death in pediatric oncology and the emotionally difficult
nature of this work, medical institutions such as hospitals have a responsibility to
assist pediatric oncologists in coping with this challenging aspect of their work.
Future research is needed to evaluate how best to implement these changes on the
institutional level to help oncologists cope with patient death and the effect of using
these strategies on their quality of life.

18. Can art therapy reduce death anxiety and
burnout in end-of-life care workers? a quasi-
experimental study.
Author/s: S Potash J., Hy Ho A., Chan F., Lu Wang X., Cheng C.
Date: May 2014
Abstract
BACKGROUND:
The need for empathy and the difficulties of coping with mortality when caring for the
dying and the bereaved can cause psychological, emotional, and spiritual strain.
OBJECTIVE:
The aim of this study was to examine the effectiveness of art-therapy-based
supervision in reducing burnout and death anxiety among end-of-life care workers in
Hong Kong.
METHODS:
Through a quasi-experimental design, 69 participants enrolled in a 6-week, 18-hour
art-therapy-based supervision group, and another 63 enrolled in a 3-day, 18-hour
standard skills-based supervision group (n=132). Pre- and post-intervention
assessments were carried out with three outcome measures: the Maslach Burnout
Inventory-General Survey, the Five Facet Mindfulness Questionnaire, and the Death
Attitude Profile-Revised. The data was analysed using paired sample t-tests.
RESULTS:
Significant reductions in exhaustion and death anxiety and significant increases in
emotional awareness were observed for participants in the art-therapy-based
supervision group.
CONCLUSION:
This study provides preliminary evidence that art-therapy-based supervision for end-
of-life care workers can reduce burnout by enhancing emotional awareness and
regulation, fostering meaning-making, and promoting reflection on death.

19. Helping Nurses Cope with Grief and
Compassion Fatigue: An Educational
Intervention
Author/s: Dereen Houck, RN, MSN, OCN
Date: August 2014
Oncology nurses may experience intense physical and emotional exhaustion,
identified in the literature as symptoms of cumulative grief and compassion fatigue,
with significant consequences for both nurses and organizations. The first step in
preventing these consequences is recognition.
Organizations should provide nurses with resources including education, counseling,
and opportunities to grieve. Nurses need to learn the importance of work-life
balance, self-care strategies, and communication skills. Using recommendations
from the literature, an educational intervention was designed with the purpose of
providing nurses with knowledge, skills, and resources to practice effective self-care
and recognize when assistance is needed. The program’s objective was to help
nurses develop the coping skills and inner resources necessary to maintain their
emotional and physical health.

20. How nurses cope with patient death: A
systematic review and qualitative meta-
synthesis
Author/s: Ruishuan Zheng, Susan Lee & Melissa Bloomer
Date: July 2017
Abstract
Aims and objectives:
To review literature on nurses' coping strategies with patient death.
Background:
Dealing with the loss of a patient was viewed as one of the most demanding and
challenging encounters in clinical practice. Those nurses who are not competent in
coping with patient death may be inadequate in supporting dying patients and their
family members, and minimise the quality of end-of-life care. To get a broader
understanding of how nurses cope with patient death and to develop meaningful and
effective interventions, a systematic review which would help underpin the
multidimensional approaches is needed. Design: A systematic review.
Methods:
Exhaustive searching in ten databases: CINAHL Plus, EMBASE, MEDLINE, AMED,
PsycINFO, ProQuest Health & Medical Complete, ProQuest Dissertations & Theses
Global, Google Scholar, EThOS and CareSearch. Meta-aggregation was used to
synthesise the findings of the included studies.
Results:
This systematic review aggregated ten categories from the sixteen qualitative
studies included, and then two synthesised findings were derived: intrinsic resources
and extrinsic resources. The intrinsic resources consisted of setting boundaries,
reflection, crying, death beliefs, life and work experience, and daily routines and
activity. The extrinsic resources were comprised of talking and being heard, spiritual
practices, education and programmes, and debriefing.
Conclusion:
This systematic review synthesised the findings about what resources nurses use
when coping with patient death and made recommendations on future directions.
Areas which could be developed to improve deficiencies that nurses had when faced

21. with the losses of their patients were identified. Nurses need more support
resources, which better assist them in coping with patient death. Relevance to
clinical practice: The results of this systematic review could provide evidence for
nurses' coping strategies when dealing with patient death, and the recommendations
could be employed by nurses to cope with the losses of patients.
Coping of staff nurses in losing patients:
assessment utilizing the developed coping
interventions tool for nurses (CIT-N)
Author/s: John Christian V Villanueva
Date: February 27, 2019
Abstract
Nurses encounter death more than most. Death is inevitable and also a reality of life
that everyone has to deal with. This descriptive research aimed to assess the coping
of staff nurses utilizing the developed Coping Interventional Tool for Nurses (CIT-
N).1 A total of 51 staff nurses from two-respondent hospitals were selected based on
the set criteria. Later, the studies revealed that majority of the staff nurses, in both
respondent hospitals, were observed to be high in their coping after losing patients.
In addition, there is no significant difference between their assessed coping. For
Hospital A, delivering their nursing care to the dying patients with utmost
professionalism and believing that acceptance plays a vital role in the process
commonly contributed in their coping after losing patients. For Hospital B, it is still
grateful that their rendered nursing services adds to the quality of life towards the
peaceful death of the dying patients.

22. Self-competence in death work among health and
social care workers: a region-wide survey in Hong
Kong
Author/s: Cheung, J.T.K. & Au, D.W.H. & Chan, W.C.H
Date: November 15, 2017
Abstract
Background: According to the Quality of Death Index, Hong Kong is lagging behind
many other Western and Asian countries in the category of palliative and healthcare.
To ensure the provision of high-quality palliative care, it is important to explore the
self-competence of health and social care workers in coping with death work
including palliative care. This region-wide study aims to assess the level of self-
competence with a validated Self-Competence in Death Work Scale (SC-DWS) and
examine its correlates.
Methods: The SC-DWS was administered to a cross-sectional convenience sample
of health and social care workers across eight healthcare institutions between
January and October 2016. Total scores for the 16-item SC-DWS and its Existential
and Emotional subscales were calculated. We then examined sociodemographic
variables (e.g., age, profession, place of employment) in relation to the total and
subscale scores using multiple linear regression. Coding was conducted on
responses to a final open-ended question asking about the personal views of the
workers towards their self-competence in death work.
Result: We collected data from 885 health and social care workers. Mean score of
the SC-DWS was 60.16 (range: 16 – 80), while its Existential and Emotional
subscales scored 37.90 (range: 10 – 50) and 14.46 (range: 4 – 20) respectively.
Four categories of personal view towards self-competence in death work including
(1) personal resources; (2) existential challenges and coping; (3) emotional
challenges and coping; and (4) personal recommendations on improving self-
competence were identified. In multivariate analyses, workers aged 50 or above,
divorced, working in Hospice A, Rehabilitation Hospital B (where a quality
improvement initiative in end-of-life care was implemented) and Acute Hospital B (a
Christian institution with strong caring culture) and with personal bereavement
experience had significantly higher scores, whereas nurses scored significantly lower
than less-educated personal care assistants.
Conclusion: There is still room for improvement in self-competence in death work
among health and social care workers, particularly the young, nurses and those

23. working in acute hospitals. Future initiatives should involve identifying barriers in
individual healthcare institutions. Training of the provision of palliative care is
necessary.
Impact of Death Work on Self: Existential and
Emotional Challenges and Coping of Palliative Care
Professionals
Author/s: Wallace Chi Ho Chan, Agnes Fong, Karen Lok Yi Wong, Doris Man Wah
Tse, Kam Shing Lau, Lai Ngor Chan,
Date: November 27, 2015
Abstract
Palliative care professionals, such as social workers, often work with death and
bereavement. They need to cope with the challenges on “self” in working with death,
such as coping with their own emotions and existential queries. In this study, the
authors explore the impact of death work on the self of palliative care professionals
and how they perceive and cope with the challenges of self in death work by
conducting a qualitative study. Participants were recruited from the palliative care
units of hospitals in Hong Kong. In-depth interviews were conducted with 22
palliative care professionals: five physicians, 11 nurses, and six social workers.
Interviews were transcribed to text for analysis. Emotional challenges (for example,
aroused emotional distress from work) and existential challenges (for example,
shattered basic assumptions on life and death) were identified as key themes.
Similarly, emotional coping (for example, accepting and managing personal
emotions) and existential coping (for example, rebuilding and actualizing life-and-
death assumptions) strategies were identified. This study enhances the
understanding of how palliative care professionals perceive and cope with the
challenges of death work on the self. Findings may provide insights into how training
can be conducted to enhance professionals’ self-competence in facing these
challenges.

24. Nursing Students’ Reflections on the Death
Process
Author/s: Hanzeliková Pogrányivá, A.
García López, M.V.
Conty Serrano, M.R.
López Davila Sánchez, B.
Barriga Martín, J.M.
Martín Conty, J.L.
Date: January 2014
ABSTRACT
One’s attitude toward and fear of death in the nursing field can determine the quality
of care that a dying patient receives, which makes this topic an important one to
consider and discuss.It is necessary for one to learn to perceive death as a natural
process. Healthcare workers treat dying patients, interpreting the phenomenon of
death as well as death itself through their own personal lens and breadth of
understanding. Training in thanatology and palliative care is scarcely and irregularly
included in regular academic curricula. The objective of this study is to analyze the
contributions of 3rd -year nursing students on the subject of palliative care upon
writing a reflective journal entry about an article that surrounds a nurse’s view on the
process of dying. Phenomenology was used as a methodological instrument which
intended to inductively draw up a standardized explanation of the phenomenon of
death through the students’ expressed thoughts on the matter.
Relating to the attitudes that nurses that work with the terminally ill have towards
death, the following facts stand out as impactful: lack of preparation, ineffective
coping, and personal fears, values, and beliefs. Additionally, uneasiness associated
with the use of life support and the care team’s obstinate insistence on saving what
cannot be saved is predominant. The results emphasize a very elevated level of the
nurse’s emotional involvement in caring for a dying patient. Specific preparation
geared toward a better adaptation in working with terminal patients has been
identified as a fundamental pillar for nurses in this line of work. Personal interest and
emphasis on occupational excellence also stand out as influential factors.It is very
important to analyze the problems regarding this “environment of death” and its
impact on nursing students. Qualitative research in this field could be a useful tool in
detecting worries and uncertainties surrounding this matter.

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