The acknowledgment and normalization of grief, loss, and other emotions are crucial to the well-being of oncology staff, said Sandra Tan, LCSW, ACHP-SW, Palliative Care Social Worker, Thomas Johns Cancer Hospital, Richmond, VA, at the 2016 Association of Community Cancer Centers National Oncology Conference.
On average, 15 patients with cancer die monthly in inpatient units, and hospital staff can become very close to these patients. “We wanted to offer something to staff beyond just touching base with them throughout the day when they’re too busy to really divulge,” said Ms Tan.
Staff often regret missing the chance to say goodbye to their patient’s family members, in addition to lamenting the loss of their patient. To address this issue, she worked closely with a chaplain to create a “service of remembrance” for family members and staff at her hospital.
The service was designed to fulfill 3 main requirements—“To create an intimate environment where people can feel connected and safe, to offer opportunities for staff to participate in an event (before, during or after), and to incorporate a ritual acknowledging the person who died,” she said.
“But as we all know, when staff attend a service of remembrance, they still feel like the caregiver and can’t really get to those feelings of sadness in front of the family,” said Ms Tan. So she and her team created a reflection service designed for staff only. “This service enables us to create an intimate environment where staff feel heard and can share emotions,” she added.
“Eat, Play, Reflect”
The reflection service allows staff to acknowledge and normalize their emotions, and to recognize the importance of self-care. It also brings together members of different departments, all of whom may be grieving the loss of the same patients. The voluntary service helps these staff members, who do not typically communicate, to laugh and relax, recall stories, and share memories and emotions. “We call the service ‘Eat, Play, Reflect’ to make it more playful, to make something light about it,” she said.
Ms Tan underlined the importance of providing food, because staff may only be able to attend the service briefly and between duties, when they may typically go get something to eat. They play soft music and use aromatherapy, and play a slideshow of the patients who died.
“The slideshow is very subtle, but helps staff to remember their patients, and stories start to flow––of laughter or frustration––but that’s how people start to communicate,” she said. “We like to balance it with thank you letters that staff members have received so they’re reminded of how much their care meant.”
The service focuses on asking staff questions in order to access deeper emotions, she said. Questions such as, “How does grief manifest in you (in the body, daily living)?” “How do you normally express grief?” “What kind of support is most meaningful and least helpful to you during this time?” “What practical and emotional needs do you have?”
Art has been helpful in getting staff to express emotions that they may find difficult to share, said Ms Tan. Some common themes have emerged from these exercises. For example, staff feel they must be “the rock,” and this means hiding their feelings; staff feel frustrated that they are not able to do more for their patients; and staff lack the time to process their patient’s death and have to compartmentalize their emotions. They also do not want to take their emotions home, but when they do, they often cry by themselves (in the bathroom, shower, car).
“It’s very powerful to have a room of staff together sharing their coping mechanisms,” she said. “By saying them out loud and seeing other colleagues cry, it almost gives them permission to feel and touch that emotion.”
Feedback and Observations
The service has been helpful to new and seasoned staff, because even seasoned staff struggle. They find it cathartic to normalize their emotions, and they value the exchange between coworkers that creates more unity in the hospital. Ms Tan reported that all participants would like to continue the service 2 to 4 times annually, and many have expressed the desire for additional coping mechanisms.
They plan to have twice-yearly reflection services and twice-yearly exercises, with a focus on education, teaching mindfulness, self-compassion, resilience, and coping mechanisms for grief.
“We have so many experiences, but we always just jump to the next one and keep everything inside,” she said. “But we want to stress the importance of reflecting on those experiences.”