Pediatric Oncology Intervention Focuses on a Common Adverse Effect of Nursing

Nurses who care for children with cancer practice in one of the most challenging and fraught subspecialties of a difficult profession. Nursing is not restricted to the care of an individual patient for a limited period of time; it often involves a relationship with the child’s parents and family during the long course of the patient’s illness and possible death. Compassion fatigue is a constant risk.¹

A group of nurses at the St. Jude Children’s Research Hospital in Memphis, Tennessee, recently reported on a project designed to reduce compassion fatigue in the facility’s pediatric oncology nurses. For the project, the group evaluated the impact of an evidence-based compassion fatigue program on nurse-reported burnout, secondary traumatic stress, and compassion satisfaction. They also sought to measure the program’s effect on correlated factors of resilience and coping behaviors.

The study came about because there was concern about compassion fatigue among the nursing staff at St. Jude. The group undertook a 6-month quality improvement pilot program on a 20-bed unit at the hospital. Fifty-nine registered nurses, aged 20 to 29, participated; 5 were men. Only 37 of the 59 participants completed the study due to maternity leave, unit transfer, or they were lost to follow-up. At intervals before, during, and after the study, the researchers used the Professional Quality of Life Scale V (ProQOLV) to gauge compassion fatigue and compassion satisfaction, defined as fulfillment resulting from performing a job well and from helping others; and they measured coping and resilience with Brief COPE and the Connor-Davidson Resilience Scale-2.

Self-Care in the Forefront

Study participants were given a binder with educational materials that explained compassion fatigue, compassion satisfaction, and how they could enhance their professional quality of life. The materials covered health and wellness, grief and bereavement, and the advantages of using the respite room.

Health and wellness information included nutrition support through individual consultations with a clinical registered dietitian, who also offered healthful snacks such as granola bars, blueberries, and kale smoothies. Project-related resources included a monthly compassion satisfaction newsletter, which contained healthful recipes; physical activity resources, including health coaching; and access to a fitness center free-of-charge, as well as hand weights and yoga mats in the respite room. Also included were shift-sensitive guidelines, information about maintaining a good sleep schedule, and instructions for exercises easily performed at the nurses’ station. Each participant received a Fitbit One™ calorie, activity, and sleep tracker as an incentive to help monitor and reach health and wellness goals.

Grief and bereavement support includes a monthly Time of Remembrance session established by the spiritual care service in memory of patients who had recently died. During this session, participants can share memories and write messages on papers that are then folded into origami cranes for display in the respite room. After a patient dies, staff members from the spiritual care and quality of life services are readily available to nurses individually or in groups for debriefing and counseling. In addition, sympathy cards were placed in each nurse’s education binder. The nurse could send these to the families of children when they died, in a gesture that helped with closure for all.

The respite room was a converted consultation room on the inpatient unit. In addition to the yoga mats and hand weights, the room had comfortable seating, soft lighting, and reading material on self-care and relaxation techniques for those seeking nonphysical activities. There was quiet music to promote relaxation and mindfulness for the soul, and a mini fridge stocked with healthful snacks and drinks for the body.