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DISCUSSION
None of these situations are unusual for oncology nurses. We see a myriad of family reactions to poor prognosis and impending death. Grief takes on so many faces, and masquerades in ways that can be confusing. Having 3 complicated situations back to back created and aggravated the stress level of the nurses on the oncology unit. None of us could change what was happening with the patients, and our interactions with each of these families presented challenges. What we could do was acknowledge how difficult it was, provide support for the families, and most importantly provide support for each other.
It is easy to wade into messy situations and inadvertently make them messier. It is easy to be drawn into complaining about difficult families, easy to retell details of the interactions, and easy to get frustrated. How we support each other through these challenges is something we can anticipate and control. We need a care plan for ourselves in these situations. One way to provide that is by debriefing. Too often we move on to caring for our next patient and the anecdotes of those difficult family dynamics become almost folklore — “Remember that family we had to call a code gray on?” “Remember how Brad used to drive us all crazy?” Debriefing does not have to be formal; it can be a nurse-to-nurse endeavor. And it can start as soon as we recognize that we are in a stressful patient situation. Instead of shrugging our shoulders and moving on we can acknowledge the complexity of what is happening. Rather than moving on it makes sense sometimes to stay in that moment, to review our feelings and ask ourselves what we might do differently next time. What we did that worked. What we did that didn’t work. What we want to prevent is frustration masquerading as burnout.
Ann Brady is the symptom management care coordinator at the Cancer Center, Huntington Hospital, Pasadena, California.
