Does the implementation of a nurse-facilitated guided reflective exercise following patient death in adult ICUs impact nursing emotional response?

By Erica Kuntz, RN

Background

In the ICUs, nurses are exposed to death frequently and do not always have the tools to process the emotions that accompany it. This puts them at risk for moral distress and Second Victim Syndrome.

PICO Question

Does the implementation of a nurse-facilitated guided reflective exercise following patient death in adult ICUs impact nursing emotional response?

Methods

-Assess ICU nurses’ current practices related to death
-Develop a guided reflective exercise to be used post-death
-Provide education to nurses on reflective exercise
-Elicit nursing response

Results

16 reflective exercises were completed, with the highest number being done with “do not resuscitate” order patients, correlating to the expectation of death.

Discussion

Performing the guided reflective exercise allowed many nurses to process the complex feelings related to death in a supportive environment with coworkers. The main success was the development and availability of a standardized script for the guided reflective exercise. The highest rate of completion was on the author’s home unit.

Implications/Conclusion

There are strong, positive responses to performing a guided team reflective exercise following a patient’s death. Many nurses were able to report feelings of togetherness, inclusion, and peace following patient deaths. Patient families were included in three of these exercises, and all included positive interactions.