Although allogeneic stem cell transplantation (SCT) may cure many hematologic malignancies and non-hematologic conditions, unfortunately, the mortality rate from graft-versus-host disease (GVDH) is 25%-40%, depending on patient risk factors. Oncology nurses who care for patients with GVHD must build resilience to better care for their patients and themselves.
Amy E. Rettig, DNP, MALM, RN, APRN-BC, discussed resiliency in nursing at the 2023 Tandem Meetings, Transplantation & Cellular Therapy Meetings of ASTCT and CIBMTR.
What Is Resilience?
Resilience is a buzzword these days that oncology nurses may be tired of hearing. However, it is critical for a sustainable career in oncology nursing. Resilience is “the ability of an individual to positively adjust to adversity.” For example, “personal protective factor” is an analogy for resilience to navigate stressful circumstances. Stress management is dealing with an issue, typically after the occurrence of a challenging situation. On the other hand, resilience is strength-building and strategies to withstand stressful events before they occur.
Dr. Rettig from the Ohio State University, James Center Hospital, Columbus, OH, presented a session titled “Resiliency in Nursing” at the 2023 Tandem Meetings. She explained that there are “no pills or sprays or clinical trials or drinks or potions,” so oncology nurses must build their own resilience. Her key message was simple:
Resilience = Sustainment
3 Ways to Build Resilience
Oncology nurses can develop a plan for personal resilience to survive and thrive while caring for patients with GVHD. Resilient nurses take action to maintain and constantly build their resilience. Identifying personal grief, monitoring energy levels, and fine-tuning stress management strategies are just 3 key strategies to promote resilience for a sustainable career in nursing.
- Identify your grief
Some patients with GVHD physically die, but others psychologically grieve the loss of certain aspects of their lives. Oncology nurses witness patients mourning the loss of relationships, disruptions in the normal developmental process such as work or school, changes to their bodies, and loss of health. Dr. Rettig explained that “every death [loss] that happens in your career has an impact on us. The very first grief experience helps set a lens of how you are going to see loss and death in the future.”
The first step in processing grief is to identify and name it. Next, realize that grief is not just from death. For instance, Dr. Rettig suggested that having one’s idea at work dismissed can cause suffering or grief. Bereaved oncology nurses may experience anger, depression, frustration, helplessness, hopelessness, and being overwhelmed. After identifying your grief, explore coping methods by checking out these 6 strategies.
- Monitor your fatigue
Oncology nursing is stressful. It involves long hours, rotating or extra shifts, demanding physical labor, missed snacks or meals, limited bathroom breaks, and sleep deprivation. In addition, many often drink lots of caffeine and do not stay hydrated. All these actions can lead to significant fatigue. Pay attention to your fatigue level. Using a 0-10 scale, with 0 being full of energy and 10 being fatigued, what number do you give yourself on most days?
Dr. Rettig emphasized that oncology nurses need to “monitor their bodies.” Fatigue, anxiety, depression, difficulty sleeping, physical issues (eg, headaches, gastrointestinal issues), and frequent illness are some symptoms of unhealthy stress levels. By monitoring your body’s reaction to stress, you can better manage it.
- Fine-tune stress management skills
Caring for SCT patients, particularly those living with GVHD, can increase stress levels among oncology nurses. At the 2023 Tandem Meetings, Dr. Rettig asked oncology nurses working with SCT patients how they handle stress. Their responses ranged from eating junk food to drinking alcohol—mostly non-healthy coping skills. Instead, consider more beneficial strategies. For example, pets, music, aromatherapy, meditation, and laughter are some ways to shut off the release of stress hormones and turn on positive responses.
Dr. Rettig suggests a natural body function to mitigate stress and symptoms: breathing. Oncology nurses are aware of breathing and mindfulness as coping strategies. However, they often forget to pause and focus on their own breathing. Dr. Rettig stressed that deep breathing is a powerful intervention because it is attached to both sides of the brain—sympathetic and parasympathetic—and can be done anywhere at any time.
Building resilience is critical for all nurses, particularly oncology nurses and those working with SCT patients. Adding the complexity of GVHD management can create another stressor. According to the American Nurses Association Code of Ethics, nurses have a duty to themselves and others, which makes self-care a professional responsibility. When oncology nurses care for their own health by creating a resilience plan, it is reasonable to think that this will help them better care for their patients.
2023 Tandem Meetings: Dr. Amy Rettig
Mindfulness Meditation for Oncology Nurses