“After the death of a patient, surviving family members are at increased risk for depression, anxiety, post-traumatic stress disorder, complicated or prolonged grief, and social distress,” Kelly Preti, MSN, RN, AGACNP-BC, OCN^®, PMGT-BCTM, Elizabeth Giles, MSN, RN, AGPCNP-BC, CHPN, and ONS member Mary Elizabeth Davis, DNP, RN, CHPN, AOCNS^®, wrote.

How Condolence Cards Help

According to the World Health Organization and the National Consensus Project for Quality Palliative Care, caring for bereaved family members is an integral part of palliative care. Bereavement practices such as sending condolence cards can support deceased patients’ family members and healthcare providers through the grieving process, Preti et al. said.

Having worked in multiple oncology settings and developed relationships with patients and their families, Preti said she wanted to do more for bereaved families after the death of a patient as well as support healthcare professionals. “With nursing burnout being a major issue today, I wanted to offer nurses and patient-facing staff a resource to prevent or reduce burnout,” Preti said.

Preti and her team uncovered evidence to support that “although the goal of writing a condolence card is to support bereaved family members, the act of writing a condolence card can positively affect healthcare staff, providing them with closure when grieving the loss of a patient” and “follow-up responses from families, although unexpected, can help prevent burnout by allowing healthcare staff to exchange a final farewell with the family and hear the impact of their actions.”

They also noticed a knowledge gap among healthcare professionals about bereavement practices. “Nursing programs often lack intensive training on bereavement practices and end-of-life care,” Preti said. “My aims with this project were to educate staff on the practice of writing condolence cards and to provide the resources for staff to incorporate the practice into their workflow.”

The Art of Writing a Condolence Card

Prior to the program initiation, nearly 65% of staff on a medical-surgical unit reported that they had no experience writing condolence cards. In response, Preti and her team designed the project to:

• Prepare nurses and other staff to write condolence cards.
• Help staff incorporate the practice into their workflows.
• Support deceased patients’ family members and staff during the grieving process.

The educational component consisted of a short module that focused on the benefits of condolence cards and tips for writing, including the five main components of an effective condolence card:

• Expression of sorrow for the death
• Recall of specific memories
• Appreciation for having cared for the patient
• Offer of support
• A warm closing

The training encouraged staff to use specific memories and sincerity to develop a heartfelt and effective message and recommended against generic statements or revisiting details of the death. Participants also learned that two weeks after a death is the ideal time to send a condolence card and that “sending too soon or too late could yield negative outcomes,” Preti said.

Program participation was voluntary because the team was concerned that required participation might affect the cards’ quality and sincerity. “We encouraged patient-facing staff who had formed a relationship with the deceased patient to participate if they wished,” Preti said.

Effect on Healthcare Staff

On the program’s evaluation survey, 100% of staff answering the questions said that the practice did not disrupt their workflows and that they would continue writing condolence cards beyond the project time period. Prior to the program, 64% of participants had little experience in writing condolence cards. Additionally, 94% said the practice gave them a sense of closure.

The project team didn’t solicit responses from card recipients because of ethical reasons; however, Preti said that “all of the voluntary feedback that we received from family members of deceased patients was positive, thanking us for sending the cards and caring for their loved ones.”

Preti personally attested to the benefits she’s obtained from writing condolence cards. “Sending condolence cards to family members of my deceased patients has provided me with a sense of closure and supported me through the grieving process, especially when recalling positive memories of patients,” she said.

Grief, particularly cumulative grief, can take a deep toll on nurses’ mental health. Find evidence-based resources for coping with grief in the sidebar.