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Caregivers experience many losses during downsizing. Four specific approaches can help resolve its adverse effects: making conscious decisions; grieving to completion; trusting alternative approaches; and connecting with others. A chaos model of grief helps caregivers recognize each stage of the recovery and complete the grieving process. [ABSTRACT FROM AUTHOR]

Purpose/objectives: To explore dream work as a possible means for nurses to increase self-understanding and problem solving in personal and professional life., Design: Hermeneutic phenomenologic, descriptive, and interpretive., Setting: A comprehensive cancer center in the southern United States., Sample: Six nurses with a mean age of 40 and 1-10 years of oncology nursing experience., Methods: Interviews, guided by descriptive and interpretive phenomenology, were conducted with nurses before and one and six months after they participated in eight weekly sessions of a group focused on dream work. Phenomenologic analysis was done on verbatim transcriptions of all interviews., Findings: Nurses found value in participating in dream groups, including having more open discussions about feelings and death, managing difficult situations, and attending to patients in the present., Conclusions: The value of learning to attend to dreams may be subtle but has value to nurses., Implications for Nursing: Incorporating dream work is one holistic intervention that may be useful to improve job satisfaction, communication, and relationships in this time of nursing shortage.

Background: Patient communication is a cornerstone of comprehensive oncology nursing care. Oncology nurses, however, do not appear to receive much advanced training in communication skills and many nurses do not feel adequately trained in this area., Method: We designed a 33-item questionnaire to assess nurses' perceived level of difficulty and skill in a variety of common clinical situations where patient communication was a challenge. Three hundred fifty oncology nurses in a major cancer center completed the questionnaire., Results: Nurses rated areas where they addressed the physical complaints (pain, fatigue, appetite and weight loss) as least challenging and areas in which they were most prepared. Several items ranked as most difficult and where nurses felt they had the least skills had to do with issues related to death and dying, especially requests for euthanasia and patient loss. Advanced practice nurses rated their perceived communications skills more highly in several different areas., Conclusion: The communication challenges faced by oncology nurses require skills that go beyond simple supportive techniques like empathy and listening. Teaching advanced communications skills geared to specific problems identified by nurses may be useful.