Skills of Grief Counseling Among Health-Care Workers

The results of our survey showed that the average SGCS score among health-care workers was 18.96 ± 4.66, with a mean score rate of 59.2%. This indicated that health-care workers’ grief counseling skills need to be improved urgently. The following 2 reasons may explain this phenomenon. First, it is likely that a large number of Chinese health-care workers have not received systematic grief counseling training. ^{Reference Gao, Kong and Fan24} Unlike some developed countries that have established a complete grief counseling system, grief counseling is still in its preliminary stage in China. ^{Reference Zhou25} As mentioned before, grief counseling has not been included in the medical curriculum in China. ^{Reference Luo and Fu17} Nevertheless, it is gratifying that more and more Chinese hospitals have realized the importance of grief counseling and have started providing relevant training for their health-care workers in recent years. ^{Reference Cui, Li and Zhao26} Second, some of the health-care workers on the frontline of pandemic fight had limited experience of receiving bereaved families in their previous work, which also resulted in their poor grief counseling skills. During the COVID-19 outbreak period, health-care workers from almost all departments were mobilized to deal with issues of insufficient human resources in Wuhan. ^{Reference An, Ye and Chen27,Reference Liu, Wang and Chen28} Generally speaking, health-care workers from the emergency department, intensive care unit, and oncology department are more likely to contact bereaved families. Hence, a large proportion of health-care workers lack sufficient experience in receiving bereaved families.

Attitudes of Grief Counseling Among Health-Care Workers

The average AGCS score among health-care workers was 33.36 ± 8.70, with a score rate of 66.6%, indicating that the attitude of grief counseling among health-care workers toward bereaved families of COVID-19 victims was not very positive. The following 3 reasons may account for this result. First, job burnout among health-care workers may have an impact on their attitudes toward grief counseling. An emergency hierarchical medical system was established in Wuhan during the first quarter of 2020. ^{Reference Peng, Tu and Yang29} A total of 51 hospitals were transformed into COVID-19–designated hospitals by the Wuhan municipal government; these hospitals were responsible for treating patients with severe clinical symptoms. ^{Reference Fang, Pan and Li30,Reference Li, Lu and Zhang31} As the pandemic progressed, tens of thousands of patients flooded into these COVID-19–designated hospitals, leading to severe shortages in hospital personnel. ^{Reference Liu, Wang and Chen28} Many health-care workers in Wuhan had to continuously work overtime, resulting in different degrees of job burnout. ^{Reference Mo, Deng and Zhang32,Reference Wu, Wang and Luo33} Previous research demonstrated that job burnout of health-care workers may cause compassion fatigue. ^{Reference Zhang, Zhang and Han34} Thus, it is reasonable to infer that a huge workload may have weakened the compassion of health-care workers toward bereaved families to some degree. Second, it is possible that psychological issues among health-care workers affected their service attitudes. A vast number of health-care workers suffered from psychological issues, such as depression, fear, and anxiety in combating the COVID-19 pandemic. ^{Reference Lai, Ma and Wang35,Reference Van Mol, Kompanje and Benoit36} While health-care workers struggled with severe acute respiratory syndrome, their psychological issues had a negative impact on their work attitude. ^{Reference Maunder, Lancee and Balderson37} These health-care workers afflicted by various psychological problems engaged in a series of unprofessional behaviors and poor work performance, such as decreased punctuality, less contact with patients, and reduced working time. ^{Reference Maunder, Lancee and Balderson37} Last, bereaved families’ behaviors will also affect the of health-care workers’ attitudes toward grief counseling. Among Chinese, death is regarded as a taboo topic whose mention is usually avoided in social interactions. When relatives pass away, Chinese either bear the grief alone or seek comfort from family members. ^{Reference Zhang, Zou and Zhang38} Because bereaved families in China rarely seek help from health-care workers, health-care workers take for granted that they are not responsible for offering grief counseling service to the bereaved.

Factors Affecting Skills of Grief Counseling Among Health-Care Workers

Our research demonstrated that the potential influencing factors of grief counseling skills comprised of sense of responsibility, frequency of contact with bereaved families, and relevant training. To begin with, we found that possessing a strong sense of responsibility was closely related to health-care workers’ good grief counseling skills. It is likely that a responsible health-care worker will not only devote much attention to a patient’s condition but also show concern for bereaved families. Responsible health-care workers have accumulated abundant experience in the process of receiving bereaved families, which has continuously improved their skills. Next, we found that health-care workers with more experience receiving bereaved families in general are better equipped to offer grief counseling. This result was generally consistent with that of previous research. ^{Reference Dai, Xia and Ma19,Reference Gao, Kong and Fan24} It is likely that, during frequent contacts with bereaved families, health-care workers not only realized the need for grief counseling but also grasped stronger communication skills. If grief counseling training is carried out in the future, it is recommended that trainers should specifically focus on health-care workers with less experience of receiving bereaved families. Last, health-care workers who have received relevant training have significantly better grief counseling skills. Relevant training included grief counseling, grief therapy, death education, and hospice care. ^{Reference Zhang23} Luo and Fu’s research also proved that relevant training can help Chinese health-care workers quickly master the theory and practical skills of grief counseling. ^{Reference Luo and Fu17}

Factors Affecting Attitudes of Grief Counseling Among Health-Care Workers

Our research demonstrated that the potential influencing factors of attitudes of grief counseling are other grief counseling skills, communication skills, education background, and relevant training. First, we found that the stronger their skills of grief counseling health-care workers were, the more positive their attitudes would be. Other grief counseling skills included health education skills, grief risk assessment, psychological interventions, and self-emotional regulation. ^{Reference Zhang23} This result was aligned with a previous research. ^{Reference Dai, Xia and Ma19} It is likely due to the fact that health-care workers with excellent abilities in grief counseling often have rich practical experience in grief counseling emphasizing strong humanistic care. Therefore, they are more enthusiastic about getting involved in efforts related to bereaved families. Second, we found that health-care workers’ communication skills were closely related to their attitudes of grief counseling. Communication skills included counseling skills, empathy ability, listening ability, and expressive ability. ^{Reference Zhang23} This is probably because health-care workers with good communication skills can often accurately and rapidly grasp the personality characteristics and psychological condition of bereaved families, and choose the corresponding communication strategy. Third, the higher the education level of health-care workers, the more positive their attitude toward the bereaved. In addition to receiving abundant training as part an advanced medical curriculum, highly educated health-care workers have a better comprehensive quality, which enables them to implement the concept of humanistic medicine in clinical work. Finally, this research showed that after receiving relevant training, health-care workers can clearly improve their attitude toward grief counseling. The relevant training included death education, life education, hospice care, grief counseling, and grief treatment. It is strongly recommended that relevant training or education should be offered to health-care workers as soon as possible.

To this end, the following suggestions are put forth. First, grief counseling is a complex systematic task involving multiple professionals, including health care workers, grief therapists, psychological counselors, psychiatrists, social workers, and family therapists. A hospital-community information system should be established so that health care workers can share the therapeutic process of the deceased with family therapists and social workers. In this way, social workers and family therapists can provide more targeted grief counseling to bereaved families. Second, a standardized training course should be established immediately in China. Because the threat posed by the pandemic remains, online public classes, webcast, and short videos are recommended for training. Health care workers with lower education levels and health care workers with less experience of receiving bereaved families should be paid more attention to in the training. Third, it is necessary to strengthen the promulgation of grief counseling in China. Workers in communities, schools, and hospitals can all be mobilized to publicize and popularize the concept of grief counseling to the public.

Limitations

Several limitations of this research should be considered. First, as a cross-sectional survey, this research could only assess the status of grief counseling at a specified time without follow-up observations of the health care workers. Second, due the limited number of hospitals that participated in this survey, our sample size might be too small to generalize the results. Thus, it is necessary to carry out a larger scale research in the future. Finally, as AGCS and SGCS are relatively new scales, so they may not have a history of much use. Considering the urgency of the COVID-19, time stresses did not allow us to test these scales fully ahead of use.