Dr Caroline Phelan1, Dr Raechel Damarell1, Dr Claudia Virdun1, Dr Elizabeth Miller1
1Research Centre for Palliative Care, Death and Dying, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
Biography:
Dr Caroline Phelan teaches into the Postgraduate Palliative and End of Life Care programs at Flinders University and is an active clinical and health professional education researcher. She is part of the Flinders Research Centre for Palliative Care, Death & Dying, where she applies critical theories to address complex healthcare challenges. Caroline is also co-lead on End-of-Life-Essentials, a Commonwealth-funded project that provides online learning opportunities and practice resources for doctors, nurses and allied health professionals to improve the quality and safety of End-of-Life care in hospitals.
Abstract:
Background:
Acute care clinicians frequently encounter patient death and dying, often without the formal supports of specialist palliative care. While individual losses may be expected, repeated exposure is increasingly recognised as an occupational hazard. Literature links this exposure to burnout, compassion fatigue, and moral distress, yet organisational responses remain inconsistent. Education and training may offer support, but their effectiveness in addressing the emotional and ethical toll in generalist settings is unclear.
Aims:
This scoping review aims to map evidence on how cumulative exposure to death and dying affects acute care staff, and the role of education as a support strategy.
Methods:
We included English-language studies (all designs) published since 2010 that examined burnout or related psychological hazards linked to exposure to death and dying in acute care settings in high-income countries. Studies focused on specialist palliative care were excluded. Searches across four databases were followed by dual review at title/abstract and full-text stages. Data extraction focused on setting, impact type, organisational interventions, and implications for education/training.
Results:
Of 1847 citations, 94 met eligibility. Preliminary mapping shows most studies examine burnout (26%) or emotional distress (25%), focus on nurses (85%), and adult or paediatric ICU settings (57%). Over half are cross-sectional studies (surveys) while only 16% describe an intervention. Most studies identified insufficient staff training as a contributing factor, with 70% recommending education to mitigate the impact of repeated exposure to death.
Conclusions:
Preliminary analysis suggests limited attention to organisational responsibility in addressing cumulative exposure effects. However, most studies highlight staff training as a key support strategy to equip clinicians with the skills and resilience to manage emotional toll. Final findings will inform targeted educational campaigns within the End-of-Life Essentials program, advocating for workforce education as a core organisational responsibility to promote staff wellbeing and ethical care delivery.