Self Care
Providing palliative care and support can be rewarding and challenging. It can also be stressful, so taking care of yourself is essential. When the oxygen mask drops down in an aeroplane, it is important to fix your own mask in place before helping others. If you cannot take good care of yourself, you will not be able to provide good care to your clients. Your organisation should have resources and supports in place for staff to access as part of their workplace health and safety responsibilities, so make sure you use these as part of your self-care.
Self-care means taking care of yourself so that you are able to take care of others. This is particularly important in areas of work that can be stressful and that involve situations where emotions run high, such as palliative care.
Watch
Watch this video to understand the importance of self-care in palliative care work: Self-care Matters – Understanding self-care’ from Palliative Care Australia.
Employers’ Responsibilities
Employers and workers each have responsibilities for managing physical, mental and emotional health and wellbeing. You also have some responsibilities for supporting team members in managing their wellbeing.
Your employer has a responsibility to you under workplace health and safety legislation to provide a safe workplace. This includes addressing mental health issues that may affect staff and providing access to internal and external supports and resources to help resolve issues relating to stressful situations.
Internal supports and resources may include:
Using teamwork structures and peer support mechanisms
The benefits of working in teams includes being able to share the load, share skills and strategies, and support each other when things get tough. Most palliative care services use teamwork for these reasons.
Debriefing procedures following critical incidents
When a dangerous or distressing event occurs, debriefing procedures provide an opportunity for everyone involved to get it off their chest and talk over what happened. This allows you to express your feelings and can reduce feelings of isolation. Sharing thoughts and feelings in a supportive environment is important for addressing possible trauma. These procedures also help the organisation to identify gaps or flaws in their practices and resources, and to act to correct these and prevent further incidents.
Providing adequate training and supervision
Your employer should ensure that you are adequately trained and supervised to carry out your work safely and competently. Work practices that support staff to work safely, within the boundaries of their job roles, and within their range of competencies.
Working within the boundaries of your work
role is an essential self-care strategy and can prevent risks to you, to your clients, and to your colleagues. If you feel you are being asked or expected to take on tasks that are not part of your job role, or to carry out activities that you do not have the skills for, discuss this with your supervisor. This sounds simple enough, but requires good communication skills, the confidence to be assertive, and a good understanding of what your role entails, and of your work rights. effective, open, two-way communication is essential to all these supports. You must be able to communicate effectively and to have confidence in your employer and your colleagues so that you can raise and discuss issues that concern you.
External Counselling or Staff Support Services
Access to external counselling or other support services and resources is often provided to staff as part of the organisation’s workplace health and safety measures. It is sometimes easier for a worker to discuss issues that are causing them stress or distress with a person outside the workplace, in a safe situation where confidentiality is guaranteed. Many organisations within the community services and health industry provide access to counselling from organisations such as Relationships Australia.
Your Self-Care Responsibilities
You have significant responsibilities in relation to your own self-care. You are the best person to identify when you are under stress, not coping, or distressed by something to do with your work. Others may be able to identify behavioral signs of stress, but you are the only one who can really know when you should take action or ask for help. In the long run, soldiering on will not help you or your clients. Identifying and acting on signs of distress early is important. Taking care of yourself is part of your duty of care towards your clients, your colleagues, and your employer.
Self-Care
Self-care includes good nutrition, sleep and exercise, maintaining supportive relationships, engaging in meaningful activities, and using strategies such as meditation and mindfulness to manage stress.
Reading
Explore this link for more information about self-care and watch the short videos included: ‘Self-care matters’ from Palliative Care Australia
Work related burnout is the result of unrelieved, repeated, or chronic work-related stress. It is a state of emotional, mental, and physical exhaustion and results in loss of motivation, feelings of powerlessness and disillusion. Burnout can affect all areas of the person’s life. Stress management and self-care strategies can be effective in preventing burnout. In palliative care, there are several common sources of stress. These include being faced daily with the inevitability of death and dying, dealing with the emotional distress of clients and their families, being confronted with physical, mental, and emotional suffering, ethical issues and dilemmas, and feelings of responsibility and powerlessness.
Stress and burnout are common challenges faced by healthcare professionals working in palliative care settings due to the emotional and often demanding nature of the work.
Here are some examples and case studies illustrating stress and burnout in palliative care:
Case Study
Case Study 1: Compassion Fatigue in Hospice Nursing
Sarah is a dedicated hospice nurse with several years of experience. She has been caring for terminally ill patients and their families, providing physical, emotional, and spiritual support. Over time, Sarah notices that she's becoming emotionally detached and experiencing feelings of hopelessness and helplessness. She finds herself unable to connect with patients as she once did and is emotionally drained after each shift. Sarah is experiencing compassion fatigue, a form of burnout commonly seen in healthcare providers working in palliative care.
Case Study 2: Physician Burnout in a Palliative Care Clinic
Dr. John is a palliative care physician working in a busy outpatient clinic. He's responsible for managing the complex medical needs of terminally ill patients while offering emotional support. The workload is overwhelming, and Dr. John often finds himself working long hours, attending numerous family meetings, and dealing with difficult end-of-life decisions. His personal life is suffering, and he's experiencing symptoms of burnout, including emotional exhaustion and depersonalisation. He's at risk of compromising the quality of care he provides due to his own burnout.
Case Study 3: Social Worker Stress in a Hospice Team
Emily is a social worker on a hospice care team. She's responsible for assessing the psychosocial needs of patients and their families, coordinating support services, and assisting with end-of-life planning. One of her patients, a young mother with cancer, recently passed away, leaving behind two young children. Emily had formed a strong bond with the patient and is deeply affected by her death. She starts having trouble sleeping, feels overwhelmed, and is emotionally drained. Emily is experiencing acute stress and grief, which can lead to burnout if not addressed.
Case Study 4: Palliative Care Chaplain's Emotional Toll
Rev. Maria is a chaplain in a hospice setting, providing spiritual support to patients and their families. She listens to their fears, regrets, and hopes, often sharing in their emotional struggles. Rev. Maria has been witnessing to the suffering and loss of many patients, and over time, she begins to feel a sense of despair and emotional exhaustion. Her own faith is challenged, and she's at risk of losing her sense of purpose in her work, which are signs of burnout.
In these case studies, healthcare professionals in palliative care settings experience stress and burnout due to various factors, including emotional exhaustion, high workload, exposure to patient suffering and death, and the challenging nature of the work. Addressing these issues often involves support from colleagues, access to mental health resources, self-care strategies, and organisational efforts to reduce workload and improve the emotional well-being of healthcare providers in palliative care.
Reading
Read more about burnout at the following link:
Workplace burnout is all too common. Here's how to tell if you're affected’ from ABC News
Stress is a common experience for healthcare professionals working in palliative care due to the emotional and demanding nature of the work. Effective stress management is essential to ensure the well-being of both patients and caregivers. Here are some insights into stress and stress management in palliative care:
Sources of Stress in Palliative Care
- Emotional Burden: Witnessing patients' suffering and death can be emotionally taxing. Healthcare providers often form close relationships with patients and their families, which can lead to grief and sadness when a patient passes away.
- High Workload: Palliative care often involves complex patient cases, frequent family meetings, and intricate end-of-life decisions. This workload can be overwhelming and lead to stress.
- Difficult Conversations: Healthcare providers in palliative care must have difficult conversations about prognosis, treatment options, and end-of-life preferences. These conversations can be emotionally charged and stressful.
- Lack of Control: Palliative care providers may feel a lack of control over patient outcomes, as many patients have advanced illnesses. This lack of control can lead to stress and frustration.
- Moral and Ethical Dilemmas: Ethical dilemmas, such as decisions about withholding or withdrawing treatment, can be stressful for healthcare providers who must navigate these complex issues.
Stress Management Processes and Self-care Strategies
Managing one's emotional responses in palliative care is crucial to provide high-quality care while maintaining personal well-being. Here are processes for managing emotional responses, along with self-care strategies specifically tailored to the challenges of palliative care:
1. Self-Awareness
- Process: Begin by recognising and acknowledging your emotional responses to patient situations.
- Self-Care Strategy: Regularly reflect on your feelings and emotions. Journaling can be helpful in gaining insight into your emotional responses. Recognise and acknowledge your own emotional reactions to the challenges of palliative care. Understand that it's natural to feel a range of emotions when caring for individuals at the end of life.
2. Emotional Regulation
- Process: Develop techniques to regulate your emotions when facing distressing situations.
- Self-Care Strategy: Practice deep breathing exercises, mindfulness, and meditation to help you stay calm and centered during emotionally charged moments. Practice mindfulness, meditation, deep breathing, or other relaxation techniques to manage stress and stay grounded. Take regular breaks during your shifts to rest and recharge. Avoid overworking yourself.
3. Peer Support
- Process: Share your experiences and emotions with colleagues who understand the unique challenges of palliative care.
- Self-Care Strategy: Join or form a support group for healthcare professionals in your palliative care team to provide mutual emotional support. Connect with colleagues who are also providing palliative care. Sharing experiences and insights can be comforting and validating.
4. Supervision and Debriefing
- Process: Regularly engage in supervision or debriefing sessions with a supervisor or experienced colleague.
- Self-Care Strategy: Use these sessions to discuss challenging cases, seek guidance, and process your emotional responses in a supportive environment. Participate in debriefing sessions after particularly challenging cases. This allows you to share your feelings and learn from the experiences of others. Consider your emotional well-being when transitioning from work to personal time. Develop routines that help you transition smoothly.
5. Set Boundaries
- Process: Establish clear boundaries between work and personal life to prevent emotional spillover.
- Self-Care Strategy: Create a routine that allows you to mentally transition from work to personal life, such as taking a walk or practicing relaxation techniques before going home. Be aware of signs of compassion fatigue, such as emotional exhaustion, apathy, and feelings of hopelessness. Act if you notice these signs. Set clear boundaries between your professional role and personal life to prevent emotional burnout. Understand your limits and avoid overextending yourself emotionally
6. Self-Compassion
- Process: Be kind and understanding toward yourself, recognising that it's natural to experience a range of emotions in palliative care.
- Self-Care Strategy: Practice self-compassion by treating yourself with the same care and empathy you extend to your patients. Understand that you cannot control all outcomes. Focus on providing compassionate care rather than trying to fix every situation. Understand that you may not have all the answers or solutions. Accept that imperfection is a part of caregiving.
7. Regular Breaks
- Process: Take short breaks during your workday to recharge and prevent burnout.
- Self-Care Strategy: Use breaks to engage in activities that help you relax, such as walking, stretching, or enjoying a healthy snack. Take time to reflect on your experiences, thoughts, and emotions after providing care. Journaling or talking with a trusted friend can help you process your feelings.
8. Social Connections
- Process: Maintain relationships with friends and loved ones for emotional support.
- Self-Care Strategy: Prioritise spending time with loved ones to maintain a strong support network outside of work.
9. Seek Professional Help
- Process: If you find it challenging to manage your emotional responses or experience persistent distress, consider seeking support from a mental health professional.
- Self-Care Strategy: Recognise that seeking help is a sign of strength and a vital step in maintaining your emotional well-being. Regularly participate in supervision sessions with a mentor, supervisor, or counsellor. Discuss your feelings, experiences, and challenges to gain perspective and guidance. Engage in ongoing education and training related to palliative care. This can enhance your knowledge and coping skills.
- 10. Mindfulness Practices
- Process: Incorporate mindfulness and relaxation techniques into your daily routine to stay present and reduce stress.
- Self-Care Strategy: Practice mindfulness meditation, progressive muscle relaxation, or yoga regularly to help you stay grounded and resilient. Prioritise self-care activities that promote physical, emotional, and mental well-being. Engage in activities you enjoy, such as hobbies, exercise, relaxation techniques, and spending time with loved ones
11. Healthy Lifestyle
- Process: Maintain a healthy lifestyle with proper nutrition and regular exercise to support your physical and emotional well-being.
- Self-Care Strategy: Prioritise nutritious meals, stay hydrated, and engage in regular physical activity to boost your overall resilience.
These processes and self-care strategies can help healthcare professionals in palliative care effectively manage their emotional responses, reduce stress, and maintain their well-being while providing compassionate care to patients and their families.
Remember that taking care of yourself is not only crucial for your own well-being but also for providing the best possible care to your patients. By implementing these processes and strategies, you can effectively manage your emotional responses while offering compassionate palliative care.
Case Study
The following case studies demonstrate the various types of emotional support and self-care strategies that can be considered in each situation:
Case Study 1: Managing Emotional Responses
Patient: Mary, a 45-year-old woman with advanced cancer and a young child. You are her palliative care support worker.
Question 1: Mary's condition is deteriorating rapidly, and she's in a lot of pain. You've grown close to her during her treatment. How do you manage your emotional response when seeing her suffering?
Answer 1: When faced with Mary's suffering, it's essential to acknowledge my emotions and seek support from my colleagues. I might also take short breaks to process my feelings privately. Additionally, I can engage in mindfulness exercises to stay grounded and empathetic while providing the best care possible.
Question 2: Mary's young child often visits her in the hospice. How do you handle your emotional response when witnessing the child's emotional distress?
Answer 2: It's challenging to see a child in emotional distress. I would try to provide emotional support to the child and their family, offering resources for child-focused counselling if needed. I would also lean on my colleagues for emotional support and consider discussing the case during a debriefing session.
Case Study 2: Self-Care Strategies
Patient: John, a 65-year-old man with end-stage heart failure, is in palliative care. You are his palliative care support worker.
Question 1: You've been working long hours and have many other patients to attend to. How do you ensure you maintain a healthy work-life balance?
Answer 1: To maintain a work-life balance, I would set clear boundaries, prioritise self-care, and use my time management skills effectively. This may involve speaking to supervisor for delegating tasks to other team members, taking scheduled breaks, and ensuring I have time for my personal life and hobbies.
Question 2: Dealing with patients like John can be emotionally draining. What self-care strategies do you employ to prevent burnout?
Answer 2: To prevent burnout, I regularly engage in self-care activities such as exercise, meditation, and hobbies that help me relax and recharge. I also seek support from my colleagues and attend regular debriefing sessions to process difficult cases and emotions.
Case Study 3: Emotional Response to Difficult Conversations
Patient: Sarah, a 60-year-old woman with advanced cancer, has just received a poor prognosis. You are her palliative care social worker.
Question 1: Sarah is devastated by her prognosis and is struggling to come to terms with it. How do you manage your own emotions when discussing her prognosis and end-of-life planning?
Answer 1: When discussing difficult topics like prognosis and end-of-life planning, it's essential to remain empathetic and supportive. I would practice active listening and ensure I have access to a support network of colleagues and supervisors with whom I can discuss my emotions and seek guidance.
Question 2: Sarah's family is also distressed by the news. How can you provide emotional support to them while maintaining your own emotional well-being?
Answer 2: While providing support to Sarah's family, I would encourage open communication and offer resources such as counselling services. To maintain my emotional well-being, I would regularly engage in self-care activities, attend support groups, and seek supervision from my supervisor to process any emotional challenges that arise from my interactions with the family.
These case study-based questions and answers demonstrate how healthcare professionals in palliative care can manage their emotional responses and employ self-care strategies to provide high-quality care while safeguarding their own well-being.
Here is a quick and easy access to the meanings of important palliative care terms with quick and easy access to the definitions of key terms and concepts used throughout the course material.
- Aged Care: The provision of support and services for older adults, including residential aged care facilities and home care services, to meet their care needs, including palliative care.
- Advance Care Directive (ACD): A legal document that allows individuals to express their healthcare preferences, including end-of-life decisions, in case they become unable to make decisions themselves.
- Carer: A person who provides informal care and support to a family member or friend who is aging or experiencing a life-limiting illness, often a key part of the palliative care team.
- Comfort Measures: Medical and non-medical interventions aimed at providing relief from pain and other distressing symptoms without a curative intent.
- Do-Not-Resuscitate (DNR) Order: A medical order that indicates a person's preference not to receive cardiopulmonary resuscitation (CPR) in the event of cardiac arrest or respiratory failure.
- End-of-Life Care: Care provided to individuals in the final stages of their life, with a focus on comfort, dignity, and symptom management.
- EOL (End-of-Life) Plan: A care plan that outlines a person's preferences for end-of-life care, including their goals, treatments, and location of care.
- Grief and Bereavement Support: Assistance and counselling offered to family members and friends following the death of a loved one, helping them cope with their loss.
- Holistic Care: Care that considers the physical, emotional, social, and spiritual aspects of an individual's well-being, focusing on the whole person rather than just their illness
- Hospice Care: Specialised palliative care provided to individuals with a limited life expectancy, often in a dedicated facility or at home.
- Multidisciplinary Team (MDT): A group of healthcare professionals with different expertise working together to assess, plan, and provide comprehensive care to palliative care patients.
- Palliative Care: A holistic approach to care that focuses on improving the quality of life for individuals facing life-limiting illnesses, addressing physical, emotional, social, and spiritual needs.
- Palliative Care Plan: A comprehensive plan tailored to an individual's specific palliative care needs, including pain management, symptom control, and emotional support.
- Palliative Care Team: A multidisciplinary team of healthcare professionals, including doctors, nurses, social workers, and counsellors, who work together to provide palliative care.
- Respite Care: Temporary care provided to give primary caregivers a break from their caregiving responsibilities, ensuring that their loved ones still receive appropriate care during that time.
- Spiritual Care: Care that addresses the spiritual and existential needs of individuals, providing emotional and religious support as desired.
- Symptom Management: The treatment of specific symptoms, such as pain, nausea, or shortness of breath, to improve the patient's comfort and quality of life.
- Terminal Illness: A condition or disease that cannot be cured and is expected to result in a person's death within a relatively short period, often prompting the need for palliative care.
- Voluntary Assisted Dying (VAD): A legal framework in some Australian states that allows individuals with a terminal illness to request assistance in ending their life if they meet specific criteria.
