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Self Care and Staff Support

Key Messages

  • The nature of palliative care work, heavy workloads and lack of support contribute to stress and burnout. [1,2]
  • Health professionals in rural areas are particularly vulnerable to work stress caused by isolation from colleagues and difficulty separating professional and personal roles in a small community. [1]
  • How care staff experience their first patient death often shapes their future professional practice which may either positively or negatively influence their preference to work in palliative care in the longer term. [3]
  • Care staff who have taken a palliative care elective during their training feel more prepared to perform such patient care. [3]
  • Coping strategies and support from others can create ‘resilience’ and counter the negative consequences of stress. [1,2]
  • Self-care is a coping strategy to manage stress. [1,4]
  • Self-awareness, maintaining perspective and enough emotional distance are important aspects of self-care. [1]
  • Feeling supported by a team or mentor may also be an important strategy in self-care. [1]

Background

Caring for people is a vocation which demands the ability to engage at a personal level with the patient. People coming into working in aged care are often not sufficiently prepared for managing death or palliative care goals creating stress and burnout. Burnout can be characterised by exhaustion, cynicism and inefficacy which can significantly impact on patient care. [4] Self-care is important in managing burnout that can occur as a result of working in a palliative care setting.


This page discusses the evidence in support of self-care strategies for carers in palliative care.


Evidence Summary

In theories of caring it is suggested that the vulnerable partner in the relationship is the patient, however it may be realistic to acknowledge that both partners - carer and the patient are vulnerable in the palliative care relationship. Palliative care is unique in that the service focuses on the needs of the dying rather than maintaining or improving functional capacity [1] and it is estimated that 50% palliative care staff are at risk of poor mental health as a result of work stress. [4]


In the time in which care is provided, relationships may be formed causing significant grief when a patient passes. This can create a dilemma in how caregivers are expected to provide care that is not emotionally disconnected from the patient, whilst also protecting themselves emotionally. [3,5] Palliative care staff not equipped with adequate coping strategies are at risk of ‘burnout’. Studies suggest this may be largely due to the nature of the work but it can also be exacerbated by other work stressors such as heavy workloads and a lack of resources. [1,2]

 
Employers therefore, have an obligation to their staff to promote wellness and wellbeing. [4] It is proposed that with training and intervention, care givers can acquire skills in self-care, which can assist staff in finding their role deeply rewarding and even protective of burnout. Palliative care staff that engage in activities of self-care such as reflection, employing some emotional distance and who engage in activities where they feel supported by other team members, are more likely to work in palliative care long term and are less likely to suffer from work related burnout. [1,2]

 

Quality Statement

Quality of the evidence discussed is generally high, however the systematic reviews are based on primarily qualitative data and in non-aged care contexts. Findings lack clear conclusions on how to teach resilience or self-care in a palliative care setting despite a consensus that it is important in preventing burnout.
 

Further research: More research is required, particularly for aged care staff and regarding how to engage staff in self-care strategies, on which best practice guidelines could be based.

 

Page updated 22 May 2017
 

  • References

  • About PubMed Search

  1. Peters L, Cant R, Sellick K, O'Connor M, Lee S, Burney S, et al. Is work stress in palliative care nurses a cause for concern? A literature review. Int J Palliat Nurs. 2012 Nov;18(11):561-7.
  2. Gillman L, Adams J, Kovac R, Kilcullen A, House A, Doyle C. Strategies to promote coping and resilience in oncology and palliative care nurses caring for adult patients with malignancy: a comprehensive systematic review. JBI Database System Rev Implement Rep. 2015 Jun 12;13(5):131-204.
  3. Zheng R, Lee SF, Bloomer MJ. How new graduate nurses experience patient death: A systematic review and qualitative meta-synthesis. Int J Nurs Stud. 2016 Jan;53:320-30. Epub 2015 Oct 9.
  4. Hill RC, Dempster M, Donnelly M, McCorry NK. Improving the wellbeing of staff who work in palliative care settings: A systematic review of psychosocial interventions. Palliat Med. 2016 Oct;30(9):825-33. Epub 2016 Mar 4.
  5. Pitfield C, Shahriyarmolki K, Livingston G. A systematic review of stress in staff caring for people with dementia living in 24-hour care settings. Int Psychogeriatr. 2011 Feb;23(1):4-9. Epub 2010 May 18.

Definition

Carers can also be educated about the importance of looking after their own health. This form of education, sometimes called self care or psychoeducation, concentrates on how to cope with problems of stresses in caring. For example, the feelings of anger sometimes experienced by carers may be addressed by anger-management strategies. Information and education are often offered by support groups and self-help organisations (Comprac p.133).

Search

((staff[tiab] OR carer*[tiab] OR caregiver*[tiab] OR care giver*[tiab] OR careworker*[tiab] OR care worker*[tiab] OR nurses[tiab] OR nurse[tiab] OR professional*[tiab] caregivers[majr] OR nurses[majr]) AND (well being[tiab] OR support*[tiab] OR coping[tiab] OR cope[tiab] OR frustration[tiab] OR stress*[tiab] OR problem*[tiab] OR demands[tiab] OR self care[tiab] OR self help[tiab] OR psychoeducation[tiab] OR unsupport*[tiab] OR burnout[tiab] OR burn out[tiab] OR satisfaction[tiab] OR dissatisfaction[tiab] OR workload[tiab] OR feedback[tiab] OR resilience[tiab] OR counsel*[tiab] OR tension*[tiab] OR debrief*[tiab] OR burden[tiab])) AND