Self-care

Evidence summary

The challenges of working with patients, who are approaching death, and their families, may be rewarding both professionally and personally [15,16] but can also be associated with stress for clinicians. [13,17,18] The stress experienced by clinicians can lead to burnout, moral distress and compassion fatigue, that impact on clinical decision making, and can adversely affect quality of patient care through increase in errors [13] and has been associated with poorer general health status, and loss of staff. [14] This has implications across the whole health system.

Whilst it is often presumed that recurrent exposure to death and to the sadness and distress of patients and families is in itself stressful, working in specialist palliative care has not clearly been identified as more stressful than other areas of health care. [8-10] However the staff who have chosen to specialise in palliative care, [19] and their work environment may differ when compared to those who occasionally provide end-of-life care for patients in other settings.

Recent review of evidence in hospice and palliative care found that self-compassion among health professionals was positively associated with psychosocial and spiritual well-being of patients and health professionals themselves. [20] On this basis it was suggested that self-compassion, that is responding kindly and compassionately to one’s own suffering and failures, might improve capacity for self-care and decrease perceived burnout risk and secondary traumatic stress.

For non-specialists who are occasionally involved with end of life care, this role may be experienced as distressing and confronting. [21,22] Provision of palliative care may not be easy to accommodate within the clinician’s usual workload, and may also require a shift in goals and style of care. This can require different skills which non-specialists may find challenging to cope with. For staff working in residential aged care or other long-term care facilities, there are particular issues associated with providing palliative care. These can include the provision of futile and inadequate care that contributes to the stress [23] and the rapidly changing aged care environment. [24,25] This will be of increasing importance as the aged care sector becomes a more frequent place of death. There may be little organisational support or recognition of the stress associated with provision of palliative care and care for end of life patients and residents by non-specialist providers. Some of the settings in which these concerns have been identified include intensive care units, [26,27] oncology, [14] paediatric services, [28] general practice, [29] general wards, [30] medical, [22] nursing homes [28] and emergency work. [21] There is still paucity in studies examining the prevalence or significance of these concerns across the health care system though it is an increasing area of research.

The negative outcomes related to this stress make it crucial to ensure there are strategies in place to mitigate them. One key strategy is to facilitate self-care, defined as group of activities performed by an individual to promote and maintain personal well-being throughout life. [2]

The stress can lead to physical and psychological challenges that may impact on patient care. This is recognised in the Standards for Providing Quality Palliative Care for all Australians [31] Standard 13 ‘Staff and volunteers reflect on practice and initiate and maintain effective self care strategies’. This Standard requires the palliative care service culture and structure to provide education about potential effects and possible management strategies and opportunities to reflect about feelings related to interaction with patients and their families.