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Palliative care workers often come in contact with death, "when a client under our care dies, we may feel a sense of loss both in professional and personal manner" (Rich, 2004, p. 6). Self-care refers to ways in which the palliative care worker copes with this emotional stress.
- Risk factors for poor grievement outcomes
- Effects of grief on health care professionals
- Debriefing in healthcare
- Stress Management
- References
Risk factors for poor grievement outcomes
Health care professionals working in palliative care may be personally affected by their work (Palliative Care Australia, 2003; Sheldon, 1998), particularly when all or some of the following risk factors are present/applicable:
- Caring for a palliative client for 6 months or longer, prior to his/her death (Sheldon, 1998).
- Female doctors are more affected than male doctors (Redinbaugh et. al. 2003).
- The circumstance of the death e.g. the age of the client, or if the client has a young family (Rich, 2004).
- Whether the death was preventable, e.g. by earlier diagnosis of cancer (Rich, 2004).
Effects of grievement on health care professionals
The literature provides us with some insights in to the possible outcomes related to the factors identified in the previous section (risk factors for poor grievement outcomes), for example:
- Affecting the health care professional's work in the future; following a client's death the professional may isolate their emotions and withdraw from future clients. This may result in a lower quality of care and prevent effective end-of-life care for clients.
- Affecting the health care professional personally; health care professionals may develop a fear of death and dying themselves or transfer the loss of their client into their own personal circumstance, for example if the age of the dying person is the same as the health care professional.
- The health care professional may become frustrated and depressed as a result of the powerlessness of their situation (Rich, 2004).
These reactions may be precursors to burnout from the emotional stress of working in palliative care.
These are scenarios that we as health care professionals would prefer to avoid. Therefore grief must be resolved in order to avoid the above possible consequences.
Debriefing
Formal and informal debriefing has been reported by speech pathologists working in palliative care to be an effective coping mechanism* Informal debriefing often consists of discussion with colleagues regarding difficult or stressful client cases or incidents*. Formal opportunities are often not utilized*, however these may include meetings with the hospital social worker and/or regular team meetings.
Rich (2004) suggests that Critical Incident Stress Debriefing (CISD) is an effective debriefing method. This method is usually led by trained peers, counsellors, or a health care professional who is not actively involved in the specific palliative care case. This structure of debriefing provides the health care professionals with a safe and supportive environment in which to share their feelings and emotions in relation to a specific palliative care case. It involves the following seven steps:
- Introduction - the group is oriented to the specific case up for discussion and boundaries of the discussion are set, for example confidentiality of the meeting.
- Fact phase - group members are asked to lay down the facts of the case and what happened.
- Thought phase - group participants describe thoughts they had prior to, during and subsequent to the event.
- Reaction phase - group members talk about their reactions and emotions that they felt/feel.
- Symptom phase - the team leader talks about the possible signs of emotional, physical and social stress that the group members may be feeling.
- Teaching phase - the team leader suggests possible indicators of an individual needing further attention and debriefing in order to deal with the situation, e.g. individual counselling.
- Reentry phase - appropriate suggestions for coping with the situation are recommended, questions are answered and closure is accomplished.
Rich (2004) suggests staff sign a sympathy card, following a client's death for the client's family or attend a memorial service/funeral. This may assist the individual health care professional to acknowledge the death and provide a means of closure to the case for that individual.
Sheldon (1998) supports the use and effectiveness of counselling for the bereaved, as does Worden (1991). Worden (1991) states that professional counselling and self-help services are beneficial in reducing the risk of psychiatric and psychosomatic disorders resulting from bereavement.
Stress Management
Burnout: Burnout is caused by a person's inability to cope with the physical and mental symptoms that stress may cause and contribute to (Malugani, 2004).
Preventing burnout:
- Bond with collegues and discuss difficult situations can help reduce stress
- Talk out problems and let others do so too (see DEBRIEFING section above)
- Evaluation
- Constantly evaluate life priorities and keep them in mind
- Stay healthy - adequate exercise, sleep etc. (Stockdale 2004)
"Healthcare professionals are prone to 'compassion burnout'" (Malugani, 2002, p. 1). This refers to the common scenario of healthcare workers putting client needs above their own.
Warning signs of burnout:
- Having too much work
- Feeling helpless at work
- Not feeling recognised for the work you are doing
- Feeling intense pressure
- Having conflicting values/views with your employers
- Not finding work gratifying or rewarding (Stockdale, 2004)
Intervention:
- Take a break (a short break or even a job change)
- Re-assess your work life (goals, expectations and make them realistic)
- Ask for help from colleagues, psychologists or your doctor (Stockdale, 2004)
References
Malagani, M. (2005). Surviving stress: Coping skills for healthcare professionals. USA: Monster Healthcare and Irish Health. Retrieved June 22, 2005, from www.healthcare.monster.ie/articles/surviving_stress Palliative Care Australia (PCA) (2003). Palliative care service provision in Australia: A planning guide. Retrieved June 10, 2005, from http://www.pallcare.org.au/Portals/9/docs/publications/Planning%20guide2003.pdfRedinbaugh, E., Sullivan, A., Block, S., Gadmer, N., Lakoma, M., Mitchell, A., Seltzer, D., Wolford, J., & Arnold, R. (2003). Doctors' emotional reactions to recent death of a client: cross sectional study of hospital doctors. British Medical Journal, 327(7408), 185-195. Rich, S. (2004). Providing quality of end-of-life care. Journal of cardiovascular Nursing, 20(2), 141. Sheldon, F. (1998). Abc of palliative care: Bereavement. British Medical Journal, 316(7129), 456-458. Stockdale, A. (2004). Are you burned out? North America: Medhunters. Retrieved June 22, 2005, from www.medhunters.com/articles Worden, J. (1991). Grief councelling and grief therapy: A handbook for the mental health practitioner. London: Springer. |
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