Professional wellbeing

Key messages

Evidence summary

The definition of burnout—a work-related syndrome—comes from the seminal work by Maslach and Jackson. [1] It is characterised by three primary dimensions: emotional exhaustion, depersonalisation and reduced personal accomplishment. [2,3] Emotional exhaustion refers to feelings of being overextended and depleted of emotional and physical resources. Depersonalisation involves a distant or indifferent attitude towards one's work, often manifesting as cynicism or detachment. [2,3] The tendency to evaluate oneself negatively, particularly with regard to work with patients and families, is referred to as reduced personal accomplishment and can occur during burnout. [2,3]

The nature of palliative care work, which involves frequent encounters with suffering and death, can lead to high levels of stress and anxiety. [3,4] Palliative care health professionals can sometimes face moral and ethical dilemmas, have to manage complex patient and family dynamics, and work in environments with high emotional demands and inadequate resources. [5] This chronic stress can lead to anxiety disorders and other mental health issues if not adequately addressed. [6]

Palliative care nurses often experience a range of emotional impacts, including feelings of sadness, grief, anger, guilt and dissatisfaction. [4,6] These professionals may suffer from physical symptoms such as headaches, irritability, sleep disturbances and gastrointestinal issues. [4,6]

Mindfulness-Based Interventions (MBIs) have been explored as a potential strategy to mitigate stress and burnout among palliative care health professionals. [2] MBIs focus on enhancing awareness through focused physicality to expansive inclusivity, and fostering a non-judgmental attitude towards both internal and external experiences. [2,3] Studies have shown that MBIs can help reduce symptoms of burnout, improve emotional regulation and increase overall wellbeing. [2,5] However, more robust research is needed to confirm these benefits and to develop standardised MBI programs tailored for palliative care settings. [2,5]

Resilience is the ability to adapt positively in the face of adversity. [3,7] For palliative care health professionals, resilience involves maintaining mental wellbeing, finding meaning in work and experiencing personal growth alongside the challenges of caregiving. [7] Strategies to enhance resilience include fostering supportive work environments, promoting self-care practices and providing training in stress management techniques. [6,7] Building resilience within individuals, the community of practitioners and the system as a whole is important for sustaining the mental health and professional efficacy of palliative care health professionals. [6,7]

The work environment and support systems play a critical role in the wellbeing of palliative care health professionals.[5,6] Factors such as high workload, role complexity, lack of support from colleagues and poor organisational culture can exacerbate stress and burnout. [8,9] Conversely, supportive work environments that offer adequate human and material resources, peer support and opportunities for professional development can enhance job satisfaction and reduce burnout. [5,6] Organisational interventions such as regular clinical supervision, professional counselling services, and resilience training programs are essential in supporting the wellbeing of palliative care staff. [2,6]

Continuous professional education and training are vital in equipping palliative care nurses with the skills to manage stress and burnout effectively. [5,6] This includes training in communication skills, bereavement care and self-care practices. [5,6] Regular workshops, seminars and access to up-to-date research can help professionals stay informed about the latest strategies for managing stress and enhancing resilience. [5] Education programs should also include training in recognising the signs of burnout and strategies for early intervention. [2,6]

Equity and access

The availability of support and resources for palliative care nurses varies significantly across different regions and institutions. [6] In well-resourced settings, nurses may have access to comprehensive support systems including psychological counselling, peer support groups and professional development opportunities. [6,8] In contrast, nurses in under-resourced settings often face higher levels of burnout due to inadequate support systems, insufficient staffing and lack of access to essential material resources. [6,9] This disparity highlights the need for equitable distribution of resources to ensure all palliative care professionals receive the support they need. [5]

Understanding and respecting diverse cultural values, beliefs and practices can significantly influence end-of-life care preferences and decision-making, reducing stress for healthcare providers. [10] Awareness of cultural rituals surrounding death and dying affects the experiences and expectations of care, alleviating emotional burdens on providers. [11] Incorporating these rituals into care plans helps enhance therapeutic relationships, decreasing stress and improving job satisfaction. [12] Addressing cultural taboos and family decision-making practices through tailored education bridges gaps in care, aligning plans with patients' values and reducing professional frustration. [13] Culturally tailored support and training programs in cultural competence enable healthcare providers to handle complex situations more effectively, mitigating burnout. [14] Enhancing cultural competence fosters a supportive environment, improving both patient care and professional wellbeing. [14]

Care context

The specialist palliative care in-patient setting presents unique challenges and rewards. [5,9] Hospice staff often develop deep, meaningful relationships with patients and their families, which can be both a source of fulfilment and emotional strain. [5,9] Factors such as the ability to spend more time with patients, a peaceful work environment and the emotional impact of witnessing patient suffering are specific to hospice settings. [5] Time demands and limitations make it difficult for staff to balance responsibilities and attend support programs, adding to their stress. [4,14] Addressing these time constraints is essential for supporting hospice staff effectively, ensuring they can provide patient-centred care and participate in targeted support programs. [5,14] Staff in these settings may benefit from targeted support programs that address the emotional and psychological demands of providing hospice care. [6,9]

Nurses working in paediatric palliative care face unique stressors related to the emotional demands of caring for children with terminal illnesses. [6,9] These professionals often experience intense emotional responses, including grief and helplessness, due to the young age of their patients and the involvement of the patients' families. [6] Paediatric palliative care nurses require specific support systems and training tailored to address these unique challenges. [5,6] This may include specialised counselling services, peer support groups and training in paediatric end-of-life care. [2,6]

Occupational stress among professional dementia carers in residential aged care settings can significantly impact care quality, carers' health and workforce sustainability. [15] Specific interventions that have proven effective include leadership development programs that empower managers to create supportive work environments, peer support groups that provide emotional and professional support, and initiatives to improve organisational culture by fostering open communication and recognising staff contributions. [15] Educational programs that focus on stress management, self-care and resilience-building are also critical. These interventions not only reduce non-resident-related stress and burden but also enhance carers' self-efficacy and job satisfaction, leading to better care for residents and reduced turnover among staff. [15] Aged care providers must integrate these strategies to maintain a healthy and capable workforce, ensuring the delivery of high-quality palliative and end-of-life care. [15]

Implications for families and carers

Burnout among healthcare professionals can lead to reduced quality of care, decreased empathy and increased likelihood of errors, which directly affects patient care and family satisfaction. [3,6] Families may sense the emotional strain and stress in healthcare providers, potentially leading to diminished trust and communication. [5] Moreover, when palliative care staff are supported and resilient, they are better equipped to provide compassionate and consistent care, which can ease the emotional burden on families and carers. [7]