Self-Care

Coping with stresses of palliative care nursing

Related Evidence

Many areas of nursing can be stressful, none more so than Oncology and Palliative Care. The emotive nature of working closely with patients and families at one of the most difficult times of their lives can be challenging. While rewarding and satisfying for much of the time, it can be overwhelming and difficult to face at other times.

Prioritising self-care is an important first step for health professionals’ self-care. However, this needs to be taken together with strategies to promote awareness, expression, and planning, as well as compassion for self and others to be effective. [1]

Self-care includes ways of coping with stress, grief, burnout, compassion fatigue, and ways of being, including the promotion of health and maintenance of wellbeing. [1]

Sources of stress

There is extensive literature about the prevalence of stress in the healthcare workforce. A number of significant risk factors have been identified:

Conflict and interpersonal issues in the workplace
Workload and/or lack of control over the work environment, lack of balance between home and work life
Unresolved losses, unrecognised mental health issues
Personality and coping style
Mismatch between motivations and expectations, and the actual reality of day-to-day work, and
Problems with identifying boundaries and setting limits on expectations - either those of patients or colleagues, or the clinician’s own expectations of him or herself.

Dealing with stress

Self-reflection, mindfulness, and meditation are just some of the ways proposed to encourage self-awareness and address stress. Similar to the benefits of plans for optimising patient care, planning for self-care is regarded as beneficial and warranting a systematic approach. [1] The Palliative Care Australia resource Self-Care Matters provides support and guidance on caring for yourself.

Visit Palliative Care Australia’s website for Self-care Matters tools

Palliative Care Australia

Burnout

Burnout is a syndrome of emotional exhaustion, depersonalisation and reduced accomplishment which occurs in health workers and others who work in human services. Burnout occurs when the stressors exceed the person’s ability to cope. It is frequently assessed using the Maslach Burnout Inventory, which has been well validated and is widely used in research.

Some markers of burnout are:

Negative or cynical attitudes about patients and their needs
Negative attitudes to work, the workplace, and/or colleagues
Pervasive feelings of dissatisfaction and unhappiness related to work, and
Physical and emotional symptoms (fatigue, boredom, irritability, headaches, weight loss, etc) which can be associated with absenteeism.

The impact of burnout on the healthcare worker, on the quality of the care they can provide, on their workplace and colleagues, and on their family and friends, are potentially highly significant.

Burnout is a significant cause of psychiatric morbidity and of loss of staff.

Compassion

The feelings triggered when confronted with the suffering of another, coupled with a desire to relieve that suffering is known as compassion. [2,3] This is recognised as central to palliative care. In the context of stress or suffering self-compassion refers to compassion applied to oneself. Although the evidence base is small, there is support for the benefit of self-compassion for hospice and palliative care staff as well as for patients. [2] These benefits include psychosocial and spiritual well-being. What also needs to be considered is compassion fatigue, which results from the relationships between clinicians and patients and their families. [4] The absence of self-care strategies has been associated with compassion fatigue. [1] This ongoing issue for those who work with the dying, with the constant need to form new relationships and then subsequent losses, can contribute to stress and to burnout.

Resilience

Resilience is the capacity to adapt under stress, and the ability to thrive and find satisfaction from producing good outcomes in difficult situations. The resilient palliative care provider is able to monitor their own levels of distress and identify and deal with potential problems in their practice. There is an evolving literature on resilience and how to promote the qualities that also support professional survival and growth.

Why it is important for nurses and other health professionals to think about self-care

Video by Dr Jason Mills

Mills J, Wand T, Fraser JA. Palliative care professionals' care and compassion for self and others: a narrative review. Int J Palliat Nurs. 2017 May 2;23(5):219-229. doi: 10.12968/ijpn.2017.23.5.219.
Mesquita Garcia AC, Domingues Silva B, Oliveira da Silva LC, Mills J. Self-compassion In Hospice and Palliative Care: A Systematic Integrative Review. J Hosp Palliat Nurs. 2021 Apr 1;23(2):145-154. doi: 10.1097/NJH.0000000000000727.
Deichmann RE. Compassion: Lessons from the Humanities. Ochsner J. 2018 Fall;18(3):199-200. doi: 10.31486/toj.16.0115.
Gallagher R. Compassion fatigue. Can Fam Physician. 2013 Mar;59(3):265-8.