Caring for and communicating with people affected by life-limiting illness can be stressful.[1-4] Healthcare professionals are often confronted by human suffering, clinical deterioration, dying, death and family grieving.[1, 2, 5] This may force you to face your own mortality and previous personal experiences with death and loss. You may also confront grief and bereavement in a manner that you haven’t previously.[6] You can also find yourself confronting issues which are unique to palliative care and that are inherently hard to resolve including:[2-4, 6-9]
- Your own concerns, beliefs, morality and ethical views about dying and death – which can also trigger a trauma response depending on your own personal experiences
- Clinical anxieties, for instance if there is a perception that a diagnosis was missed or delayed
- Traditional Western culture which views death as clinical failure
- Difficulty in deciding how and when to shift from a curative to palliative approach
- Feelings of reluctance to take on complex problems because of time constraints
- Difficulty dealing with the clinical uncertainty that dying and death, and palliative care in general, create
- Feelings of clinical helplessness if you are unable to completely relieve the distress and pain of a person affected by a life-limiting illness or if an outcome was unacceptable
- Sustained and exclusive focus on life-limiting illnesses and end-of-life care
- Caring for people with whom you identify with in some way – including being involved in caring for a dying friend, colleague or family member
- Cultural anxiety caused by divergent cultural beliefs and experiences, both with self and the person affected by a life-limiting illness
- Accumulated losses.
Accumulated stressors can have emotional and spiritual effects which can compromise personal wellbeing. Unexamined emotions can lead to burnout, moral distress and compassion fatigue.[3, 4, 10-12]
Burnout |
Burnout is a significant cause of psychiatric morbidity and of loss of staff.[13, 14] Burnout indicators include:[13, 14]
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Moral distress |
Moral distress is a predictable response to situations where a person recognises that there is a moral problem, believe that they have a responsibility to do something about it, but cannot act in a way that preserves their integrity or ethics.[16] Circumstances which can cause moral distress include:
Moral distress can result in serious adverse consequences, including:[16]
Moral distress can lead to burnout.[10, 15] |
Compassion fatigue |
Most people enter healthcare in order to help other people – especially people with critical physical, mental, emotional, and spiritual needs. The nature of continually showing compassion for people with a life-limiting illness, whose suffering is often continuous and unresolvable, can become exhausting – resulting in compassion fatigue.[22, 23] Compassion fatigue can also occur when, in the process of providing empathic support, you personally experience the pain of people in your care and their families.[24] Compassion fatigue can lead to burnout.[10, 15] |
Self-care resources
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Thinking Points
- What signs would indicate that your colleagues are experiencing burnout or compassion fatigue?
- Access one of the self-care resources listed and consider the key areas where developing appropriate self-care strategies will be helpful for you.
- Reflecting on your own personal beliefs, can you anticipate circumstances which cause moral distress / compassion fatigue?
- For the healthcare professionals involved in Michelle’s care and support, what are some of the sources of potential:
- Burnout
- Moral distress
- Compassion fatigue.
References
- Sarafis, P., et al., The impact of occupational stress on nurses’ caring behaviors and their health related quality of life. BMC nursing, 2016. 15: p. 56-56.
- Kamal, A.H., et al., Prevalence and Predictors of Burnout Among Hospice and Palliative Care Clinicians in the U.S. Journal of pain and symptom management, 2016. 51(4): p. 690-696.
- Hall, L.H., et al., Healthcare Staff Wellbeing, Burnout, and Patient Safety: A Systematic Review. PloS one, 2016. 11(7): p. e0159015-e0159015.
- Therapeutic Guidelines Ltd, Caring for dying patients: impact on healthcare providers. 2018: Melbourne.
- Peters, L., et al., Is work stress in palliative care nurses a cause for concern? A literature review. International Journal of Palliative Nursing, 2012. 18(11): p. 561-567.
- Sinclair, S., Impact of death and dying on the personal lives and practices of palliative and hospice care professionals. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 2011. 183(2): p. 180-187.
- Murray, S.A., et al., Palliative care from diagnosis to death. BMJ, 2017. 356.
- Peters, L., et al., How death anxiety impacts nurses’ caring for patients at the end of life: a review of literature. The open nursing journal, 2013. 7: p. 14-21.
- Ingebretsen, L.P. and M. Sagbakken, Hospice nurses’ emotional challenges in their encounters with the dying. International journal of qualitative studies on health and well-being, 2016. 11: p. 31170-31170.
- Sanchez-Reilly, S., et al., Caring for oneself to care for others: physicians and their self-care. J Support Oncol, 2013. 11(2): p. 75-81.
- CareSearch. Self-Care. 2017 June 06, 2017]; Available from: https://www.caresearch.com.au/caresearch/tabid/3462/Default.aspx.
- Rizo-Baeza, M., et al., Burnout syndrome in nurses working in palliative care units: An analysis of associated factors. J Nurs Manag, 2018. 26(1): p. 19-25.
- CareSearch. Burnout. Information for nurses 2017 16 November 2017]; Available from: https://www.caresearch.com.au/caresearch/tabid/2179/Default.aspx.
- Maslach, C. and M.P. Leiter, Understanding the burnout experience: recent research and its implications for psychiatry. World psychiatry : official journal of the World Psychiatric Association (WPA), 2016. 15(2): p. 103-111.
- McCarthy, J. and C. Gastmans, Moral distress: a review of the argument-based nursing ethics literature. Nurs Ethics, 2015. 22(1): p. 131-52.
- Campbell, S.M., C.M. Ulrich, and C. Grady, A Broader Understanding of Moral Distress. Am J Bioeth, 2016. 16(12): p. 2-9.
- Resnik, D.B., Moral Distress in Scientific Research. The American journal of bioethics : AJOB, 2016. 16(12): p. 13-15.
- Phelps, A.C., et al., Addressing Spirituality Within the Care of Patients at the End of Life: Perspectives of Patients With Advanced Cancer, Oncologists, and Oncology Nurses. Journal of Clinical Oncology, 2012. 30(20): p. 2538-2544.
- Wiener, L., et al., Cultural and religious considerations in pediatric palliative care. Palliative & Supportive Care, 2013. 11(1): p. 47-67.
- Gallagher, R., Compassion fatigue. Canadian Family Physician, 2013. 59(3): p. 265-268.
- Gallagher, O., et al., Nursing student experiences of death and dying during a palliative care clinical placement: Teaching and learning implications, in Transformative, innovative and engaging session at the 23rd Annual Teaching Learning Forum 2014: Perth.
- Cocker, F. and N. Joss, Compassion Fatigue among Healthcare, Emergency and Community Service Workers: A Systematic Review. International journal of environmental research and public health, 2016. 13(6): p. 618.
- Nolte, A.G.W., et al., Compassion fatigue in nurses: A metasynthesis. Journal of Clinical Nursing, 2017. 26(23-24): p. 4364-4378.
- Lombardo, B. and C. Eyre, Compassion fatigue: a nurse’s primer. Online J Issues Nurs, 2011. 16(1): p. 3.