A study on the self-care strategies of over 550 hospice workers in the US and their self-care strategies found that physical activity and social support were the most commonly cited strategies in managing stress. [1]
Protective practices will:
- Help compartmentalise work from the rest of life – identify ways to leave the job behind
- Clarify and support staff in establishing professional boundaries
- Promote emotional and physical health, and
- Include regular self-care techniques for managing stress.
Protective skills in dealing with complex interactions can:
- Support providers who are dealing with complicated or emotionally challenging situations
- Reduce conflict over goals of care
- Reduce conflict within the multidisciplinary team, and
- Often use humour.
Protective arrangements by health services can:
- Have a process to actively manage distress and dysfunction of their staff members
- Create opportunities for debriefing
- Focus on effective teamwork
- Promote areas of work autonomy for staff, and recognise achievements
- Promote a workplace culture which supports a balance between home and work life, and actively encourage staff to set appropriate limits on expectations, and
- Provide access to confidential supportive services including counselling.
Experienced clinicians should take every opportunity to model good self-care practices, mentor junior staff in good self-care practices and explicitly teach self-care skills.
A study undertaken of community nurses highlighted the need for shared responsibility by healthcare organisations in relation to self-care. The authors also recognise that some nurses feel there is a stigma that prevents them from prioritising self-care needs. [2]
Self-care Plans
The concept of an individualised self-care plan for palliative care providers [3] focuses on four self-care domains:
- Physical
- Emotional / cognitive
- Relational, and
- Spiritual.
The plan encourages a systematic approach to identifying warning signs of stress and burnout in each area, and the development of protective practices. This process has not yet been formally validated, but has the potential to be used by individuals, or incorporated into mentoring and supervision relationships within palliative care teams.
Developing self-awareness is an important step in self-care. It assists you to identify your strengths and weaknesses as well as to understand why you react the way you do in certain situations. Being self-aware can assist you to manage your emotions rather than being overwhelmed by them. Develop your self-awareness by reflecting on how you respond in stressful situations and why you respond this way. Questions to consider in relation to your work include:
- Physical: What is happening to my state of health and well-being?
- Emotional: How do I feel during and after I finish work?
- Perceptions: How do I make sense of my experiences at work?
- Activities: How well do I balance my work and personal life?
- Relationships: How has work impacted on my relationships (family, friends)?
- Expertise: What am I learning in my work role?, and
- Spiritual: How have my faith and personal meanings changed?
Along with increasing your self-awareness, other self-care strategies that will assist you in responding effectively to grief include:
- Acknowledge your grief and recognise that it is a normal reaction to the experience of loss
- Talk to your supervisor and colleagues about what you are experiencing and request their help
- Seek support from a professional counsellor
- Develop self-care strategies that promote your physical and emotional well-being (eg, healthy diet, regular exercise, find activities that help you to relax and make time to do them
- Have fun with your family and friends, and
- Think positively and be proactive in raising and addressing concerns. [4]
The Isolated Practitioner
Practitioners who work in isolation from others or are not part of a palliative care team may find it more difficult to meet their own needs for self-care. It is also important for isolated practitioners to identify potential mentors and people with whom they can debrief.