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  • Introduction
  • 1. Advance Care Planning
  • 2. Communicating Bad News
  • 3. Whole Patient Assessment
  • 4. Pain Management
  • 5. Assisted Suicide Debate
  • 6. Anxiety, Delirium
  • 7. Goals of Care
  • 8. Sudden Illness
  • 9. Medical Futility
  • 10. Common Symptoms
  • 11. Withholding Treatment
  • 12. Last Hours of Living
  • 13. Cultural Issues
  • 14. Religion, Spirituality
  • 15. Legal Issues
  • 16. Social and Psychological
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    Site Index
    Back to Module 16: Social and Psychological Considerations
    Caring for Oneself as a Health Care Professional

    Understanding the Psychological and Social Experience of a Dying Person
    Grief of the Dying Person and Survivors
    Special Considerations for Families
    Caring for Oneself as a Health Care Professional Working With Dying Persons

    Caring for Oneself as a Health Care Professional Working With Dying Persons

    • To provide outstanding end of life care, it is critical for health care professionals to be aware of their own responses to this work, including their responses to its stresses and strains
    • Health care professionals working with seriously ill individuals will likely experience multiple losses of their patients during the course of their careers along with the losses that they will experience in their personal lives
    • Special stresses of work in end of life care
      • Awareness of loss and our own losses

      • Awareness of our own mortality

      • Experience of existential anxiety

      • Experience of multiple losses and accumulating grief (bereavement overload—Kastenbaum, 1969)

      • Reminders of our own difficult or traumatic loss experiences contributing to reexperiencing of this trauma

      • Awareness of the limitations of medicine as well as our own limitations as caregivers
        • Threats to feelings of self-control, mastery, and self-esteem
        • Feeling of disillusionment with the uncomfortable, unbeautiful realities of death

      • Lack of organizational and professional support for the grief of health care professionals

    One Fellow’s Story


    What is Burnout?

    • Occurs when stress is prolonged
    • Coping resources are exhausted
      • Physically and emotionally spent
      • Cynical attitudes
      • Withdrawal from patients
      • Work becomes ineffective


    Ways that Health Care Professionals Working With Dying Persons Can Care for Themselves to Avoid Burn-out (adapted from Rando, 1984)

    • Allow time and places for health care professionals to express their grief
      • Quiet room for staff
      • Memorial services
      • Encouraging time off for rest and recreation
    • Provide formal and informal time for staff to debrief after a death
      • Formal debriefing
        • Support conference (focused on staff needs and caregiver concerns about work)

        • Closure conference (focused staff feeling about a particular patient who has died or left the care unit and with whom they have developed a close relationship)

      • Informal meetings
        • Gathering for lunch or coffee
    • Promote an environment of care where colleagues respect the need to express grief and understand that the expression of grief is critical to the well-being of health care professionals working in end of life care
    • Build relationships with supportive colleagues who will listen to concerns and accept the expression of grief
    • Develop self-awareness of the impact of stress and energy available for work
      • Understand one’s own energy levels and limits

      • Develop assertiveness in work situation so that work beyond one’s limits does not occur

      • Learn to request assistance without guilt

      • Develop an appreciation for one’s own abilities, rather than comparing one’s self to others who may have different needs or circumstances
    • Schedule regular time off for vacations
    • Participate in continuing education activities
    • Create home environment that allows for rest and renewal
    • Develop awareness of personal attitudes and beliefs about dying and death and end of life care
      • What expectations do you have for yourself in caring for dying persons and their families?

      • How would you define success in your work with dying persons and their families?
    • Work as a part of a team, if possible, to allow for coverage when taking time off
    • Attend to own physical, psychological and social needs
      • Nutrition
      • Exercise
      • Relaxation
      • Sleep
      • Sex
      • Affection
      • Time with others
    • Make time for creative and restorative activities
      • Art, music, dance, performance, theatre, movies
      • Meditation—formal and informal (walk in the park, hot bath)
      • Relaxation techniques
      • Massage
      • Yoga
      • Nature
      • Sports
      • Crafts
      • Reading
      • Classes
    • Recognize end of life care situations that are particularly stressful and seek support and guidance
      • Ethical concerns—seek consultation from ethics team

      • Legal considerations—seek advise and support from legal council

      • Psychological concerns
        • Seek formal therapy or consultation from psychologist, social worker, psychiatrist
        • Develop informal collaborative relationships with mental health care professionals
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