Take stock of successes, avoid compassion fatigue
Be comforted by what you can do for dying patients
Health care professional who work with dying patients should be protective of themselves, take comfort in how they have helped patients and families, and seek support from their coworkers in dealing with the emotions that death and dying stir up, says Elizabeth Clark, PhD, ACSW, MPH, executive director of the National Association of Social Workers, based in Washington, DC.
"Professional grief is not a concept that is well understood. I believe that witnessing suffering is very hard, and we underestimate the impact that it has on staff. It's important for hospitals to have support for staff who are caring for dying patients," Clark says.
Caring professionals find it impossible to wall themselves off from their patients. They get involved with their patients and feel good when they get well and sad when they die, adds Catherine M. Mullahy, RN, BS, CRRN, CCM, president of Mullahy Associates, LLC, a Huntington, NY, case management consulting firm.
"Case managers can feel good that when a patient is dying, they are there to help the patient get the pain management they need and get their affairs in order. It's difficult to say goodbye, but it's satisfying to know that you helped them have the kind of death they want," she says.
Helping people deal with the end of life by bringing in services and providing support to make the rest of their life better is a great service, adds Diane Siddall, RN, CHPN, case manager with Hospice of Summa in Akron, OH.
"Death is a natural part of the cycle of life, and it doesn't have to be chaotic and out of control. Our job is to help provide support in these difficult situations," she says.
Health care professionals should step back and examine how they feel about the emotionally charged issues surrounding death and dying, Mullahy says.
"Case managers should see themselves as part of the solution. They can help patients have the kind of death that each of us would want," Mullahy says.
Conduct an assessment of your psycho-social successes, Clark suggests.
"Take some comfort in what you have been able to do for the dying person," she says.
Think of something special you have done for a patient or something you did that a patient really appreciated.
"You wouldn't document in the medical record that you got a card for the patient who wasn't going to be there for his wife's birthday, but things like that make a huge difference to a dying patient," she says.
She suggests a monthly conference where the hospice or oncology team can talk about psycho-social successes.
"Usually the treatment team is limited to having case conferences about problems. Have everybody bring a success to a conference," she says.
Even if there's no formal meeting, sit and talk to your fellow clinicians about your feelings and concerns and offer your support when they are grieving, suggests Carol Kucharski, RN, OCN, care manager in the acute palliative care unit at Summa Health System's Akron City Hospital in Akron, OH.
Don't put stress on yourself to come up with the perfect thing to say to a dying patient or his family, advises Melissa Jones, BSN, RN, CCM, case manager and palliative care nurse coordinator at Methodist Medical Center in Oak Ridge, TN.
"Go in with the idea that you can't fix everything but you can listen and lend support," she says.
Allow your case managers and social workers to grieve, Mullahy advises. "It should be OK to cry on the unit, where you can have the support of your colleagues all around you," she says.
If one case manager has to care for a number of dying patients and another one has been admitted who is not likely to have a good outcome, assign that patient to someone else, Mullahy advises.
"If you give people a break, it can prevent burnout," she says.
Keep your work and your personal life in balance.
"The best nurses and social workers are people who are happy and adjusted in their own life," Mullahy says.
Take a break and walk around the hospital grounds. Think of the people you did help and those who did survive, Mullahy suggests.
"We can't save everyone, but if we can help people exit the world peacefully and help the family come to terms with it, it's a real gift," Mullahy says.
Health care professional who work with dying patients should be protective of themselves, take comfort in how they have helped patients and families, and seek support from their coworkers in dealing with the emotions that death and dying stir up, says Elizabeth Clark, PhD, ACSW, MPH, executive director of the National Association of Social Workers, based in Washington, DC.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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