Contributing Factors

Factors unique to palliative care and often resulting in clinician stress include:

• Accumulated losses
• Emotionally charged care
• Sustained and exclusive focus on terminal illnesses and terminal care
• Mortality issues of the clinician (existential, spiritual, or personal)

Clinicians who care for only a few palliative care patients in their practice may be greatly affected. They may experience:

• Difficulty shifting from curative mode, where death is seen as a clinical failure, to a palliative and supportive role with death an inevitable and appropriate outcome
• Guilt, if perceiving that a diagnosis was missed or delayed
• Trauma, if unable to relieve difficult symptoms or intense distress in the patient or their family, and
• Confronting their own mortality.

Those who work in well-functioning palliative care teams often experience some powerfully protective factors:

• Supportive teams allow opportunities for reflection and debriefing
• They create an emotionally open work environment, and
• They have a shared culture of care and accumulated wisdom about supporting patients and families at the end-of-life.

Nurses are not always very good at looking after themselves. It isn’t always easy to factor self-care strategies into busy work or social lives despite it being something that most nurses know they should include. If stress builds up without an outlet nurses can face the possibility of burnout. Building self-care into daily routines can help to avoid the build-up of stress and avoid burning out.