Michael Kearney is an Irish physician with over 30 years experience in end-of-life care in England, Ireland, at Our Lady’s Hospice, and in Canada, at McGill. Currently based in California, Dr. Kearney is the Medical Director of the Palliative Care Service at Santa Barbara Cottage Hospital and Associate Medical Director at Visiting Nurse and Hospice Care. Dr. Kearney teaches internationally and has published two books on psycho-spiritual aspects of end-of-life care: Mortally Wounded: Stories of Soul Pain, Death and Healing and A Place of Healing: Working with Nature and Soul at the End of Life.
What are the some specific challenges for caregivers at the end of life?
Stressors specific to care at the end-of-life include inadequate time with dying patients because of growing workloads; inadequate coping with one’s own emotional response to dying patients; the need to “carry on as usual” in the wake of patient deaths and, in my view an especially important one, the inability to live up to one’s own internalized standards (e.g. to provide a “good death” every time for every patient.)
How frequently do burnout and Compassion Fatigue affect those working in palliative care?
Burnout is a syndrome that results from occupational stress. In one large study of US physicians and nurses about 30 per cent of both groups demonstrated features of burnout. Compassion Fatigue is a syndrome that results from interpersonal stress. The prevalence of Compassion Fatigue is thought to be less than with Burnout affecting somewhere in the range of 10% of caregivers. Studies suggest that clinicians involved in palliative care have neither more nor less stress and burnout than other health care professionals.
What are some ways for caregivers to better care for themselves and in turn offer better care for their patients/family members?
A good place to start is to make a “self-care inventory”. On a blank page make two columns. Title one column “What gives me life outside work?” and the other “What gives me life at work?” then fill in each column, notice what comes up, and commit to making one positive change in each column. In my view the key to good self-care is “self-awareness”, which means knowing oneself well enough to recognize when one is stressed and needing to take remedial action on the one hand and to appreciate what in one’s work makes one happy and is replenishing on the other.
What would you say to the view that we cannot afford to think of caregiver self-care given the many other demands in health care?
Self-care is essential to good clinical care. Self-care enables caregivers to care for their patients in a sustainable way with greater compassion, sensitivity, effectiveness, and empathy. Remember, the heart must first pump blood to itself.
Michael Kearney delivers the 15th annual Sandra Goldberg Lecture: Caring for self while caring for others at the end of life on May 8 at 5:30 in Moyse Hall.