Building the resilience of palliative care staff

Kate Binnie, music, mindfulness and yoga therapist and guest lecturer on the Palliative Care MSc at King’s College London, explains why self-care is so important for people providing palliative care to others.

As we begin to ride the second wave of Covid-19 with an exhausted workforce and a backed-up healthcare system, it’s more important than ever to attend to the emotional and psychological needs of staff caring for people with life-limiting conditions.

For the last five years I’ve been running bi-annual CPD courses at the Sobell Centre for Education and Research in Oxford called Breath-Body-Mind integration. These day-long courses have been attended by a variety of clinical staff from across the country; nurses, hospital doctors, GPs, allied health professionals, chaplains and bereavement therapists.

The premise is to help attendees feel more confident to manage the complexity, distress, emotional burden and uncertainty that is part and parcel of working with people who are ill, who are frightened, confused and coping with change, loss and death. Non-pharmacological skills are so important – especially in situations where medical management may not be the whole answer. But why do we need to invest in them, why do they relate to not only our care for others, but self-care? Importantly, what are they and how do we do them?

Managing emotions

In order to begin to unpick these questions, during 2018-19 I was awarded funding to do some consultation in various settings where people die. I spoke with teams in secondary care, in hospices and in care homes.

I found that there were certain situations and symptoms that healthcare professionals across multi-disciplinary teams found hard to deal with, such as family distress, breathlessness, delirium, existential anxiety and complex team dynamics.

During the consultation process I asked the groups how dealing with such complexity and stress affected their behaviour. Answers included being short tempered, disappearing, procrastinating, becoming clinical/abrupt/dissociated and avoidant, going off sick, and not caring for themselves.

When I asked how this made them feel, they answered with frustration, sadness and exhaustion among other things. Physically, they said they had muscle tension, stomach problems, sleep issues, headaches and trouble concentrating.

What had started as a discussion about “complex symptoms and situations” from a professional and medical perspective, had turned into something much more revealing about the behavioural, emotional, and embodied costs to the individual.

The importance of self-care

My last question was “what helps?” Here they said things like having time off, communication, nature, exercise, yoga, dancing, friends and family, and hugs.

The list went on, but could be broadly themed into rest and relaxation, creativity, getting back to the body, relationships and emotional support, and something hard to define that could be defined broadly as spirituality.

The Breath-Body-Mind integration course is a day where we address the relationship between how we are and how we care. It brings together various skills from psychotherapy, mindfulness, yoga, philosophy, clinical experience and training in supportive and palliative care to give attendees the confidence to not only cope in challenging professional situations, but to maintain their own resilience and body-mind health along the way.

Practical support

Breathlessness, for instance, is well-known to be a complex and distressing symptom, increasing in many conditions like COPD and heart failure, in advanced illness and towards the end of life. It is also difficult to “fix” medically, and causes a ripple effect of anxiety from patient, to family caregiver, to healthcare professional.

For professionals, it requires a huge amount of personal effort, sensitivity and presence to help the person experiencing the breathlessness to down-regulate their distress. In simple terms, by remaining calm with steady breathing, you are able to regulate with the breathless person, enabling them to gradually self-regulate their own breathlessness and distress.

In these uncertain times, where healthcare staff are required to dig ever deeper as we go into winter and a second wave of Covid-19, learning practical ways to support breathlessness and making the link between self-care and providing good care is hugely important.