Background
Methods
Research design
• In the context of palliative care practice, what does self-care mean to you? • From your experience, how would you describe effective self-care practice? • Tell me about the self-care strategies you find to be most effective • What supports your self-care practice? • What, if anything, gets in the way of your self-care practice? |
Data analysis
Sample
Demographic | n (%) |
---|---|
Gender | |
Female | 15 (63) |
Male | 9 (37) |
Age Group | |
30–39 years | 4 (17) |
40–49 years | 11 (46) |
50–59 years | 7 (29) |
≥ 60 years | 2 (8) |
Population Focus | |
Adult Palliative Care | 19 (79) |
Paediatric Palliative Care | 2 (8) |
Aged Palliative Care | 3 (13) |
Work Status | |
Full-time | 14 (58) |
Part-time | 10 (42) |
Years Worked in Palliative Care | |
1–5 years | 1 (4) |
6–10 years | 3 (13) |
11–15 years | 12 (50) |
≥ 16 years | 8 (33) |
Results
A proactive and holistic approach to promoting personal health and wellbeing to support professional care of others | |
---|---|
Prudence |
Through self-care, what we are doing is developing a relationship with ourselves – which actually supports us in developing relationships with everybody else.
|
Gwendolen |
Self-care - it’s looking after me to look after patients, so to speak; if I’m not of a good healthy physical state or emotional state, I’m hardly likely to be able to support someone.
|
Darrell |
You can’t look after dying patients without looking after yourself, really, can you? And do a good job of that, in a compassionate way?
|
Felicity |
Balancing care for yourself and others is essential.
|
Patrick |
It’s part of a holistic approach… if you’re not caring for yourself then you’re less able to care for others.
|
Merilyn |
[It’s about] maintaining a good balance between body and mind… being able to stay fit and healthy.
|
Winston |
You look after your own health so that you can deliver patient-centred care.
|
Prudence |
That’s what self-care is; it’s a way of living, it’s a way of living every moment.
|
Mason |
The thing is, [self-care] is not a tick-box commodity.
|
Philis |
It’s really not formulaic; it’s really quite individual, and so everybody has to find their own way of doing it.
|
Carmel |
You not only need self-care strategies in the workplace - but also in your personal life.
|
Felicity |
I do try and exercise a reasonable amount and I try and get to bed on time because I have to get up at a reasonable time… and diet’s important.
|
Gwendolen |
I regularly exercise, do yoga and have a regular massage as well.
|
Abbie |
[Having] a bath; it’s almost like I’m washing the hospital off me.
|
Larissa |
I have an extremely supportive, very good husband and I have an extremely good network of friends, so… spending time with family and friends.
|
Doreen |
Maintaining relationships with family; making sure I’m spending a reasonable amount of time with my children makes me feel that all is right in the world.
|
Abbie |
Meditate for half an hour a day; that’s all I actually need to do to function well - I’m great at work, I’m calm with [son]. But if I don’t do that, then I get irritable [and] I don’t have as much to give at work. With just half an hour of meditation a day as my top priority for the day, I’m just better all round.
|
Lucas |
I’m quite involved in my Church, and faith is actually a big anchor [that keeps me grounded].
|
Reece |
…my spiritual practice which, for me, is a very reliable tool; Buddhist practices… to do with strengthening my connection with compassion or loving kindness for self and others.
|
Deanna |
Work-life balance is really important.
|
Sandra |
There’s no such thing as work-life balance, it’s rubbish.
|
Cathi |
If it’s after five o’clock: (a) I won’t be [at work]; and (b) my diary will be sitting on my desk with my mobile phone on it turned off, with my name tag sitting on it. My computer will be off. [It’s] about making certain that work is at work, so I don’t take my mobile phone home. I don’t take my diary home [to follow up on things]; no, sorry that’s work, and it will wait… work stays at work.
|
Felicity |
I take the train… I can only arrive at a certain time and leave at a certain time – those boundaries are actually very helpful. I’ve never been very good at placing boundaries, so I actually have to do this physical boundary of ‘Right, the train’s leaving, and I have to go’ - and that’s worked quite well.
|
Deanna |
My de-escalating time is driving home and when I walk in the door at home, work stays at work… and I find that something to be really important to me actually – that the two don’t intermix.
|
Winston |
It’s not sustainable to give out more than you really can on an ongoing basis… absolutely [regulating work demands is important].
|
Cathi |
I take regular holidays. I’m not somebody who’s got an annual leave balance; I always take my meal breaks, take my days off, and sick leave when ill.
|
Larissa |
I chose [to work] part-time.
|
Scott |
It’s very difficult to do self-care without [team] support, and so you support each other in doing self-care at work, definitely.
|
Doreen |
A mindful activity, just grounding yourself …this conscious thing of ‘Okay, what can I see? What can I feel? What am I touching?
|
Carmel |
Supervision [provides] a safe and guided reflective space that allows you to talk about your practice; to think about what is meaningful to you, about a time, something you did, something you’ve been experiencing recently… allow yourself to really drill into - not just the story - but how did it make you feel… how did you behave… what would you change?
|
Darrell |
[informal debriefing] is a sign of a healthy team because that’s… self-initiated, as opposed to organised or imposed.
|
Deanna |
It’s Friday, I’m tired. A lot has gone on, and I’m giving a handover. I get half-way through the ward and then I start wrapping up. And they go, ‘What are you doing? There’s still the other half of the ward to go yet’, and I’m like, ‘Oh, damn’! So, being able to [make a mistake] and be able to laugh about it was important. Being kind and being compassionate about that. Being able to accept that you are human.
|
Abbie |
We’ve all got a very black sense of humour, so it works really well.
|
Cathi |
There’s too many patients and you can’t get enough done… busyness contributes to poor self-care because you actually don’t stop to go ‘How has this affected me? What can I do? What do I need to make me ‘okay’ about it?’
|
Patrick |
There is an expectation that people won’t take holidays, but how are people supposed to recharge so they can keep working?
|
Scott |
There’s this… culture sometimes where you just sort of ‘soldier on’ and do what’s expected – take work home.
|
Merilyn |
It just follows you home and it can really impact on your home life and your health, because you’re just… stressing about things
|
Gordon |
The biggest hindrance to self-care is organisational culture.
|
Larissa | There’s a big culture shift that needs to ha in order for people to be able to look after themselves properly. |
Winston |
There is still a lot of stigma around having feelings or accepting feeling or being vulnerable… we do see confronting things but there is still that superhero, you know, not letting it affect you.
|
Peggie |
People are considered to be selfish if they do something for themselves… you know, if you take a day off because you’re on a mental health day people think ‘Oh, she’s so selfish because she’s let her team down’
|
Prudence |
Lack of self-worth and self-value is a bit of an issue… I can see that in how my colleagues - how people treat themselves, and that’s not a judgment - it’s an observation coming from someone doing pretty much the same kind of thing.
|
Sandra |
Self-care always get shoved down to the bottom… that self-worth thing of… you know, something else always being much more important.
|
Philis |
I certainly used to be quite critical about myself… which isn’t a particularly helpful thing to do really… [most of us] just beat ourselves up emotionally and physically… and then eventually work out why you can’t keep doing that for the rest of your life.
|
Carmel |
Self-care goes down the toilet when it’s random… there’s no effective random self-care.
|
Peggie | I’m very conscious of [self-care] because I’ve been a in bad spot before with palliative care… I really didn’t cope very well, so I’m [now] highly vigilant about self-care. |
Gordon |
I was ‘young and bullet-proof’… and I found [that] to be a fairly unpleasant experience; ‘young and bullet-proof’ didn’t work very well. But it took me about seven years to work that out, and I became significantly burnt out… So, having burnt out… taken time off, and readjusted… I’m now very conscious of how important self-care is.
|
Abbie |
When I do [prioritise self-care] I’m calm and I’m more compassionate.
|
Winston |
Preventative maintenance… Yeah, well it is [like having a regular check-up and a tune-up]
|
Reece |
I have written self-care plans for myself… but I don’t approach that in a sense of, you know, at six months – ‘now I need to redo my self-care plan’. An ongoing planning process is the critical element rather than just the piece of paper.
|
Carmel |
Leadership. It’s got to come from the top. You can’t have someone at the top who thinks that people who need to go for counselling are ‘poor little things’. Seriously, it’s not going to work
|
Kaleb |
Having a reasonable degree of self-awareness is hugely important [for effective self-care], particularly in our line of work.
|
Cathi |
Finding the positive in situations… also taking account of things that have negatively impacted me [but still finding] something positive.
|
Doreen |
…intentionally choose how I want to be each morning, and how I want to leave work, and respond to events; having a mindset of gratitude.
|
Reece |
Practising self-compassion is a really important enabler – without that I’m not really sure how authentic my self-care would be.
|
Gordon |
Being realistic about your limitations is central to self-care… self-care involves being honest about a whole host of things, and it’s primarily being honest with yourself - and being prepared to take that up with other people where you need to - but it’s about being honest with yourself in relation to your limitations.
|
Lucas |
Contemplating my own mortality is very important in terms of self-care. I have to have confronted that; there but for the Grace of God go I… and this could be me [dying]… Really puts things into perspective and helps you to live and enjoy your life to the full.
|
Theme 1: A proactive and holistic approach to promoting personal health and wellbeing to support professional care of others
Theme 2: Personalised self-care strategies within professional and non-professional contexts
Self-care in personal settings
Establishing and maintaining boundaries between home and the workplace was considered an effective self-care strategy. Some boundaries involved commuting to the workplace via modes of transport that prevented over-working, while for others the commute time itself constituted a process of unwinding from work so as to separate from it when arriving home.It’s never like you’ve got this nice balance - where work finishes, then you’ve got an hour to sort of wind down before the rest of life begins… [it’s more about] just trying to keep all the different areas of life flourishing (Darrell).
Self-care in workplace settings
Self-regulation of workload was important, but often difficult to achieve. It involved being assertive about one’s capacity in relation to workload and wellbeing. Taking meal breaks, taking recreation leave for regular holidays, and taking personal leave during illness were also considered effective self-care strategies. For some, choosing to work part-time was an effective self-care strategy that provided ongoing regulation of workload in relation to other competing demands.The amount of resources [allocated to the] palliative care service - that actually creates a certain set of boundaries within which I can work - I’m not going to step over those boundaries; if they want additional work, they need to increase the resourcing… It’s about managing expectations around what I will do and what I won’t do - and being able to be very upfront in relation to that… with management… with staff that I work with, so [they] are aware of what we can do, and what we can’t; but more importantly, with patients and their families, so there’s a very clear set of expectations around what can reasonably be done for them (Gordon).
Theme 3: Barriers and enablers to self-care practice
Self-care barriers
Self-care enablers
Normalisation… the reason I bang on about [self-care] is because I think, yes, you do need to normalise it. I think the key thing is the ethos of the unit, and I think that’s set firstly through the medical head but then also the administrative or hierarchal structure [helps] - if it’s normalised and supported from the top then I think that flows down through the service… [from my observation] it is the leadership group of the team, and unfortunately that is still medical, who set the ethos of the unit. So, if you want to change the culture of the place, my approach would be to get the most senior consultants on board, (Winston).
Self-care is built on self-compassion. If your compassion does not include yourself, it is not complete; it extends to yourself and to your clients equally. And if you’re not doing that, then something’s not working (Carmel).