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Self-care when you work with death and loss

One of the most stressful situations that healthcare providers experience on the job is death. One important thing to remember is that grief is just as natural of a reaction for providers as it is for the family members of someone who has died. Thus, just as we care for grieving families, we must also  care for ourselves.

Having the courage to take care of yourself is the best thing for your patients, too, because you as a provider need to be well to provide the best care that you can.

Thejal Srikumar, MD / clinical fellow

One of the most stressful situations that healthcare providers experience on the job is death

Unsurprisingly, patient death, and the grief surrounding this experience, contributes to the risk for burnout among healthcare professionals. One important thing to remember is that grief is just as natural of a reaction for providers as it is for the family members of someone who has died. Thus, just as we care for grieving families, we must also  care for ourselves. It can be helpful to think of self-care as a way to manage our grief, as well as a preventive approach to lessen stress and burnout. Here are some ideas for self-care that you may wish to consider incorporating into your practice.

Recognize the warning signs of burnout

Here are some signs it is time to take care of yourself:

  • emotional arousal is high
  • focusing on behavior only
  • reactions are judgmental or defensive
  • feeling pulled to control the situation
  • feeling pulled to withdraw or run away from the situation
  • feeling frozen, numb, or shut down
  • feeling stress in our body (fatigue, headache, muscle aches, reflux, difficulty sleeping, loss of appetite) 

Reflect on mental states

Once you have recognized it is time to take care of yourself, a helpful place to start is by reflecting on mental states. This is something you can do in the moment, on the job, and as soon as you notice that stress is taking hold. It does not require 'homework' or extra time. Try using the questions below as a starting point. Begin to notice how mental states and behaviors can be cyclical. Just by noticing patterns in your work, you regain power to provide more sensitive care to your patients and yourself.

reflective cycle graphic, including the words How am I feeling? What is running through my mind? How is this impacting my behavior at home? At work? The care I am providing? How is the family feeling? What are they thinking? How are they making sense of things?  How is the family's emotions impacting the behavior I am observing?

Recognize barriers to self-care

Self-care is very often easier said than done. Lots of things can stand in the way, and in order to take care of ourselves, we have to identify the barriers first. Which of these may be at play for you?

  • Failing to recognize or dismissing the warning signs of burnout
  • Accepting stress and burnout as an occupational hazard
  • Fear of being judged as ‘not up to the job’
  • Believing emotions are a sign of weakness
  • Being resigned to the belief that nothing will change
  • Not recognizing the importance of caring for yourself in order to care for others
  • Avoiding talking about emotions out of fear of its impact on future prospects
     

Model a culture of care

Being part of a supportive team is vital in preventing burnout and reducing the effects of occupational stress. Although we are all responsible for our own self-care, it is easier when this is the expectation and culture in our workplace. It may need start with you. To model this culture of care you may consider...

  • Helping others feel safe to connect with you.
  • Being willing to listen to colleagues without needing to fix their problems.
  • Embodying empathy, integrity, and confidentiality
  • Reminding yourself and your colleagues that compassion and vulnerability are not weaknesses
  • Reminding yourself and your colleagues that emotions aren’t unprofessional
     

Create new habits

Outside of work, you may consider developing new habits that help you remain more resilient to the stress that is inevitable when working with dying people. Here are just a few ideas:

  • Grounding: Pay attention to the 5 senses to ground yourself in the present moment. 
    • 5 things you can see? 
    • 4 things you can hear? 
    • 3 things you can touch? 
    • 2 things you can smell? 
    • 1 thing you can taste?
  • Mindfulness: breathing and acknowledging feelings and thoughts without judgment.
  • Affirmations: What are the things you can remind yourself of that help you get in touch with your value and the meaning of your work?
    • I am doing the best I can
    • I am making a difference
    • This too shall pass
    • I will be remembered by the families I care for
    • I am grateful to do meaningful work
  • Looking for the learning: 
    • What have I learned? (About myself, the families I care for, death, grief, illness...)
    • What have I helped others learn?
    • Is there a silver lining?
    • What are the successes I can celebrate? 
  • Self compassion: Instead of being your own worst enemy, try being your own best friend.
  • Gratitude: Don't focus solely on pain and suffering; what is there to be grateful for even when stress is high?
  • Connection: Maintaining supportive relationships can buffer stress. It is critical to connect with self, others, community, and nature. Remember that communication is part of the connection and prevents isolation.