nurse-self-care-during-end-of-life-care

Caring for Oneself While Providing End-of Life Care

Keith Carlson, RN, BSN, NC-BC - 03/13/19

When a nurse provides end-of-life care to a dying patient, the situation can be fraught with emotion. Whether in a hospital, residential hospice, or a patient’s home, the dying process can lead to expected and unexpected reactions in the nurse; thus, self-care and self-awareness are essential tools in the nurse’s psycho-emotional toolbox.

The Nurse’s Outer Self

In death-and-dying situations, the nurse is looked to for clear guidance, steadfast support, and specific knowledge. Both the patient and their loved ones may be confused and frightened by increasing symptoms and impending death, so the nurse must be on his or her toes when it comes to meeting the needs of those relying on nursing expertise in order to face one of life’s most challenging passages.

Maintaining firm professional boundaries is expected of any healthcare professional, although many hospice nurses will admit that showing some emotion can be considered therapeutic use of self, as long as the benefits of the nurse’s relative transparency is for the benefit of the patient and family, and not self-serving for the nurse.

The challenge is that the nurse may feel emotionally triggered at any point, even though he or she needs to maintain composure and be present for the family and patient. Clear thinking is essential when symptoms become more pronounced and fear takes hold, thus the nurse is both buoy and lifeguard.

Riding the knife’s edge of emotion is a significant challenge, and the nurse’s bottled up feelings should certainly be processed later. After all, as a famous quote attributed to psychiatrist Henry Maudsley (1835-1918) states: “the sorrow which has no vent in tears may make other organs weep.”

The Nurse’s Inner Self

End-of-life care is a part of nursing and medicine that some healthcare providers avoid like the plague. Oftentimes, this may have to do with the individual’s own anxieties about death.

In our training, we professionals are taught to save lives; however, in end-of-life care, hospice, and palliative care, we turn this approach on its head, focusing instead on symptom management and quality of life rather than treating, curing, and life extension. In the presence of a vulnerable and helpless child who is dying, the stakes are even higher and emotions more profound for all involved.

Childhood trauma, life experiences, and one’s own inner landscape contribute to one’s particular outlook on disease, dying, and death. A nurse who witnessed tragic or violent deaths as a child may have strong feelings about this part of life; whether working in hospice helps to heal those past experiences or not largely depends on the nurse’s ability to navigate those difficult spiritual and emotional waters.

Nurses exposed to death and dying must face their own demons, fears, and memories. Being present for others means being able and willing to be present for one’s self, no matter the hard work involved in doing so.

Useful Self-Care Strategies 

There are a variety of self-care strategies that the thoughtful nurse can employ when faced with these types of circumstances. Decisions regarding how to address what’s coming up will be influenced by many factors, including the nurse’s personal history, professional experience, the quality of clinical supervision, as well as the nurse’s level of self-knowledge, spiritual attunement, and personal agency.

Some strategies to potentially employ include, but are not limited to:

  • Seeking mentorship from a more experienced colleague
  • Looking to a trusted faith leader for spiritual guidance
  • Leaning on fellow members of one’s faith-based or spiritual community
  • Partaking in counseling or psychotherapy for the processing of deeper emotional issues and memories
  • Using self-study for increased self-knowledge, including books, articles, podcasts, films, and other media related to death and dying
  • Participating in self-growth workshops or seminars that explore the nurse’s psyche
  • Using meditation, prayer, and other practices as a foundation for psycho-spiritual wellness
  • Improving physical self-care, including exercise, hydration and nutrition, rest, sleep hygiene, and time away from work
  • Therapeutic writing, journaling, or artistic expression

It’s All About Presence

When faced with issues of death and dying, the nurse’s experience is all about presence. Being present for the family of a dying patient is crucial, and being present for a frightened or worried patient even more so.

Beyond patients and families, the nurse must be present for his or her own journey and feelings. Deep self-awareness will guide the nurse in knowing what to say, how to act, and when and when not to disclose his or her own feelings.

Death and dying are universal, as are the human emotions that accompany this natural process. The nurse can be a guide, steward, and skilled support when self-knowledge is present. After all, caring and compassion have been, and always will be, one of the cores of nursing’s power; thus the nurse’s compassion for self only serves to fuel that power of healing presence.