Emotions in a caring context

Caring for the dying and their families

Clinicians, care assistants, chaplains, priests, therapists – as well as many others – all have critical roles to play in caring for dying people and their families. People working in the caring professions need to know how to cope with grief.

If you are regularly accompanying people on their final journey, it can be as much a challenge as it is a privilege. In these circumstances, it is important, also, to look after yourself.

Caregivers sometimes find their physical and emotional batteries can run very low, or that a situation has become too hard to deal with. Others discover that they have become emotionally affected by someone’s death.

Coping with grief and ‘compassion fatigue’

‘Compassion fatigue’ is a well-known phenomenon among those who care for the dying. It’s a kind of burnout and it’s what happens when the experience of relentlessly providing care becomes overwhelming. It can take the form of acute stress due to witnessing so much suffering.

Over time, over-involvement in the suffering of patients can also lead to struggles in maintaining the right boundaries. Combined with the usual pressures of life, these kinds of issues, if unchecked, can lead to anxiety, fatigue and even depression.

Living with grief

Dr Mary Vachon, writing in Living with Grief: Before and After the Death¹, refers to the hidden impact of grief on clinicians and carers.

She says: “As professional caregivers working with persons who are dying and with their family members, we can become involved and experience significant grief both during the dying process as well as after the death. Yet the grief we experience is often unrecognised by ourselves as well as the systems in which we work.”

Talking about it with others

Her advice is that it’s critical to be able to compare notes: “Regular opportunities to meet and talk together can help teams debrief about their experiences of grief when patients die and can also help them understand that not everyone grieves in the same way.”

Fellow caregivers usually see the value in caring for each other, but sometimes it’s not easy to schedule regular time to get together as a team.

Therefore – particularly if you are relatively new in your role – one suggestion is to look for a professional mentor; someone who has more experience of dealing with dying patients who can act both as a listening ear and sounding board.

Importance of maintaining the right boundaries

In some cases, caregivers can find themselves becoming too attached to patients. Dr Karen Groves from Merseyside, who works in palliative care, emphasises the importance of maintaining the right boundaries.

“You work as a professional,” she says. “Unless you remain in your professional role, you can’t be as useful as you might be. For professional staff it’s very important to recognise where the professional/personal boundaries are.”

She continues: “We need to help clinicians to follow their professional codes. For doctors and nurses, this means that they make a holistic assessment of a patient’s needs – but that they also  keep their professional/personal boundaries intact. That way, they won’t land themselves in situations where they feel out of their depth.”

Your patient’s emotions

When someone is dying, it’s normal for them to feel a range of emotions, and for there to be bad days and better days. In some cases, however, a person’s mental health can be more seriously affected by the fact that they are dying.

For example, research has shown many terminal cancer patients suffer from depression – although few receive any kind of treatment for it. As a result, their overall outlook might feel bleak. When caring for dying people, therefore, you may find that their moods affects your own. If you find this happening, it’s OK to take the occasional step back.

Recognising your emotional limits

Sister Kathleen Mary is both a qualified nurse and one of the Little Sisters of the Poor. She is also the assistant manager of St Anne’s Care Home for the Elderly in London. Sister Kathleen acknowledges that everyone has emotional limits. She says:

“I think in all settings there’s the possibility that people will it find it difficult when they are journeying with someone who is seriously ill. There has to be an awareness on the part of everybody – and certainly a responsibility if you have a staff team – of the duty of care; primarily to your resident, but then also to every member of your team.

Teamwork and communication

“Not everybody in the team can cope to the same level with an intense situation such as journeying with somebody who is dying. There has to be a platform where team members can express their fears, their worries and their concerns.”

Sister Kathleen adds: “Carers have to be allowed to step back from a situation if they are finding it too difficult and permit somebody else to take their place. Not everybody can stay in an intense situation for a prolonged period of time. Some people cope better than others; this doesn’t mean that they are a failure. It’s perfectly acceptable to have emotions – we’re all human, after all.”

Read more about helping the bereaved.