The advent of caring for dying people can often serve as a constant reminder of the fragility of our own lives, provoking worry and anxiety. While we all know that death is a certainty, caring for dying people can bring this concept back to the forefront of our minds and, by extension, build on our existential threat, which penultimately shapes the psychological labour of caring.
Great thinkers like Martin Heidegger and Søren Kierkegaard have argued that we move from our natural day-to-day living without thinking of our existence, to being more mindful and aware of life and our need to exist. Hence, all attempts are made to preserve life. While thinking of our existence more consciously can be useful, it also means that we inevitably bring death to the forefront of our thought processes, which needs to be carefully balanced out with caring for others. Palliative care is notorious for exposing and reminding us about this through the people we care for on a daily basis. Admittedly, not talking about death does not, in itself, make us escape its inevitability. Therefore, our minds are perpetually disturbed by this elusive phenomenon in the form of death, with a potential negative effect on how we care for the dying.
We have known for some time now (Nyatanga and Nyatanga, 2011) that worrying about death affects our resilience and reduces the ability to cope with stress. In today's healthcare environments, which are characterised by staff shortages, low remunerations and morale, and poor work terms and conditions, it is not surprising to see nurses and ambulance staff go out on strikes. Doctors and other public service workers are also balloting for industrial action. It is clear that the situation has remained unabated for years, and what we see now is that healthcare staff are at their breaking point, resulting from burn-out. The burnout syndrome (Nyatanga, 2011) is characterised by the inability to cope, ill-health and individual absenteeism in healthcare professionals. Strike actions demonstrate collective absenteeism and is arguably driven by desperation (as nurses always want to care for their patients and have never gone on strike before) and a call to be visible, demanding lawmakers address their concerns. While strikes continue on, it is the dying who are affected. It is also a misrepresentation for the Government to assume that nurses who are burned out can provide a minimum level of service. According to Nyatanga (2011), such nurses may now lack compassion due to compassion fatigue, with a negative impact on the dying patient's experience of care, which is also most likely to affect those deemed important to the patient as they navigate their grief.
What can be done?
First, recognise that palliative caring can be a double-edged sword, where one is:
- Privileged to be part of someone's intimate dying experience, while providing their care
- Being exposed to death and continually reminded of their own fragility, and provoking the psychological labour of caring.
Community nurses and managers need to find ways of supporting staff to avoid the negative episode of death and burnout. One way is through regular debrief sessions at the end of the day. There is the realisation that death often comes with uncomfortable experiences for both the family and healthcare professionals, which often makes any conversations that follow, difficult. However, to avoid such conversations is to deny reality and suffocate any efforts to genuinely support patients and relatives during this phase of their lives. From such a position of honesty, it may also be easier to maintain positive relationships and help ensure we continue to give our best care possible. While the labour of caring can take its toll on us, this can be ameliorated by delivering the best palliative care possible—making us feel like we have done what we signed up to do.