Caregivers Urged to Take Care of Themselves


Caregivers Urged to Take Care of Themselves

Linda Emanuel, Martha TwaddleProfessional caregivers don’t have any special immunity to the stress of caring for seriously ill and dying individuals. While the satisfaction of helping patients and their families draws people to the health care field, physicians, nurses, and other highly skilled caregivers can also face compassion fatigue and burnout, according to Martha L. Twaddle, MD, GME ’89, chief medical officer of Midwest Palliative & Hospice CareCenter in Glenview, Illinois.

“Caring for ill folks is challenging. It takes a lot out of us,” said Dr. Twaddle, featured guest speaker at the 12th annual Eckenhoff Lecture held October 29 at Northwestern Memorial Hospital. Sponsored by the Buehler Center on Aging, Health & Society, the lecture series honors the memory of former medical school dean James E. Eckenhoff, MD. “Sometimes we don’t recognize the impact of caring for those who are very ill and what it means to be in that caregiver role,” said Dr. Twaddle (shown, on right, with Linda L. Emanuel, MD, PhD, Buehler Center director).

Discussing the “suffering on both sides of the sheet,” Dr. Twaddle noted that rapid advances in medical technology and new therapies have complicated end-of-life care for all involved. “What we can do isn’t often what we should do,” she explained. “The concept that tomorrow’s death could perhaps be avoided if we find yet one more intervention is very appealing because it offers fixes and interesting twists, but it is not always meaningful and can create suffering for the person in the bed.”

Most seriously ill people spend some time in hospitals, where more than 50 percent of U.S. adult deaths occur. Some 15–55 percent of Medicare decedents had at least one stay in an intensive care unit in the six months before death, according to Dr. Twaddle. Quoting from author Stephen P. Kiernan’s book Last Rights: Rescuing the End of Life from the Medical System (St. Martin’s Press, 2006), she said, “The delivery of health care, from staffing to billing, is organized around institutions instead of patients. Gradual dying is treated as a medical crisis instead of a natural process.”

Caring for critically ill patients—particularly in the hospital setting—can lead to work-related stress when professional caregivers feel they can’t help alleviate patient suffering and lack adequate training or support in improving matters. The traditional practice of medicine and delivery of health care focuses on curing various body systems rather than looking at whole person care, remarked Dr. Twaddle. This disconnect between caregivers and their patients, in part, can whittle away at job satisfaction and performance. In the case of those professional caregivers who experience compassion fatigue and burnout, it can expand into depersonalizing patients and others and treating them as objects as a form of self protection.

In her review of the literature about job burnout among health care professionals, Dr. Twaddle found that it was more likely to occur in individuals dedicated to their work and motivated by a need to be liked or accepted. She also discovered that professional caregiver stress appeared to be less common in those who care for patients in palliative care settings versus oncology, critical care, and mental health arenas. And hospital-based palliative care staff reported more stress and less satisfaction with their work environment than colleagues in hospice or home care.

“Interestingly, no evidence exists that caring for the dying creates burnout. That’s not the linkage,” said Dr. Twaddle. “In fact, however, there is a direct relationship in the time spent with families and patients in terms of burnout. When you look at hospice nurses, what is fascinating is that the fewer hours of direct contact they have with their patients the more likely they are to get burned out. So it’s a reciprocal relationship.”

To promote a healthy work environment, Dr. Twaddle suggested keeping an eye out in the workplace for behavioral and cognitive signs of stress and burnout such as irritability, inflexibility, paranoia, and cynicism. She urged the audience to accept personal responsibility for self-care and wellness and designate people who will hold them accountable for taking care of themselves. She encouraged those attending the lecture to seek opportunities to enhance communication and management skills.

“We need to constantly see ourselves as students, who are always learning,” said Dr. Twaddle. “We don’t want to miss those teaching rounds and didactics. They give you a chance to reflect and take away a nugget to contemplate about what you may need to do in your world whether you are a professional caregiver, or caregiver in another milieu, to avoid the costs of burnout.”

Posted November 2, 2007

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