It has been reported that a high percentage of health care professionals complain of psychological distress: stress and burnout.[1] It is especially true in palliative care givers who often encounter stressful and emotional situations. Burnout is a syndrome of feeling emotionally exhausted, depersonalized, and inability to feel satisfied with work performance.[2] A number of studies have shown that there are three categories of stresses in palliative care settings: professional, emotional, and organizational. Professional stressors are related to professional role, such as difficulty in symptom management, lack of private time, and conflicts with other colleagues. Emotional stress mainly comes from frequent death encounters in the workplace, and exposure to patients and their families. Organizational stress includes lack of palliative care philosophy and caring facilities. Actually, occupational stress and burnout involve a number of factors, and Integrated Occupational Stress Model concludes them in a picture as below: [3]



1. Avoidance of stress and burnout
A combination of intrinsic and extrinsic ways of managing stress and avoiding burnout may be helpful. One way of balancing personal and professional stressors in healthcare professionals (HCP) working in the field of oncology and palliative care is through the following 3C model: complementary therapies, clinical supervision and counselling [4]



A stress management programme should offer counselling as primary or secondary interventions. Counselling allows the health care professionals to step back, consider where they are, how they arrived there, to look at their goals, and decide what they need to change in order to get to their goals. Confidential counseling separate from the organization would be a best choice.[4]
Supervision is a primary intervention in an organization where it is mandatory for all staff. Clinical supervision provides an opportunity for staff to wash away the grime acquired at work. It provides “time, space and a supportive relationship that enables practitioners to reflect on their own practice and professional development”. A good supervisor should be able to distinguish between supervision issues and those requiring therapy and recommend referral on for the latter. [4]
Complementary therapies including aromatherapy, massage, and reflexology have been reported to decrease anxiety, depression and fatigue, as well as increase vigor. [4]

Good coping strategies are also helpful in dealing with stress and burnout in pallitiave care professionals. Developing a sense of competence, control, and getting pleasure from one’s work; having control over one’s practice; establishing one’s personal view of death and illness; obtaining support from family and friends…all these are helpful in avoiding stress and burnout.[6]



Environmental coping strategies also play important roles in avoiding stress and burnout. Collaborative work relationships, support groups, administrative policies, team building are good examples.[6]
2. Enhancement of teamwork

Weekly support meeting supported by two trained therapists is a good way to enhance teamwork. The aim is to create “a safe place where the team members get the opportunity to enter their personal experiences of working in palliative care (…) and to care for themselves”. There is no fixed curriculum for the meetings. The only fixed item is the opening session (a relaxation exercise), after which the facilitators (two trained therapists) invite team members to suggest freely topics for the meeting. The facilitator’s role is to guide the process of introspection in the meetings and to offer a safe environment ‘not by judging, not by offering opinions but simply by asking what they themselves feel’. Staffs also expect to learn from each other through these meetings. Teambuilding would be enhanced and that mutual collaboration would improve through such meetings. [5]
Music therapy has been shown to assist participants in working together and developing a sense of team. So it may be a effective method to enhance teamwork, though large-scale, randomized control trial is lack at present.[2]

3. Importance of self-care

As mentioned above, stress and burnout in workplace can put staffs at high risk of suffering in physical, emotional, cognitive, behavioral and interpersonal well-being. Physical problems including cardiovascular diseases, gastrointestinal problems, increased risk of cancer, and immune system problems may rise. And depression, anxiety, post-traumatic stress, substance abuse and addiction may take place as a result of such negative stress. The impact of workplace stress can be so damaging that health care professionals must learn to care for themselves to maintain physical, emotional, and mental health. [7]

Self-care is important also because it is an indispensable part in managing stress and burnout as mentioned by Lemin-Stone K.[8]




References
1. Ashley Weinberg and Francis Creed. Stress and psychiatric disorder in healthcare professionals and hospital staff.The Lancet, Volume 355, Issue 9203, 12 February 2000, Pages 533-537
2. Russell E. Hilliard. The effect of music therapy sessions on compassion fatigue and team building of professional hospice caregivers. The Arts in Psychotherapy, Volume 33, Issue 5, 2006, Pages 395-401
3. Lise Fillion, Isabelle Tremblay, Manon Truchon, Denis Côté, C. Ward Struthers and Réjeanne Dupuis. Job Satisfaction and Emotional Distress Among Nurses Providing Palliative Care: Empirical Evidence for an Integrative Occupational Stress-Model. International Journal of Stress Management, Volume 14, Issue 1, February 2007, Pages 1-25
4. Peter A. Mackereth, Keven White, Anne Cawthorn and Barbara Lynch. Improving stressful working lives: complementary therapies, counselling and clinical supervision for staff. European Journal of Oncology Nursing, Volume 9, Issue 2, June 2005, Pages 147-154
5. Anne Loes van Staa, Adriaan Visser and Nicolette van der Zouwe. Caring for caregivers: experiences and evaluation of interventions for a palliative care team. Patient Education and Counseling, Volume 41, Issue 1, August 2000, Pages 93-105
6. Mary L.S. Vachon. Caring for the caregiver in oncology and palliative care. Seminars in Oncology Nursing, Volume 14, Issue 2, May 1998, Pages 152-157
7. Bergen E, Fisher P. Stress, burnout and trauma in health care. When working hurts. Nurs BC. 2003 Dec;35(5):12-5.
8. Lemin-Stone K.Learn to manage your stress levels. Nurs Times. 2004 Nov 16-22;100(46):74-5.