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Hospice staff need support to continue the work of caring

Joanna Goodrich 16 March 2015

Joanna Goodrich, head of evidence and learning for The Point of Care Foundation, reflects on the important work of hospice staff and the need to support them in their work.

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Sixteen years ago my father-in-law died in St Ann’s hospice (Stockport). The family couldn’t cope any more at home but he didn’t want to go back into hospital, so we were incredibly relieved and grateful when he as able to go into the hospice. The care he received there was everything we had heard about hospices – practical and thoughtful, expert and sensitive. It never occurred to me then that of course the care provided by the wonderful hospice staff must come at a personal cost to them. Our report for Hospice UK Resilience: A framework supporting hospice staff to flourish in stressful times published today, focuses on the support that can be given to hospice staff and volunteers to enable them to carry on providing compassionate care.

Our literature revealed that, like the rest of the healthcare workforce, staff who work in hospices do suffer from stress and burnout. We know from previous research undertaken at the Point of Care programme, that if you are stressed or burntout it is hard to feel empathy or compassion. Although our literature review showed that caring for the dying can be very rewarding, and that this has a mitigating effect against stress, staff in hospices are still at risk because of the difficult nature of the work they are doing – dealing every day with death, dying, suffering and bereavement. Patients and families will have many different and conflicting emotions which they may expect hospice staff to help with, sometimes at the expense of paying attention to their own wellbeing.

Apart from the difficult work they do, the evidence shows there is another major cause of stress: just like workers in most organisations, the stress hospice staff feel can be because of organisational factors such as lack of good management. This is particularly true in times of a changing working environment. Hospice UKcommissioned us to write this report knowing that, as the Commission into the Future of Hospice Caredemonstrated, hospice care is becoming increasingly complex (with a greater number of patients being older, and having multiple morbidities) and staying for a shorter time. More hospice care is also taking place in the community rather than traditional hospice settings.

The good news is that there are interventions that can be put in place. There are examples of good change management practice to draw on. Management training is available for managers at all levels (team leadership, objective setting, appraisal, supervision etc). Research shows that being in a good team can be a buffer against wider organisational stress factors.

Our report presents a framework which sets out interventions available to help staff in hospices to be resilient at a time of change and to cope with the challenging nature of their work. We present the evidence for these interventions (for example, mindfulness and meditation, resilience training, clinical supervision and teamwork). We encourage hospice leaders to have a staff wellbeing strategy and we provide a checklist for hospice boards and senior leaders to use regularly. We hope our report will be a helpful and practical resource for hospices to continue the marvellous work they do.