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Thread: Working in palliative care

  1. #1
    Member Array Fairy...'s Avatar
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    Dec 2008

    Default Working in palliative care

    I've just graduated from college and am working in a hospital as a nurse. I am finding it really difficult working with palliative care patients. I just get overwhelmed with sadness.
    I've dealt with death a few times in my life, however I really find it difficult emotionally to deal with these patients.
    NF's (and others), If you are working in a hospital/with dying people, how do you cope?

  2. #2
    Plumage and Moult Array proteanmix's Avatar
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    Apr 2007


    My family is transitioning my mother into palliative care. The whole thing has been virtually indescribable. It's getting hard to remember a time when things weren't as they are now or wondering if this is how it will be until the end comes.

    My way to tackle palliative care is to learn and ingest as much information as I can. I'm currently learning about compassion fatigue and anticipatory grief. It helps me feel like I have more control over the situation to have knowledge of how things will progress. But often even having the knowledge of things does not make them more bearable. And I personally don't want to go numb and stop feeling, so the balance is how to find ways that you don't lose your heart and compassion but still be functional and not get overwhelmed. The only thing that I'm seeing right now is time, as cliched as that sounds.

    Since you work in a hospital perhaps the hospital offers support groups or programs (usually meet about once a month) to help staff deal with death. My job recently did a study about how most medical staff don't feel like they are adequately trained to deal with death and dying. I was talking to a nurse in oncology during my mother's recent hospital stay. She's been a nurse in oncology for so long that she had to numb herself in certain ways. But I found her to be very kind and sympathetic so that gives me hope that balance is possible.

    As for the sadness part, it really does hit you in the gut. I don't really know what to say about it. I'm not the type of person to disassociate and tune out so I feel like I'm right in the center of the hottest part of the fire almost constantly and there's no way out.

    I do think you should feel something and to feel what you feel isn't something you should run away from. Maybe you just need to feel it for right now to develop a sense of something I can't think of the words for right now. Maybe it's a good thing to let it run it's course. It seems to me to be a period of time where you're being shaped and formed. How you navigate this period of time may be the difference between being a mediocre nurse and a nurse par excellence. The outcome is unclear and you're worried that you won't ever get out of this place of grief. I really don't know what to say but I think recognizing this is a good thing and maybe the next step is to get in contact with people more experienced than yourself than can help guide you through it.

    Relationships have normal ebbs and flows. They do not automatically get better and better when the participants learn more and more about each other. Instead, the participants have to work through the tensions of the relationship (the dialectic) while they learn and group themselves and a parties in a relationships. At times the relationships is very open and sharing. Other time, one or both parties to the relationship need their space, or have other concerns, and the relationship is less open. The theory posits that these cycles occur throughout the life of the relationship as the persons try to balance their needs for privacy and open relationship.
    Interpersonal Communication Theories and Concepts
    Social Penetration Theory 1
    Social Penetration Theory 2
    Social Penetration Theory 3

  3. #3
    Senior Member Array Moiety's Avatar
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    Aug 2008


    I know a guy who was a nurse and worked in palliative care if I'm not mistaken. Just know why he stopped. He said something like "seeing people dying everyday affected me...".

    He ended up doing a trip over the world, old-school style (meaning nothing but the clothes on his body.not even money) and regained his former joie de vivre, but is still undecided as to what he wants to do next.

    Not much of a point to it, just thought I'd share.

  4. #4
    The Black Knight Array Domino's Avatar
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    Nov 2007
    4w3 sx/so
    eNFJ Ni


    Excellent post, Fairy.

    And thank you once again for sharing your experiences, Protean, though they have been so painful. I'm grieved for you and your family.

    Fairy, I have no idea how you have the strength to do what you do. As an NFJ, I'm so deeply and frequently cripplingly affected by the fear and suffering of others that I can't function in such an environment. My INFJ father is an occupational therapist in geriatrics. He works with people who may not ever get better. It was VERY difficult for him when he lost his first client. Having that level of empathic connection with people in general can be exhausting and scary, so being in the middle of a universally difficult field such as palliative care is going to require a very powerful coping strategy.

    I know from dealing with chronic illness how draining and hopeless it can become, much less dealing with people (and their families) who are in a place that can only be described as difficult at best.

    It would be helpful, I think, if some of the other non-NF nurses on the board offered their opinions and coping strategies here.
    eNFJ 4w3 sx/so 468 tritype
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    EII-Fi subtype, Ethical/Empath, Delta/Beta
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  5. #5
    Allergic to Mornings Array ergophobe's Avatar
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    Apr 2009


    Fairy -- I have a close friend who is a chaplain in a palliative care unit. It's hard work, I know, but the friend (INfP) is very good at leaving work behind and has often said that it came with experience. Continued exposure to the work and the process of dying itself as natural and part of life will help.

    The work all of you do in your different roles (nurses, social workers, chaplains) with these patients is just so valuable in making their lives more comfortable! Also, with most people, they're ready, in so much pain and suffering that death itself isn't so terrible. Give it time and if you feel like this is your calling, work through the emotions till you can get to a place where you can better detach from them for your own sanity.

  6. #6
    Iron Maiden Array fidelia's Avatar
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    May 2009
    1w2 so/sx


    I have spent 5 years working on an Indian reserve. Probably about 30% of the kids I teach have lost a parent in some untimely way (found them hanging, cancer, diabetes, murder, etc). Even more have lost a sibling or close relative. In the time I've been here, two girls have gone to Winnipeg and been murdered brutally. Many of the kids themselves are dealing with serious drug and alcohol addictions either personally or with those they love. There is a lot of gangs and violence. Many drop out of school by Grade 9. Many have started out nice kids and become drug dealers and racked up an extensive criminal record before the age of 20. The pregnancy rate before age 18 is astronomically high. Fetal alcohol syndrome and crack babies are very common. Even those in the community who are doing well are bled dry by all of the people close to them that are so deeply mired in their own problems and grief.

    While this isn't the same as working in palliative care, it is very hard dealing with the reality that whatever measures I can take may improve things, but cannot make a difference on a large enough scale to alter much of what is inevitable (barring a miracle). In both cases, it leaves us with a sad heavy feeling which we cannot carry around constantly, but which should not be turned off completely if we are going to be effective in what we are doing.

    I have found that having someone to talk about what is happening and why has been very useful in leaving it behind at the end of the day and in keeping me from becoming hard and complacent. It also has helped me come up with proactive ways that I can try to make things better in the realms of influence that I do have. As a result, I have come up with new ways of teaching or thinking about things that have made a positive impact. I have tried projects that I would not have embarked on otherwise. Even if it does not change the larger picture, it gives me something to focus my energies on and I think that it does change a little corner of the world.

    I have lost three grandparents to cancer, and I can tell you that the palliative care people that helped us are remembered to this day (even 20 years later). For most people, this is the first time they are dealing with a loss like this. In many cases this has happened quickly - and some have not even had a chance to restore a broken relationship with the person who is dying. Many are not even sure how to make their loved one comfortable, or they are not used to the feelings that losing a loved one may bring. Some avoid being there as much as possible because they do not know how to deal with it. You treating not only the patient, but the whole family with care and compassion will make a long term difference. Because you have seen many people go through the process, you have a perspective that they need and will value. I think that by focussing on what difference you can make for them and then finding someone to help you process it aloud, it will help you to deal with the every day sadness you are facing.

  7. #7
    Senior Member Array amelie's Avatar
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    May 2009


    You have a great deal of strength to do that work, Fairy. I'm sure that your presence and empathy for your patients is very healing, though it takes a lot out of you.

    I have worked in several mental hospitals that challenged my ability to function in regard to my level of empathy. For me, it was a process of learning to disentangle myself from others. There were many cases that I felt deeply, but eventually I did learn not to invest the same amount of energy in everyone I worked with. I simply couldn't keep connecting with all of my patients on that level. I worked with another therapist during the time that I first worked in that kind of environment, and she helped me learn to feel okay about stepping back emotionally. In your line of work, that might be a really good thing - I would think almost anyone in your position could benefit from emotional backup, whether it was via a friend, family member, or someone who was more objective.

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