Palliative care is a specialty practice that can evoke feelings of profound meaning and honor for practitioners. To be able to support patients and families with chronic or serious illnesses, or those anticipating their own death, has been described as rewarding and enriching. While this reality is true, there is a paradox in that the same professionals experience high rates of burnout, distress, compassion fatigue, decreased quality of care delivery, and secondary traumatic stress. With these in mind, coupled with the risk factors social workers face in the current sociopolitical landscape, raises great concern for palliative care social workers’ emotional distress levels, burnout, and self-care mitigation. While this is demonstrated in the literature, there is often little focus on this topic in occupational settings and educational institutions.
Contributing factors to these concerns are often multifactorial and influenced by personal features, the work environment, and the community in which one serves. Social workers may feel self-care is something that takes place outside of the workplace. Amidst balancing large caseloads, working in health care post-COVID-19, navigating leadership or organizational structures, detailed documentation, and interdisciplinary team collaboration, it is hard to consider making time to employ self-care strategies anywhere but home. However, research has established that this is something that should be practiced both in and out of the workplace setting. In 2021, the NASW made revisions to the Code of Ethics to specifically address self-care as an ethical responsibility, placing an emphasis on its significance. It not only calls for individual social workers to engage in and promote policies that support self-care, but also organizations, agencies, and educational institutions. To ensure social workers engage in ethical practice, they are required to take measures for themselves to provide care both professionally and personally, to avoid impaired care delivery, yet it still feels there is minimal attention or awareness on this.
Physical, psychological, social, spiritual, and leisure strategies are key to developing in the social work profession overall, especially when working within palliative care. It is equally important to ensure that occupationally, we advocate for and develop strategies that allow for purposeful engagement in the professional social work role, while also allowing for sustaining our overall well-being. This can be accomplished by first maintaining awareness of the significance of self-care in the professional setting, engaging in reflection on areas of opportunity that may be present within the agency/organization, and by feeling empowered to act. Through mezzo-level intervention, social workers can decrease feelings of isolation, increase supportive environments, and overall workplace satisfaction to successfully give attention to and execute the professional role, with the ultimate goal of high-quality patient care.
Over the course of belonging to the profession, it has been my subjective experience that once a social worker has successfully obtained clinical licensure, their engagement in clinical supervision starkly declines. This appears to be multifactorial; it is no longer a requirement, and supervision with one’s manager/supervisor may be more focused on administrative tasks, rather than review of ethical/ clinical practice. Supervision is not only an important space to process cases from a clinical/ethical perspective, but also to allow for processing of feelings of countertransference, distress associated with the work, and debriefing around mezzo/macro level barriers to the profession. Social workers should consider the benefits of scheduling regularly occurring peer case consultation groups to promote the continuation of this thoughtful practice. This type of setting allows for professional development, critical self-reflection, building professional relationships, and a supportive space to process the challenges with one’s caseload, systemic barriers, and moral injury. Working in the health care setting with an interdisciplinary team, there is also great benefit to holding case consultation solely with other social workers, to process from a shared, value-based lens, with others who understand the nature of the profession.
Another strategy to consider employing is the development and engagement of councils within your agency’s department. Councils can aid in identifying barriers to efficient work and other areas of opportunity to continue to enhance the delivery of quality social worker intervention. Councils can allow for a department to have shared governance and input into decisions that may be made. It may also lead to increased productivity, as members of the council can speak to barriers faced in the work and develop standard work practices and processes to optimize care delivery.
When trying to prioritize tasks and responsibilities throughout the day, it may seem that the strategies offered will only add more to one’s plate. Yet, self-care should be at the top of the list of priorities, considered in the same way we would a new consult or family meeting. Engaging in mezzo-level practices within the agency can aid in mitigating the emotional implications of working in healthcare and palliative care settings while simultaneously developing leadership skills and advocating for the profession.
References
Bodenheimer, D. (n.d.) Real World Clinical Blog: On Social Work Supervision. https://www.socialworker.com/feature-articles/real-world-clinical-sw/on-social-work-supervision/.
Gallagher, S., & Cooper, L. (2023). Self-care methods of social workers working in end-of-life care. Aotearoa New Zealand Social Work, 35(3), 89–100. https://www.researchgate.net/publication/380944624_Self-care_methods_of_social_workers_working_in_end-of-life_care
Highlighted Revisions to the Code of Ethics. NASW, National Association of Social Workers. (n.d.). https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Highlighted-Revisions-to-the-Code-of-Ethics.
Horn, D. J., & Johnston, C. B. (2020). Burnout and Self Care for Palliative Care Practitioners. Medical Clinics of North America, 104(3), 561–572. https://doi.org/10.1016/j.mcna.2019.12.007.
Lee, J. J., & Miller, S. E. (2013). A Self-Care Framework for Social Workers: Building a Strong Foundation for Practice. Families in Society: The Journal of Contemporary Social Services, 94(2), 96–103. https://doi.org/10.1606/1044-3894.4289.
Sansó, N., Galiana, L., Oliver, A., Pascual, A., Sinclair, S., & Benito, E. (2015). Palliative Care Professionals’ Inner Life: Exploring the Relationships Among Awareness, Self-Care, and Compassion Satisfaction and Fatigue, Burnout, and Coping With Death. Journal of Pain and Symptom Management, 50(2), 200–207. https://doi.org/10.1016/j.jpainsymman.2015.02.013.
