Jason Mills

On self-compassion and self-care in nursing: Selfish or essential for compassionate care?

Compassionate care in nursing is increasingly an international concern. While the literature to date has focussed on redressing a compassion and care deficit across the nursing discipline (Crawford et al., 2014, Dewar et al., 2014, Scott, 2014), we suggest here that due consideration be given to its relationship to self-care and self-compassion in nurses. After all, a deficit in these compromises nurses’ therapeutic use of self in the provision of compassionate care to patients.

Building community capacity for end of life: an investigation of community capacity and its implications for health-promoting palliative care in the Australian Capital Territory

This study identified and examined community-based activities around death, dying and end-of-life care which might reflect a health-promoting palliative care (HPPC) philosophy. This approach is argued to restore community ownership of, and agency in, dying and death through the building of community capacity. However, the enactment of the HPPC approach has not been extensively examined in Australia. Current understandings of community capacity-building relating to end of life are orientated toward service provision. A qualitative interpretive approach was used to engage with local community groups in the Australian Capital Territory with an interest in death, dying and end-of-life care. Data were collected from ten in-depth, semi-structured interviews and thematically analysed. The themes of Practical Support, Respect and Responsiveness and Connection and Empowerment were identified, reflecting community activities initiated in response to the experience of life-limiting illness. Building community capacity offers to restore community agency in end-of-life concerns, while potentially enhancing health service provision through collaborative partnerships. This study indicates an existing community capacity, demonstrated by activities that promote socialisation, peer support and normalisation of death and dying. However, as these activities occur primarily in response to illness, proactive and preparatory interventions in HPPC are a priority.

Putting the 'public' into public health: community engagement in palliative and end of life care

This special issue on public health weaves together two threads introduced in previous editions of Progress in Palliative Care. In 2003, former Editor-in-Chief Emeritus Professor Ian Maddocks outlined a vision for what he called ‘the caring community’. This vision extended beyond ‘the bedside of the dying patient’ to encompass social networks, diversity, responsibility, and participation; it was, according to Maddocks, a vision ‘likely to bring health and healing to all its participants’....

Future directions for community engagement as a public health approach to palliative care in Australia

The origins of contemporary public health approaches to palliative and end-of-life care can be traced to Victoria, Australia. The work of Allan Kellehear and the palliative care unit at La Trobe University proved seminal, and this continues to grow. But while the growth of compassionate communities continues internationally, both challenges and opportunities remain for communities in Australia. In this context, we discuss future directions for community engagement as a public health approach to palliative care. Drawing from examples of community activities and from the literature, we highlight the use of arts and social media as an emerging strength from which to build. Through the lens of positive education, we propose a positive paradigm for death education in schools to promote positive dying. The relevance and potential contribution of appreciative inquiry is then explored as an asset-based public health approach to support sustainable community development. Collective action towards these future directions will contribute to the continued flourishing of public health approaches to palliative care in Australia.

Compassion and self-coompassion in medicine

In a Lancet article several years ago, physician wellness was highlighted globally as a missing quality indicator–in the context of widespread self-neglect and ill-health. Now in our region the health and wellbeing of doctors are topics of growing interest. Both were discussed as essential to safe and effective medical practice at the recent Australasian Doctors’ Health Conference. While the provision of staff support and doctors’ health programs are imperative; so too, is effective self-care. By this, we mean actively taking care of oneself. It has now been a decade since the publication of Keeping the Doctor Alive, but there is a clear need for further work in this area. In this paper, we suggest such work could usefully explore doctors’ self-care in relation to their feelings of compassion for themselves and for others. After all, how well can doctors care for patients or themselves, if they lack such compassion?

Examining self-care, self-compassion and compassion for others: a cross-sectional survey of palliative care nurses and doctors

This study examined levels of, and relationships between, self-care ability, self-compassion, and compassion among palliative care nurses and doctors. METHODS A total of 369 participants across Australia completed a cross-sectional survey comprising a demographic questionnaire and outcome measures for each variable. Descriptive and inferential statistics were analysed, controlling for potential social-desirability bias. RESULTS Levels of compassion, self-compassion and self-care ability varied, with some individuals scoring high or low in each. Self-compassion and self-care ability were positively correlated (r = .412, p<.001), whereas a negative correlation was observed between compassion and self-compassion (r = -.122, p<.05). Linear regression further indicated that: increased compassion was associated with a decrease in self-compassion, and increased self-care ability was associated with an increase in self-compassion. CONCLUSION These results suggest important implications for self-care in the palliative care workforce. Moreover, this study contributes an empirical basis to inform future research and education to promote balanced compassion and compassion literacy in palliative care practice.

PA13 The arts and end of life conversations: an innovative approach to health promotion in palliative care

Background Dying in Australia has been recognised as amongst the most institutionalised in the world. Discussion of death and dying is largely taboo in contemporary society, resulting in a lack of formal advance care planning or personal reflection on end-of-life considerations. To address this problem, a pilot study was developed as an innovative health promotion activity, drawing upon the Arts. Aim To explore how an arts medium might influence public discussion on end of life issues in the community. Methods An action research approach was used to collect survey data from a community sample attending a Canberra marketplace. 54 participants completed a 14 item questionnaire, after viewing a photographic exhibition that provided international narratives on death and dying. Qualitative descriptors were elicited from participants to describe their reactions to viewing the exhibition, and quantitative data were analysed for frequency. Results Most participants agreed the exhibition effectively engaged members of the public in conversations about death and dying. After viewing the exhibition, they were more inclined to consider or prepare a legal will, enduring or medical power of attorney, or an advance care plan (ACP). Conclusion From this pilot study, there are preliminary but encouraging data to suggest that the Arts are an effective medium for health promoting approaches. We propose further use of Arts-based activities in communities to promote public discussions about death and dying.

Undergraduate paramedic student psychomotor skills in an obstetric setting: An evaluation

The clinical education of paramedic students is an international concern. In Australia, student placements are commonly undertaken with local district ambulance services, however these placements are increasingly limited. Clinical placements within inter-professional settings represent an innovative yet underdeveloped area of investigation. This paper addresses that gap by reporting a pilot evaluation of paramedic student clinical placements in a specialised obstetrics setting. Using a case study approach, the evaluation aimed to identify paramedic psychomotor skills that could be practised in this setting, and understand the nature of key learning events. A purposive sample of paramedic students was recruited following completion of the obstetrics placement. A combination of student reflection and assessed psychomotor skills data were collected from clinical placement logs. Content analysis of all data was conducted inductively and deductively, as appropriate. Findings indicated a comprehensive range of psychomotor skills can be practised in this setting, with over thirty psychomotor skills identified directly related to the paramedic curriculum; and seven psychomotor skills indirectly related. The themes finding confidence in maternity care, watching the experts, and putting theory into practice provide narrative insight into the clinical learning experience of paramedic students in this setting. Further research is recommended to build upon this pilot.

Exploring the meaning and practice of self-care among palliative care nurses and doctors: A qualitative study

BackgroundSelf-care practice within the palliative care workforce is often discussed, yet seemingly under-researched. While palliative care professionals are required to implement and maintain effective self-care strategies, there appears little evidence to guide them. Moreover, there is an apparent need to clarify the meaning of self-care in palliative care practice. This paper reports qualitative findings within the context of a broader mixed-methods study. The aim of the present study was to explore the meaning and practice of self-care as described by palliative care nurses and doctors.MethodsA purposive sample of 24 palliative care nurses and doctors across Australia participated in semi-structured, in-depth interviews. Interviews were digitally recorded and transcribed prior to inductive qualitative content analysis, supported by QSR NVivo data management software.ResultsThree overarching themes emerged from the analysis: (1) A proactive and holistic approach to promoting personal health and wellbeing to support professional care of others; (2) Personalised self-care strategies within professional and non-professional contexts; and (3) Barriers and enablers to self-care practice.ConclusionsThe findings of this study provide a detailed account of the context and complexity of effective self-care practice previously lacking in the literature. Self-care is a proactive, holistic, and personalised approach to the promotion of health and wellbeing through a variety of strategies, in both personal and professional settings, to enhance capacity for compassionate care of patients and their families. This research adds an important qualitative perspective and serves to advance knowledge of both the context and effective practice of self-care in the palliative care workforce.