Background Hospice work can be emotionally taxing, and staff can experience distress, especially when managing challenging cases (Cedar & Walker, 2020. Nursing Times. 116: 36; Ingebretsen & Sagbakken, 2016. Int J Qual Stud Health Well-being. 11, 31170). Reflecting on the psychological impact of these cases may help us protect carers’ well-being (The Point of Care Foundation, Florence Nightingale Foundation, Foundation of Nursing Studies & The Queen’s Nursing Institute Scotland, 2022; Gouveia Melo & Oliver, 2011. J Palliat Care. 27: 287). Traumatic cases can also raise practical considerations: Did we do enough? Can we do better? Are we OK?
Aim To reduce staff distress engendered by caring in difficult cases, whilst looking at processes or aspects of care that could be improved. Aiming for better clinical care with a cared-for workforce.
Methods We introduced monthly reflective practice sessions involving the whole hospice in-patient MDT, with cases which posed unique challenges nominated for discussion. Meetings combined elements of clinical de-brief with added focus on the psychological toll of caring. We have alternated cases where we identified learning points, with feedback from instances of exceptional work. Meetings were evaluated with a 7 point questionnaire and comments.
Results Positively received - 100% of attendees found the meetings useful, helpful in understanding pressures for other team members and promoting team development. 80% felt they promoted safer care. Comments included ‘useful and needed’ and ‘felt valued and listened to’. The main challenge identified was time to attend.
Conclusion These sessions have given space to recognise excellence and acknowledge the many individuals who go above and beyond to ensure exemplary hospice care. We have identified processes that can be improved and helped team dynamics by fostering better understanding of pressures colleagues are subject to. Challenges remain in ensuring staff have adequate time to join reflective sessions.
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