Supporting workforce wellbeing when caring at the end of life
An article written by Professor Jennifer Tieman, Director, Research Centre for Palliative Care, Death and Dying
One of the realities of aged care is providing care to people who come to the end of their life. It is part of the process of ageing that we will one day die. But the grief of nurses and care workers can often be unrecognised and not acknowledged. Several years ago, I worked with Dr Priyanka Vandersman on some research looking at the experience of families of a person who died in residential aged care. We found that grief could be felt at the point where the family came to realise that formal care is needed, across entry and settling into a facility, and then again when dealing with decline, deterioration and dying. What was clear from both the systematic review and the interviews with families and staff was that there is a complex and significant interplay in this care journey that affects the older person, the families and the staff.
We did some further work with nurses and careworkers on how they experience the loss of someone they were caring for in their home or in an aged care home. These interviews showed the impact that grief could have on staff and the importance of care, connection, and reflection. One personal care worker told us that
Because I try and build a relationship with the people I look after, when they’re palliative and they’re at the end of their life, shedding some tears for them is a way for me of saying I loved her or him and I’m going to miss them.
Too often this care is not seen, and grief remains unspoken. However acknowledging the value of the care that is being provided including at the end of life can be a powerful element in supporting our workforce. As one nurse said
And you know, if somebody grabs your hand and say thank you, all the brickbats that you receive, that’s worth a thousand of them…. Just those kinds of things are really, that’s the thing that keeps you going. It’s not all the brickbats. It’s not even the bouquets. It’s those moments where you think I’ve made a difference in your life. That’s a good thing. You’ve made a difference in mine.
This research started a process of reflecting on the type of resources we should be creating for palliAGED. We realised that both staff and providers need evidence to inform care in a changing world and resources to help guide care and service delivery. A co-design workshop with nurses, careworkers and service managers highlighted the need for actionable materials for individuals and for organisations.
As part of our guide on Being Preparing for 1 November we wanted to include a set of materials focused on self-care, burnout and well-being. Even though end of life is core business for aged care, providing care to a person at the end of life can be challenging and distressing for staff. Organisational issues can also exacerbate feelings of burnout and dissatisfaction. We went back to the evidence to develop some guidance on how services can support workforce well-being. General principles we found from the literature included:
- Prioritising person-centred care: This sends a signal to the workforce that their work is meaningful and valued by older people and the community
- Building a sense of purpose: By acknowledging the workforce, providing time for engagement and the resources to deliver quality care you can enhance the staff’s sense of professional accomplishment
- Creating a supportive work culture: A positive workplace culture can shape how staff respond to occupational challenges
- Addressing moral distress: Openly discussing what impacts or restricts quality of care can reduce concerns and conflicts felt by staff
- Acknowledging staff grief: Offering support following the death of an older person and acknowledging the emotional bonds that existed are powerful ways of recognising and validating staff grief.
- Encouraging self-care: Staff value workplaces that encourage, normalise, and support their self-care practices.
Even though end of life is core business for aged care, providing care to a person at the end of life can be challenging and distressing for staff. Organisational issues can also exacerbate feelings of burnout and dissatisfaction. Taking Care of Your Staff highlights why and how we can support staff and Organisational Tips for Staff Wellbeing provides a checklist for action. Workforce wellbeing is not only good for staff but also for workforce retention, and ultimately quality of care.
References
- Vandersman P, Chakraborty A, Rowley G, Tieman J. The matter of grief, loss and bereavement in families of those living and dying in residential aged care setting: A systematic review. Arch Gerontol Geriatr. 2024 Sep;124:105473.
- Lane AP, Tieman J. "We work in an industry where we're here to care for others, and often forget to take care of ourselves": Aged-Care Staff Views on Self-Care. Geriatrics (Basel). 2025 Jan 2;10(1):3.
Author
Professor Jennifer Tieman BSc(Hons) MBA PhD FAICH
Matthew Flinders Professor
Director, Research Centre for Palliative Care, Death and Dying (RePaDD)