Introduction
Burnout is among the top challenges End-Of-Life (EoL) caregivers experience. Burnout places personal stress encounters within a broader institutional setting of individual associations to their job. Individuals who accomplish helping tasks and professionals face a higher risk of burnout. End-of-life (EoL) caregivers, particularly nurses, are more vulnerable to burnout than physicians since they work directly with patients and families and have limited structural power in EoL situations. Many EoL caregivers choose commitment and profession, hoping to offer the best quality of care to patients or family members in moments of vulnerability and suffering (Kastenbaum & Moreman, 2018). Hence, protecting the mental, physical, and emotional well-being of EoL caregivers has been vital for different institutions. One such technique is the integration of mindfulness and meditation strategies into the institution’s policy. It ensures that the caregivers are guaranteed care for themselves as they continue their work. Some of the significant areas this mindfulness and meditation aims at covering are the reduction of stress, enhancing the emotional and physical well-being of the caregivers, and providing the nurse with techniques they can use to encourage more self-care and self-compassion as they work under a stressful environment (Cedar & Walker, 2020). This paper aims not only to analyze the effectiveness of mindfulness and meditation as an intervention towards burnout experienced by EoL caregivers by reviewing different scholarly articles, the gaps in implementing this strategy, and the different barriers that will be experienced when implementing this solution.
Current State of Mindfulness and Meditation Approach in Mitigating EoL Caregiver’s Burnout
Every well-trained professional will always experience stress, anxiety, and fatigue, leading to burnout when caring for ill patients, especially if the caregivers are to provide care to an EoL patient. According to (Cedar, & Walker, 2020), in the UK alone, over 80% of patients die in hospitals or hospices rather than their homes. For healthcare professionals, such a number can hurt their emotional and mental well-being. The author states that many organizations are fighting for EoL patients to be provided with a respectful and high-standard death request environment. However, very little is given or advocated for a better working environment that provides emotional and psychological well-being for EoL caregivers. In an article by (Covington et al., 2023), a survey conducted by the American Academy of Hospice and Palliative Medicine found that 37% of clinicians generally experience burnout. Furthermore, the global review of Palliative care surveys also found that global burnout reports by country ranged between 25%-50% (Covington et al., 2023). It is a concerning statistic, considering that very little is done for the affected caregivers.
Covington et al. (2023) assert that EoL caregivers experience the death of their patients at an average number of 7 in a month. Patient deaths can take a toll on their emotional stability, leading to compassion fatigue. Compassion fatigue develops when caregivers experience disappointment and frustration when circumstances interfere with offering the required degree or quality of care (Kastenbaum & Moreman, 2018). According to Cavington et al. (2023), this is not aspiring based on the fact that, as researchers have shown, there is a link between trauma and death anxiety. It has been shown to have very negative impacts on the EoL caregivers in that they have to interact with the said EoL patient and their families before their time of death.
Consequently, it can make them develop great care and a liking for the patient through emotional support while battling the disease. Hence, the need to provide them with relief from their pain and ease their suffering can be challenging. It becomes even more complicated when the patient dies and the nurse has to tell the patient’s family. Covington et al. (2023) state that based on a descriptive study of 216 nurses, it was discovered that 78% of them experienced moderate forms of high-risk compassion fatigue. In addition, the authors argue that based on regression analysis, 91% of the variance of the risk of compassion fatigue is due to trauma, anxiety, life demands, and excessive empathy that blurred professional boundaries. Researchers have agreed that there is a need for more investment in investigating the causes of burnout among EoL caregivers and the right and practical approach to reduce stress and burnout.
Effectiveness and Gaps in Knowledge of Mindfulness and Meditation Approach
Mindfulness and meditation go hand in hand; both represent the state of simply being aware of the present moment, observing without trying to interfere, and adopting the attitude of curiosity and acceptance. Therefore, it unites the body and mind in nonjudgmental and non-reactive awareness (“Family Comfort Hospice & Palliative Care”, 2019, para. 2). It makes it easier for healthcare professionals to focus on their sensations, emotions, and thoughts. Hence, if they feel unstable, they adopt different coping techniques to ensure they are stable. Therefore, different methods such as yoga and breathing exercises, having sessions with a psychiatrist and adopting a self-care and self-love lifestyle that includes constant physical exercises, eating rights, and having sufficient sleep can be beneficial (“Mayo Clinic”, 2022: Newsom & Rehman, 2023). As (“Mayo Clinic”, 2022) article argues, practising meditation and mindfulness has been successfully applied as a solution to various issues such as stress, anxiety, insomnia, high blood pressure, depression, and pain. Furthermore, as the article argues, some positive impacts recorded towards patients who practised meditation and mindfulness included improved attention, less job burnout, improved sleeping patterns, and helped control diabetes.
A 2020 study by (Johns et al.) analyzed the effectiveness and acceptability of mindfulness-based intervention among family caregivers of advanced-stage cancer patients. The authors of the article state that emotional distress has always been present among EoL patients and their caregivers. The study involved 26 participants, with the results showing that mindfulness intervention was “…feasible and acceptable and supported improvement in ACP and associated outcomes for patients and FCGs…” (2) Therefore, concluding that over 90% of the participants who completed the study showed high mindfulness satisfaction. This evidence is supported by a study conducted by Orellana-Rios et al. (2018) that researched the feasibility and effectiveness of “on-the-job” mindfulness practices in palliative care. The areas being measured by the study included burnout, depression and anxiety levels, emotional regulation skills, and goal attainment. The participants were palliative care professionals in Germany. The results showed that out of the 33 participants, 85% (28) goals were attained, they recorded high compliance and acceptance rates, accepted mindfulness intervention methods, and reduced distress. Thus, mindfulness training will likely effectively reduce EoL caregivers’ burnout and stress levels.
According to (Johns, et al., 2020), this was especially important for FCGs (Family Caregivers), who, like EoL caregivers, experience emotional distress during their work environment, leading to burnout. The mindfulness intervention included six–to seven-day meetings for six weeks, with the FCGs and patients having to attend a 2-hour session with a certified mindfulness facilitator. Some mindfulness exercises they participated in included yoga, compassion meditation, sitting meditation, and body scan meditation. According to the 2022 article by the Mayo Clinic, some meditation exercises, such as sitting, body scanning, and even walking, help a person be self-aware of their body and practice coping mechanisms when they experience unstable feelings or emotions. In addition, (Johns et al., 2022) show that in the study, the practices aimed at helping the participants adopt awareness of their feelings and emotions in their everyday life, mindful eating that included ensuring a better eating lifestyle and dietary, stretching, breathing exercise, yoga, mindful dialogue that aimed at encouraging self-love, non-judgment attitude, and self-care. Mindful dialogue is vital for EoL caregivers who experience compassion burnout. Practising dialogue that makes them understand they are trained to provide the patient with the best healthcare and environment helps them not overstep their professional boundaries.
(Orellana-Rios, et al., 2018) The study involved a 10-week intervention with four primary objectives in mind. They included mindfulness presence, helping the participants cultivate loving and kindness, and helping participants practice ‘Tonglen’ meditation of ‘giving and taking’ in difficult situations while helping them integrate the practices into their daily work activities. Thus, from the study, the participants adopted techniques such as breathing, walking and sitting meditation, cultivating compassion-based feelings, and being aware of one’s surroundings, feelings, and thoughts to build a resilient mind when doing their jobs. While on their job, the participant’ answers to their questionnaires showed a drop in burnout and emotional exhaustion, tension and demands, and anxiety. A majority of the participants recorded high joy, self-love and self-care. Just as (Johns et al., 2022) concluded, mindfulness and meditation techniques helped caregivers manage compassion fatigue, so did (Orellana-Rios et al., 2018). The study by Rios and College showed that they recorded low compassion fatigue by helping caregiver professionals practice self-awareness by incorporating self-awareness meditation and mindfulness practice. The practitioners become aware of the critical pathway they should take to provide their patients with the needed care. Hence, psychological distress and anxiety decreased. Hence, compassionate feelings were transferred to the caregivers before extending them to others.
However, (Johns et al., 2022) conclude that even with such study results that show mindfulness training should be applied to improving and expanding ACP, more support is needed for this approach. Low awareness is contributed by the need for EoL discussions and ACP, making it even harder for studies that prove meditation and mindfulness approaches can positively impact EoL caregivers in helping them cope with burnout. Similarly, Rois et al. (2018) state that even with such positive results of mindfulness and mediation intervention towards burnout among EoL caregivers, there needs to be more studies to address mindfulness and compassion-oriented intervention approaches in clinical settings. As argued by (Ho, et al., 2019), even though the current studies on the effectiveness of meditation and mindfulness as a solution to EoL caregiver burnout issue there is a significant knowledge gap. Mindfulness and meditation provide caregivers coping mechanisms to deal with burnout from their stressful work environment. However, the critical gap in the self-care and supportive care literature for professional caregivers (Ho et al., 2019, p. 9) makes it hard for EoL caregivers to adopt resilient coping mechanisms that encourage sustained employment and reduced burnout experience.
Barriers to Facilitating This Concept
As shown by (Johns et al., 2020) and (Orellana-Rios et al., 2018), EoL professional caregivers support mindfulness and meditation practice in helping them cope with burnout. However, even with such a significant acceptance, there are still cases of hesitation from the caregivers. It can be due to their religion clashing with some of the meditation or yoga practices. In addition, with very few studies being used to showcase the effectiveness of mindfulness and meditation practices as solutions to burnout, some caregivers might hesitate due to a lack of accurate information. Furthermore, it has been sighted that healthcare professionals need more time to incorporate interventions into their lives. Therefore, if the mediation and mindfulness intervention methods take many other caregivers’ time, they might not be likely to adopt them (Parsons et al., 2022).
In addition, another barrier will likely arise from internal policy within the organization. As (Cedar, & Walker, 2020) argue, organizational culture positively impacts the implementation of burnout intervention among EoL caregivers. However, when the intervention clashes with the stakeholder’s view and acceptance of the intervention’s quality and validity, the organization might not support it. Furthermore, the quality and validity of the intervention matter to the stakeholders as much as the complexity of it. If the intervention is complex and requires different professionals to help caregivers adapt, financial investment is needed. The organization’s likelihood of supporting the intervention method is reduced if it is expensive.
Furthermore, (Orellana-Rios et al.,2018) study showed that mindfulness invention did not have an enormous impact on the cases of depression reported among caregivers. Hence, mindfulness and meditation might face a challenge in support as stakeholders might not see it as the necessary intervention to tackle mental health issues leading to burnout that face caregivers (Parsons, et al., 2022). Therefore, gaining support from healthcare policymakers can be very helpful, as their support will ensure mediation and mindfulness become necessary for all EoL institutions to provide their caregivers. In addition, providing studies that show the benefit of mindfulness and meditation to stakeholders and EoL caregivers can help them support it. Furthermore, ensuring that the methods used are simple can ensure that caregivers integrate them into their daily activities. For example, breathing exercises or stand-up meditation are practices they can do while working. Furthermore, stakeholder support is also needed when showcasing how mindfulness and meditation can be integrated into other mental health and burnout interventions. It is an intervention that caters for the caregivers’ physical, emotional, and mental stability.
Conclusion
EoL caregivers support the most vulnerable patients at a challenging time. The presence brings relief to the EoL patients and their families. They are trained to provide the patients with a healthy dying environment, while also providing emotional and professional support to patient’s families. However, very little care is done regarding their emotional and mental health. Caring for patients can be very stressful, and adding to the stress and demanding environment, experiencing emotional and psychological instability can lead to adverse effects of burnout. Therefore, EoL caregivers need to be provided with coping interventions and approaches they can use to build a resilient mind when doing their job. Hence, creating a work environment that ensures the professionals know that their health, be it physical, mental, or emotional, is cared for will increase the workers’ morale and productivity. Therefore, the need to invest more in studies and literature supporting the positive impacts meditation and mindfulness can have on reducing burnout among EoL caregivers will ensure that there is internal and external policy support.
References
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