Palliative Care Team and Individual Stress Mitigation Strategies

This tip sheet is a complement to the blog post, “Mitigating Burnout in COVID-19.” It provides a short list of the strategies that palliative care teams and individuals can implement to reduce the long-term impact of stress related to the COVID-19 pandemic.

Preparation

Team Leaders

  • Create structural boundaries that will limit overextending providers later on:
    • Work with organizational leadership on where palliative care will be maximally effective.
    • Set concise, actionable criteria for triaging the most appropriate patients for your services. This is particularly critical for smaller programs that might have one physician or nurse practitioner, and are then suddenly called to staff an entire hospital, ED, or ICU.
    • Think “outside the box” regarding care delivery. Should you embed staff within a certain unit? Set up a peer-to-peer or patient-facing palliative care hotline?
    • Understand what “stretch” case load your team can accommodate.
  • Develop a strategy for how to channel COVID-19 response-related information so that it goes to a centralized location and reduces the amount of “noise” for team members.
  • If time allows, explore if there are any opportunities to increase the capacity of nonpalliative care specialist colleagues in communication and basic symptom management (CAPC is providing free access to relevant courses in our COVID-19 toolkit).
  • Revisit and reinforce existing strategies for team health; see CAPC’s toolkit, Building and Supporting Effective Palliative Care Teams (particularly “Team Health and Resilience”), for more information.

Individuals

  • Become familiar with existing mental health resources. Consider establishing a relationship with a new provider, or developing an action plan with an existing provider.

Escalation

Team Leaders

  • Create or expand opportunities to reduce isolation among staff, even virtually. Standard team meetings should include new “check points,” including:
    • Embedding moments of pause for relaxation, breathing, or other mindfulness practices.
    • Periodically starting meetings by checking in with each team member about how they are doing, potential concerns about loved ones, family illnesses that need navigation, child care issues, or modifications that need to be made for the next week.
  • Set aside time to debrief particularly traumatic incidents.
  • Establish recurring drop-in faculty and staff support sessions, led by social work and/or spiritual professionals on the team.
  • Establish formal buddy systems that enable peer-to-peer connections between staff.
  • (Small programs) Identify a “sister team” in or outside of the health system or organization to share strategies, ask questions, etc. Leverage CAPC’s free-to-all COVID-19 Virtual Office Hours as needed.
  • Reinforce the expectation that time off on the schedule is time off (except in extreme emergencies).

Individuals

  • Absent a formal buddy system, seek out a work “buddy” who can provide peer support and serve as an accountability partner for mental health.
  • Be disciplined in taking scheduled time off and not focusing on work.
  • Communicate anything that is causing undue stress—particularly clinical gaps—to the team leader/appropriate chain of command.
  • Avoid unhealthy coping mechanisms, e.g., junk food, tobacco, alcohol, drugs.

Survival

Team Leaders

  • Continue to make institutional resources available.
  • Monitor team members for signs and symptoms of burnout.

Individuals

  • Remember that anxiety and grief are normal responses.
  • Maintain basic functions—eating, hydrating, sleeping.
  • Look for moments of mindfulness, remain present-oriented. Some suggestions include:
    • Remember that you are alive—that there is breath and a life force in you; this can be as simple as a single deep, calming breath.
    • Literally shake your body out. Our bodies can store trauma and intense experiences, which the simple act of shaking can release (see the work of Peter Levine and Bessel Van der Kolk).
    • On your way to work, set an intention for the day; e.g., “Today, I am going to lead by example” or “Today, I am going to make someone smile.”
    • Find opportunities for gratitude; e.g., the patients being extubated and discharged today, the way your team is coming together. One veteran noted that, while in combat, the people around him were the only thing that kept him going, and remained grateful for their existence even decades later.
    • Return to your values and purpose. Remember why you got into this work in the first place, and why you are here doing this.
  • Adhere to limits on work time.

Additional Resources