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Supporting patients at the end of life: managing carers' emotions
Published on 30 January 2025
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The end of life is a complex period, marked by intense emotions for both patients and healthcare professionals. How do the emotions of carers influence the quality of care given to palliative care patients? Lilia Campagna, nurse and health executive, explains the emotions felt by healthcare professionals and how they can be managed in this specific context.
End of life and patient care
The end of life is a crucial time when care must be adapted to patients' specific needs.
The palliative approach aims to relieve pain, improve quality of life and support patients and their families at this difficult stage.
Carers play an essential role in providing this care. They welcome patients and their families and listen to their needs and concerns.
They create a therapeutic alliance based on trust in :
providing appropriate care
taking into account patients' pain, symptoms and psychosocial needs
Caregivers are also present to relieve the emotional suffering of patients and their families, while managing their own emotional charge in order to maintain a balance in the caregiver-patient relationship.
End-of-life care is a matter of good professional practice and requires a multidisciplinary approach. Enhance your knowledge of the multiple and specific needs of patients at the end of life, define each role in a multidisciplinary team and develop your skills in supporting these patients.
The emotions of carers: definition and impact on the carer-patient relationship
As a health executive, I often observed nurses who were dissatisfied with their care of patients at the end of life. These experiences aroused strong emotions. I remember one of them. She told me about her frustration at not being able to be present when Mrs D breathed her last, a patient who had no family at her bedside.
There are several reasons for this dissatisfaction:
Too much emotional charge
Lack of time
Difficult communication
Lack of resources
Conflict of values
The combination of these factors can lead carers to perceive their care as disappointing.
Emotions are psychophysiological reactions which influence behaviour and interactions. For carers, these emotions can be varied: compassion, sadness, anger, anxiety. They are often linked to empathy towards patients.
Recognising and managing these emotions is crucial to maintaining a quality relationship with patients at the end of life.
To achieve this, the emotional skills are essential in the care relationship. Knowing how to recognise and understand the emotions expressed by patients enables care to be tailored to their emotional needs. This approach strengthens trust and the sharing of information between patients, their families and carers, helping to improve the quality of care.
The question of the right distance: between empathy and professionalism
Maintaining a professional distance while being empathetic is a subtle balance. This delicate balance involves remaining emotionally present without becoming overly involved, while offering genuine, human support.
Example
Imagine a nurse working in a palliative care unit. He is looking after an elderly patient, Mr F, who has terminal cancer. Mr F is anxious, in intense pain and expresses a fear of death. The nurse feels empathy for him and wants to comfort him. He takes the time to listen to him, hold his hand and explain the treatments. However, he also knows thatthey must maintain a certain emotional distance in order to remain professional. He cannot allow his own emotions to overwhelm him, as this could affect the quality of care. So he strikes a balance between empathy and professionalism, offering Mr F warm support while respecting his dignity and peace of mind.
The right emotional distance enables carers to be present for their patients while preserving their professional role.
Managing emotions: strategies for dealing with difficult situations
Supporting patients at the end of life is an emotionally demanding task for carers. First of all, they have to carry out emotional work.
Carers have to regulate their internal emotions while displaying emotions in line with professional standards (respect, empathy, calm, patience, optimism, etc.). This can be difficult, as they are confronted with physical and psychological suffering, death and existential questions.
Secondly, they must be part of a reflective self-awareness. Carers need to question their emotions, ask themselves how they feel and how they should manage them to maintain a relationship of trust with patients. There are a number of tools that can help them do this: mindfulness meditation, keeping a diary, reading books on personal development, etc.
When faced with emotionally intense moments, carers can adopt different strategies such as clinical supervision which allows people to talk to peers or psychologists to express their emotions and find solutions.
Example of clinical supervision: the testimony of Lilia Campagna
When I was a nurse, I had the opportunity to take part in one of the supervision sessions offered by the psychologist on the ward. The session began with a welcome from the psychologist, who reminded us of the rules of confidentiality and mutual respect. The atmosphere was warm and friendly. Each participant briefly expressed their emotional state and mentioned if they had a particular situation to share. This helped us to identify the urgent or sensitive issues we needed to address.
One of my nursing colleagues then described a recent case: a terminally ill patient expressing regrets and fears about impending death. She shared her own feelings of sadness and her difficulty in responding to this patient's emotional needs. We listened carefully to our colleague and then validated her feelings, recognising the difficulty and emotional impact of this situation. The group then analysed the case and discussed the various possible therapeutic approaches. Some of us had already had similar experiences.
Sharing this experience helped to create solidarity and show that these emotions are normal and shared. Together, we drew up an action plan to help our colleague better manage her emotions and support the patient.
We also discussed the possibility of involving psychological support for patients and their families. The session ended with a final round where everyone had the opportunity to express what they had learned from the session. The psychologist summarised the key points and then thanked the participants for their commitment and sharing.
Working on mindfulness can be a way of becoming more aware of your emotions without judging them, so that you can manage them better.
And finally.., continuing education teaches stress management and communication techniques to maintain emotional balance.
Take your emotions and needs into account to "speak the truth".
Developing your presence and assertiveness
Experience what empathy really is, with yourself and with others
Ultimately, taking account of the emotions of carers is essential if we are to offer quality care to patients at the end of their lives. Healthcare professionals must be aware of their emotions, manage them and maintain an empathetic relationship while respecting their professional role. By cultivating this emotional sensitivity, they will help to provide comfort and support to patients and their families at this delicate time.
