Introduction
Methods
Study design
Sampling
Participant recruitment
Data collection
Data analysis
Trustworthiness
Results
Pseudonym | Gender | Years of practice | Practice setting |
---|---|---|---|
Brett | Male | 12 years | Private |
Kara | Female | 12 years | Public |
Lisa | Female | 20 years | Private |
Emma | Female | 22 years | Private |
Melissa | Female | 8 years | Public |
Kate | Female | 14 years | Private |
Anna | Female | 8 years | Public |
Louise | Female | 20 years + | Public |
Megan | Female | 50 years | Private |
Steve | Male | 16 years | Private |
Jessica | Female | 10 years | Public/Private |
Fran | Female | 34 years | Private |
James | Male | 8 years | Private |
Annabelle | Female | 23 years | Private |
Tim | Male | 13 years | Public |
And you become a part of their day. I know that sounds very strange, but even in that half hour you learn a lot about a person and when it’s week on week, according to them you become a part of their family. And there’s really nothing that you don’t know about them. (Kara)
The participants acknowledged the importance in recognising the emotional influence of professional-patient relationships. Some described being more profoundly affected than others following the death of a patient. They discussed the usefulness of debriefing about death with the right person, most commonly colleagues. Participants also talked about the emotional impact of death, suggesting the need for supporting discussion and resources, especially for new graduates. Three super-ordinate themes emerged through the analysis of the interviews that related to how practitioners dealt with this impact. These were: 1) Acknowledging connections; 2) Willing to share and listen; and 3) Creating support through starting the conversation.We’re incredibly unique as a profession. We spend more time with our patients than most other people, and it’s a very personal part of the body for a lot of people as well. (Brett)
Emergent themes | Super-ordinate themes |
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• Podiatrists being embedded in patient lives • Building of relationships • The ripple effect onto staff when someone dies • The additional stress of managing family members of the patient who has died • Emotionally invested due to the ongoing continuity of care • Often in a position to listen and understand a patients personal lives and belief/values • Links to your own personal life • Deep professional relationship not always recognised by others |
Acknowledging Connections
|
• Need to find the right listener • Important to have a support mechanism • Debriefing with people who understand the context • Importance of being open to seeking to help • Understanding that everyone has their own process of grieving • Having a supportive workplace • Recognising the emotional impact • Devaluing the impact because it is work related |
Willing to share and listen
|
• Increasing general discussion on the topic • Greater opportunity to have formal training on understanding the impact • Empowering practitioners with knowledge on how to support themselves • Increasing emotional awareness through effective strategies • Recognising the emotional impact within the podiatry progression • Better training for students |
Creating support through starting the conversation
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Theme 1: Acknowledging connections
Emma acknowledged that she had made a strong connection with this patient and because of that connection she recognised that when he passes away, the loss is likely to have a significant impact on her. Participants commonly talked about the deep sadness associated with losing a patient that they had established a connection with. Louise explained:Usually you have your favourites who you have more of a connection with; you know a bit more about their life and their family. I’ve got a client who reminds me so much of my grandfather and I think, when he passes away, that’ll probably affect me more than other clients. (Emma)
For Louise, it was the realisation that she would never see this person again. Even though she was aware that he did not have long to live, the loss still had an impact on her because she had connected with him on a personal level and she was part of his health journey.I happened to be reading the death notices in the paper. So I knew before his wife actually rang me. I think it just was – I felt really sad. I knew it was coming but he was a man that I actually knew a lot about his family, I knew his wife quite well, he had lots of health challenges, so I think there was a real sense of loss that I wouldn’t be seeing or treating him anymore. (Louise)
Kate also explained the sadness of watching older people deteriorate over a period of time when you have regularly talked about their life and personal challenges. The participants described that the uniqueness of the podiatry profession facilitated the development of connections over a long period of time that were not always understood by people outside of the profession. Fran captured the feeling of other participants when she described the emotional toll of losing a patient she was connected to.We do deal with a lot of sad things. People are always getting sick. My patients have been seeing me for 10 years. I’ve watched them go from walking spritely to all these crippling conditions. They’re getting old and sick and going into nursing homes and it is just so sad. Because they come in and they tell you their struggles and this and that. (Kate)
In addition, some participants noted the connections they had with their patients were not always recognised by others, especially family members as can be seen by Megan’s excerpt.It literally was devastating for me. I really struggled to let it go. I would be still in the grieving process and there were times when people didn’t understand. Like you know, it’s a client, how attached can you be to a client? How well can you know a client? People are not aware of how involved we are, how connected we are, and how open our heart is at times when we’re treating these people. (Fran)
Megan describes the frustration she feels when she is not told that one of her regular patients has passed away. Megan perceived that she played a significant role in the patient’s life and not having that connection acknowledged, devalued her importance. However, other participants had different experiences where they were unaware of just how much of an impact their contribution had made on the person. Kara indicated her surprise to the family member’s reaction towards her.And you lose these people and you don’t ever know what happened to them because I’m just the card that they stick on the fridge and the family just come in and discard all that. And often they don’t even remember, “Oh, that doesn’t matter” but I am important. I think a podiatrist plays a huge role in people’s life. It’s incredible feeling and a great responsibility, but it does burden me from time to time. (Megan)
The participants also indicated that the family connection was often strengthened if regular contact with the podiatrist was maintained by other family members. They often talked about the challenges of talking about a deceased patient to a relative.And the family comes up and hugs us after the funeral service, you realise just how much of an impact you have on their family. They consider you as part of their family. And it’s not until you get to a situation like that until you realise “Wow, they had a lot of trust in me. They treated me like I was a family member. I was a regular part of their week”. (Kara)
Annabelle’s excerpt illustrates that a shared experience, such as a death of a patient, can easily deepen the connection made with relatives that are also patients.He won’t see any other podiatrist in the clinic. He has to only see me because I was the one who looked after his deceased wife. And whilst we’d never talk about her feet or her particular foot problems or anything really, he knows I really cared about her and there’s just this way that I know he feels closer to his wife by seeing me. (Annabelle)
Theme 2: Willing to share and listen
The perception from participants was that because the emotional impact was specifically relating to ‘work’ then the reaction should be different, almost hidden, compared to if it was a close family or friend. This perception was further explored by Kara, who indicated because death and grief was not always openly talked about within the workplace, there was a sense of dealing with it alone and therefore not seeking support from others.I think as a profession maybe we don’t deal with it so well. We accept that it happens, but I think as a practice, not so much acknowledgement of the impact that it actually has on people. Particularly when you have been seeing someone for quite a long time, quite regularly, sometimes you see them more than you see your friends, so you know a lot about them. And I don’t know that we acknowledge that very well as a profession because I think we feel like you’ve got to keep going because it is work. (Anna)
Brett took this idea further, acknowledging that even though everybody grieves differently, creating the awareness that it is OK to ask for help if required, it is OK to admit that the grief has had a profound impact, and that these were important strategies to start to deal with that grief.Sometimes I think that we feel that we should grieve alone. We just kind of forget that we can use other people’s shoulders and we don’t need to grieve alone. I think just talking about feelings, someone that you trust, a family member or another person in the clinic, or a mentor – somebody. (Kara)
While the participants recognised the need to share their grief with someone, equally important was a supportive culture within the workplace that provided a safe environment for the practitioner to discuss sensitive topics such as the emotional impact of grief and loss.There are not rules when it comes to grieving. Some people get over things quickly, others don’t. Some people deal with it with talking, others with ignoring. So I think that needs to be presented because some people might feel a really profound loss whereas others might kind of be stoic. So I think creating awareness is important and also giving people the opportunity for support networks. The more opportunities we have for that, the more we can share our experience in areas like grief. (Brett)
Fran talked about the importance of having someone to speak to who understands, who has empathy. Participants emphasised the importance of finding the right person that you felt comfortable with. This may be an individual person, which participants indicated were more likely to be colleagues, as they could appreciate the circumstances. Or some participants talked about debriefing within a team environment, as discussed by Tim.In my team we ask for support often early, so if we’re struggling with something like that then we get supported and we talk about it and we’ll hug and we’ll cry and we’ll talk about how wonderful this person was. You have to speak to someone who has empathy, who understands. So it’s literally, speak to a colleague who’s going to know exactly what you’re going through. Having someone who can help you and support you understand what it is that you need to process. (Fran)
Regardless of whether the practitioner sought to debrief with an individual colleague or their team, the important component was the ability to be willing to share their grief with others and willing to listen to support those around them.Quite often we’ll be able to reminisce at a team meeting or a case study or have a laugh about the different bits and pieces they threw up throughout their journey. I think everyone needs to allow themselves to grieve, that there is fostered, within the workplace, an open discussion with both the individuals who may experience that, as well as the management and understand that [grief] can be varied. (Tim)
Theme 3: Creating support through starting the conversation.
Kara highlights the point that often the focus is on the diagnosis and management of patients without consideration of the emotional impact of working as a podiatrist. The perceived level of naivety among new graduates and not being adequately prepared to deal with these types of situations was also illustrated in Kate’s excerpt.Start talking about death. We’re always saying “diagnose, treat, and fix”. But we also need to actually focus on the death part – how we deal with death and what it means. Because I know there would be a lot of new grads out there who may not have had family members that have passed. Some people are a little bit innocent, are blinkered. I think being aware of what you do, or who you should go to, or where you can go for help, just talking about feelings. (Kara)
Not being provided with tools to recognise the significant emotional impact of a patient death has on the practitioner limits opportunities to know when and where to access support to help deal with this potentially challenging topic. In addition, participants noted that they had to learn from personal experience rather than having formalised education in this area and appreciating that grief and death was common part of the podiatry profession. As James explains, participants felt it was important to encourage, especially younger podiatrists, to speak up if they were struggling so that they could receive the necessary support.Talking about grief and loss and how you feel when a patient dies. “What are the symptoms and signs I need to look for to actually look after myself?” And that then gives them an opportunity to take ownership. That’s one thing I found when I was a new grad. There wasn’t anything that sort of prepared us for the situations. (Kate)
Starting the conversation early and developing strategies to deal with grief, possibly as part of student training, was a frequent discussion point made by participants. Alongside these elements, Annabelle emphasised that grief and loss were a common occurrence within the podiatry profession and that building resilience to deal with these types of emotions was an important aspect to assist podiatrists in coming to terms with their own reactions to these difficult situations.When I was studying I didn’t realise this would happen. You don’t realise at the start that you have to deal with these issues and these situations. Be open and don’t be ashamed of seeking help from family, friends, colleagues and professional services with grieving the loss of a patient. (James)
Some tools and reference points to go to when they’re faced with grief. Opportunity to have sessions on resilience and just accepting that there is a fair bit of grief with the job. (Annabelle)