By: Maria Panzera Rugg
After decades in palliative care, I’ve learned that the deepest truths of this work live not in policies or protocols, but in the quiet, human moments: a PSW sitting at the bedside long after tasks are done, a nurse pausing in the hallway to breathe before entering another room, a team gathering in silence after a death. These moments reveal a truth we rarely name:
Palliative care professionals carry profound emotional, spiritual, and psychological weight — and they deserve whole person care too.
The Unseen Grief and Psychological Burden of Palliative Care Providers
Research shows that the psychological well‑being of palliative care professionals has historically been taken for granted, often framed as an individual responsibility rather than an organizational one. This approach is now considered obsolete because it fails to address the systemic and ethical dimensions of caregiver suffering.
Palliative care workers face:
- Emotional exhaustion
- Moral distress
- Exposure to repeated death and dying
- High expectations with limited resources
- Fragmented systems that do not always honour the human elements of care
A 2025 study found that the accumulation of end‑of‑life care stress is one of the strongest predictors of poorer mental health among palliative care professionals. It also identified self‑compassion and psychological flexibility as key protective factors.
This aligns with what PSWs have been telling us for years: “The work doesn’t just stay at work.”
Whole Person Care for the Caregiver: Mind, Body, Spirit, Emotions
I have had the profound privilege of beginning to understand howThe Indigenous Wellness Framework can have profound effect in teaching us about wellness as a balance of the mental, physical, spiritual, and emotional, enriched by four anchors: Hope, Belonging, Meaning, and Purpose.
This framework is not only relevant for those we care for— it is profoundly relevant for us as caregivers.
HOPE
Hope is sustained when caregivers feel valued, supported, and connected to identity and purpose.
BELONGING
Belonging grows when teams create spaces where emotions are welcomed, not judged — when PSWs feel seen, heard, and included.
MEANING
Meaning emerges in the small acts of care that define palliative work: a warm blanket, a gentle touch, a moment of presence.
PURPOSE
Purpose is strengthened when caregivers understand how their work contributes to the circle of life, community, and collective care.
Indigenous wellness models remind us that healing is relational — we heal in community, not in isolation.
Caring for the Mind: Psychological Safety as Ethical Practice
Psychological safety is not a “nice to have” — it is an ethical imperative.
Research shows that emotional depletion in palliative care professionals affects:
- Quality of care
- Patient safety
- Workforce retention
- Personal well‑being
Psychological safety looks like:
- Leaders who check in with compassion
- Teams that normalize debriefing
- Workplaces that acknowledge grief
- Trauma‑informed supervision
- Permission to say “I’m not okay”
This is whole person care for the caregiver.
Caring for the Heart: Emotional Labour as Clinical Expertise
Emotional labour is one of the most skilled — and least recognized — aspects of palliative care.
PSWs and all hcp in palliative care perform emotional labour every day:
- Bearing witness to suffering
- Holding space for families
- Absorbing stories, tears, and silence
- Navigating their own grief while supporting others
This labour is not incidental. It is clinical, relational, and deeply human.
“The simple act of caring is heroic.” — Edward Albert
Caring for the Spirit: Meaning-Making and Connection
Spirit work happens in the smallest gestures — the ones that rarely make it into documentation but shape the culture of care.
Indigenous teachings remind us that wellness is rooted in:
- Connection to land
- Kinship and community
- Ceremony and ritual
- Balance and reciprocity
These teachings align beautifully with palliative care’s core values.
When caregivers find meaning in their work, they are more resilient. When teams create rituals — memory moments, end‑of‑life huddles, gratitude circles — they strengthen collective spirit.
What the Research Says About Supporting Caregivers
A 2024 scoping review identified five essential elements of resilience-building for palliative care professionals:
- Regularity
- Self‑care
- Mindfulness
- Reflective practice
- Cognitive‑behavioural strategies
And three supporting elements:
- Peer support
- Educational sessions
- Organizational support
These findings reinforce what Indigenous wellness frameworks have taught for generations: Wellness is collective. Healing is relational. Balance is essential.
A Call to Action: Whole Person Care for Those Who Care
If we want to sustain compassionate palliative care, we must care for the mind, heart, spirit, and body of the people who provide it.
This means:
- Embedding grief literacy into workplaces
- Creating psychologically safe teams
- Honouring emotional labour
- Integrating Indigenous wellness teachings
- Building rituals that support collective healing
- Recognizing PSWs as essential, skilled, relational practitioners
As Audre Lorde reminds us: “Self-care is not a luxury. It is a necessity. Your well-being matters.”
And as the Indigenous Wellness Framework teaches: Hope, Belonging, Meaning, and Purpose are not just concepts — they are lifelines.
This is whole person care. This is palliative care. This is how we care for those who care.
References
Moreno-Milan B, Breitbart B, Herreros B, Olaciregui Dague K, Coca Pereira MC. Psychological well-being of palliative care professionals: Who cares? Palliative and Supportive Care. 2021;19(2):257-261. doi:10.1017/S1478951521000134
Cuchet I, Maneval A, Dambrun M. Stress, mental health, and resources of palliative care professionals. Palliative and Supportive Care. 2025;23:e34. doi:10.1017/S1478951524002050
Tailored for PSWs, LTC Homes, and Hospice Partners
PSWs carry stories, memories, and quiet grief. Their emotional labour is skilled, sacred, and deserves recognition. #PalliativeCareEverywhere #PSWStrong #CaringForTheCarers
Caring for the mind, heart, and spirit isn’t optional in palliative care — it’s essential. #MentalHealthInCare #CompassionateTeams
Grief doesn’t only belong to families. It lives in the hearts of those who care every day. #UnseenGrief #PSWCare
Psychological safety is a workforce strategy. When teams feel safe, compassion grows. #HealthyWorkplaces #PalliativeLeadership
Small acts of care — a warm blanket, a gentle touch — are moments of spiritual connection. #SpiritOfCare #PalliativeApproach
Self‑care is not an individual task. It’s a shared responsibility across the whole care team. #TeamCare #WorkplaceWellbeing
Rituals help us carry what cannot be carried alone. #CompassionateCommunities #LTCLeadership
PSWs are the heart of palliative care. Their presence changes everything. #PSWAppreciation #PalliativeCareCanada
Grief literacy isn’t just education — it’s a retention strategy. #GriefLiterateWorkplaces #CareForTheCarers
This week, we honour the hands and hearts that hold us all. #HospicePalliativeCareWeek #NursesWeek #PSWDay
