Research

article

Open

Peer

Review

Exploring

the

meaning

and

practice

of

selfcare

among

palliative

care

nurses

and

doctors

a

qualitative

study

Jason

Mills

Timothy

Wand

and

Jennifer

A

Fraser

BMC

Palliative

Care

BMC

series

open

inclusive

and

trusted

The

Authors

Received

January

Accepted

April

Published

April

Open

Peer

Review

reports

Abstract

Background

Selfcare

practice

within

the

palliative

care

workforce

is

often

discussed

yet

seemingly

underresearched

While

palliative

care

professionals

are

required

to

implement

and

maintain

effective

selfcare

strategies

there

appears

little

evidence

to

guide

them

Moreover

there

is

an

apparent

need

to

clarify

the

meaning

of

selfcare

in

palliative

care

practice

This

paper

reports

qualitative

findings

within

the

context

of

a

broader

mixedmethods

study

The

aim

of

the

present

study

was

to

explore

the

meaning

and

practice

of

selfcare

as

described

by

palliative

care

nurses

and

doctors

Methods

A

purposive

sample

of

palliative

care

nurses

and

doctors

across

Australia

participated

in

semistructured

indepth

interviews

Interviews

were

digitally

recorded

and

transcribed

prior

to

inductive

qualitative

content

analysis

supported

by

QSR

NVivo

data

management

software

Results

Three

overarching

themes

emerged

from

the

analysis

A

proactive

and

holistic

approach

to

promoting

personal

health

and

wellbeing

to

support

professional

care

of

others

Personalised

selfcare

strategies

within

professional

and

nonprofessional

contexts

and

Barriers

and

enablers

to

selfcare

practice

Conclusions

The

findings

of

this

study

provide

a

detailed

account

of

the

context

and

complexity

of

effective

selfcare

practice

previously

lacking

in

the

literature

Selfcare

is

a

proactive

holistic

and

personalised

approach

to

the

promotion

of

health

and

wellbeing

through

a

variety

of

strategies

in

both

personal

and

professional

settings

to

enhance

capacity

for

compassionate

care

of

patients

and

their

families

This

research

adds

an

important

qualitative

perspective

and

serves

to

advance

knowledge

of

both

the

context

and

effective

practice

of

selfcare

in

the

palliative

care

workforce

Keywords

Palliative

care

Selfcare

Selfcompassion

Positive

emotions

Workforce

Background

The

concept

of

relentless

selfcare

is

well

known

to

those

in

the

field

of

palliative

social

work

Interest

in

selfcare

is

growing

within

the

nursing

and

medical

disciplines

and

its

importance

to

all

palliative

care

professionals

is

evident

internationally

through

a

suite

of

quality

standards

core

competencies

and

practice

standards

in

which

selfcare

practice

is

mandated

But

what

does

selfcare

mean

Selfcare

is

broadly

defined

by

Sherman

as

the

selfinitiated

behaviour

that

people

choose

to

incorporate

to

promote

good

health

and

general

wellbeing

Despite

this

healthpromoting

emphasis

on

good

health

and

wellbeing

the

palliative

care

literature

focuses

largely

on

coping

strategies

in

the

context

of

occupational

stressors

such

as

burnout

or

compassion

fatigue

Clearly

management

of

stress

is

very

important

however

there

are

other

important

aspects

of

promoting

good

health

and

wellbeing

that

extend

beyond

the

scope

of

coping

with

stress

In

many

cases

there

also

appears

to

be

conflation

between

the

terms

coping

strategy

and

selfcare

strategy

Further

confusion

about

the

meaning

of

selfcare

was

highlighted

in

an

Australian

survey

of

palliative

care

professionals

Beyond

academic

definitions

there

is

a

need

to

understand

and

articulate

the

meaning

of

selfcare

in

a

palliative

care

practice

context

Given

that

some

palliative

care

professionals

have

reported

low

levels

of

selfcare

ability

there

is

also

an

urgent

need

to

explore

barriers

and

enablers

to

selfcare

and

identify

examples

of

effective

selfcare

strategies

used

in

practice

In

reviewing

the

literature

significant

gaps

are

apparent

in

the

current

evidence

base

for

selfcare

practice

and

education

To

advance

knowledge

in

these

areas

this

study

aimed

to

explore

the

meaning

and

practice

of

selfcare

as

described

by

palliative

care

nurses

and

doctors

Specifically

the

following

research

questions

were

addressed

What

is

the

meaning

of

selfcare

as

described

by

palliative

care

nurses

and

doctors

How

do

palliative

care

nurses

and

doctors

describe

effective

selfcare

practice

Methods

Research

design

Given

the

nature

of

the

research

questions

a

qualitative

research

design

was

employed

An

interview

guide

see

Table

was

developed

to

address

the

study

aim

in

consideration

of

gaps

identified

from

the

literature

The

initial

guide

was

refined

in

response

to

feedback

received

from

a

small

group

of

palliative

care

professionals

not

involved

in

this

study

Open

questions

were

used

to

elicit

deeper

exploration

of

meaning

and

experience

within

a

flexible

yet

focused

discussion

about

participants

selfcare

practice

Table

Interview

Guide

In

the

context

of

palliative

care

practice

what

does

selfcare

mean

to

you

From

your

experience

how

would

you

describe

effective

selfcare

practice

Tell

me

about

the

selfcare

strategies

you

find

to

be

most

effective

What

supports

your

selfcare

practice

What

if

anything

gets

in

the

way

of

your

selfcare

practice

A

purposive

sample

was

recruited

into

this

qualitative

research

from

a

pool

of

palliative

care

nurses

and

doctors

who

had

completed

a

selfcare

survey

as

part

of

a

broader

mixedmethods

study

Consistent

with

the

purpose

of

obtaining

relevant

and

rich

data

from

an

appropriate

source

eligible

participants

were

nurses

and

doctors

practising

in

Australia

with

palliative

care

as

their

main

area

of

practice

Informed

written

consent

was

obtained

from

all

participants

through

initial

email

contact

prior

to

being

interviewed

via

telephone

A

total

of

semistructured

indepth

interviews

were

conducted

over

a

sixmonth

period

in

with

recruitment

ending

once

data

saturation

was

reached

That

is

when

the

collection

of

additional

data

served

only

to

repeat

existing

rather

than

generate

new

content

as

identified

from

the

use

of

field

notes

and

Data

analysis

Interview

transcripts

were

initially

read

and

reread

to

make

note

of

key

words

and

phrases

before

importing

them

into

QSR

NVivo

data

management

software

for

open

coding

and

qualitative

content

analysis

Qualitative

content

analysis

is

a

widely

used

method

for

interpreting

the

content

of

textual

data

through

a

process

of

systematic

classification

coding

and

identification

of

patterns

or

themes

As

recommended

by

Graneheim

and

Lundman

a

number

of

decisions

were

made

to

guide

content

analysis

and

ensure

trustworthiness

First

it

was

decided

that

a

conventional

approach

to

content

analysis

would

be

adopted

That

is

to

say

the

analysis

was

inductive

and

focused

on

latent

content

or

words

and

sentences

that

required

an

interpretation

of

underlying

meaning

Second

whole

participant

interviews

were

discerned

to

be

the

most

appropriate

unit

of

analysis

in

terms

of

providing

a

context

for

meaning

units

during

the

analytical

process

Finally

it

was

decided

that

these

meaning

units

would

comprise

interrelated

words

sentences

and

paragraphs

from

interview

transcripts

In

this

way

interview

data

were

analysed

inductively

through

the

generation

of

codes

grouping

and

collapsing

of

codes

into

common

categories

and

subsequent

abstraction

to

identify

overall

themes

that

represent

the

raw

data

in

an

aggregated

form

Figure

outlines

the

thematic

coding

and

category

content

generated

from

the

content

analysis

Thematic

coding

and

category

content

Sample

The

sample

of

participants

comprised

nurses

and

doctors

working

in

community

inpatient

or

consult

palliative

care

services

located

in

both

metropolitan

and

regionalrural

settings

across

six

of

the

eight

States

and

Territories

in

Australia

These

were

clinical

nurse

specialists

nurse

educators

clinical

nurse

consultants

nurse

practitioners

nurse

unit

managers

senior

medical

officers

consultant

physicians

and

heads

of

department

They

had

an

average

of

years

experience

working

in

either

adult

aged

or

paediatric

palliative

care

settings

Most

were

female

aged

between

and

and

worked

in

fulltime

roles

See

Table

for

detailed

participant

demographics

Table

Participant

Demographics

and

Professional

Characteristics

N

Demographic

n

Gender

Female

Male

Age

Group

years

years

years

years

Population

Focus

Adult

Palliative

Care

Paediatric

Palliative

Care

Aged

Palliative

Care

Work

Status

Fulltime

Parttime

Years

Worked

in

Palliative

Care

years

years

years

years

Results

Three

overarching

themes

emerged

from

the

analysis

in

relation

to

the

meaning

and

practice

of

selfcare

A

proactive

and

holistic

approach

to

promoting

personal

health

and

wellbeing

to

support

professional

care

of

others

Personalised

selfcare

strategies

within

professional

and

nonprofessional

contexts

and

Barriers

and

enablers

to

selfcare

practice

Figure

illustrates

the

application

of

these

as

the

meaning

and

practice

of

selfcare

Thematic

data

from

these

themes

are

reported

in

Tables

and

in

the

form

of

participant

quotations

to

ensure

trustworthiness

The

meaning

and

practice

of

selfcare

Table

Theme

A

proactive

and

holistic

approach

to

promoting

personal

health

and

wellbeing

to

support

professional

care

of

others

Prudence

Through

selfcare

what

we

are

doing

is

developing

a

relationship

with

ourselves

which

actually

supports

us

in

developing

relationships

with

everybody

else

Gwendolen

Selfcare

its

looking

after

me

to

look

after

patients

so

to

speak

if

Im

not

of

a

good

healthy

physical

state

or

emotional

state

Im

hardly

likely

to

be

able

to

support

someone

Darrell

You

cant

look

after

dying

patients

without

looking

after

yourself

really

can

you

And

do

a

good

job

of

that

in

a

compassionate

way

Felicity

Balancing

care

for

yourself

and

others

is

essential

Patrick

Its

part

of

a

holistic

approach

if

youre

not

caring

for

yourself

then

youre

less

able

to

care

for

others

Merilyn

Its

about

maintaining

a

good

balance

between

body

and

mind

being

able

to

stay

fit

and

healthy

Winston

You

look

after

your

own

health

so

that

you

can

deliver

patientcentred

care

Prudence

Thats

what

selfcare

is

its

a

way

of

living

its

a

way

of

living

every

moment

Mason

The

thing

is

selfcare

is

not

a

tickbox

commodity

Table

Theme

Personalised

selfcare

strategies

within

professional

and

nonprofessional

contexts

Philis

Its

really

not

formulaic

its

really

quite

individual

and

so

everybody

has

to

find

their

own

way

of

doing

it

Carmel

You

not

only

need

selfcare

strategies

in

the

workplace

but

also

in

your

personal

life

Felicity

I

do

try

and

exercise

a

reasonable

amount

and

I

try

and

get

to

bed

on

time

because

I

have

to

get

up

at

a

reasonable

time

and

diets

important

Gwendolen

I

regularly

exercise

do

yoga

and

have

a

regular

massage

as

well

Abbie

Having

a

bath

its

almost

like

Im

washing

the

hospital

off

me

Larissa

I

have

an

extremely

supportive

very

good

husband

and

I

have

an

extremely

good

network

of

friends

so

spending

time

with

family

and

friends

Doreen

Maintaining

relationships

with

family

making

sure

Im

spending

a

reasonable

amount

of

time

with

my

children

makes

me

feel

that

all

is

right

in

the

world

Abbie

Meditate

for

half

an

hour

a

day

thats

all

I

actually

need

to

do

to

function

well

Im

great

at

work

Im

calm

with

son

But

if

I

dont

do

that

then

I

get

irritable

and

I

dont

have

as

much

to

give

at

work

With

just

half

an

hour

of

meditation

a

day

as

my

top

priority

for

the

day

Im

just

better

all

round

Lucas

Im

quite

involved

in

my

Church

and

faith

is

actually

a

big

anchor

that

keeps

me

grounded

Reece

my

spiritual

practice

which

for

me

is

a

very

reliable

tool

Buddhist

practices

to

do

with

strengthening

my

connection

with

compassion

or

loving

kindness

for

self

and

others

Deanna

Worklife

balance

is

really

important

Sandra

Theres

no

such

thing

as

worklife

balance

its

rubbish

Cathi

If

its

after

five

oclock

a

I

wont

be

at

work

and

b

my

diary

will

be

sitting

on

my

desk

with

my

mobile

phone

on

it

turned

off

with

my

name

tag

sitting

on

it

My

computer

will

be

off

Its

about

making

certain

that

work

is

at

work

so

I

dont

take

my

mobile

phone

home

I

dont

take

my

diary

home

to

follow

up

on

things

no

sorry

thats

work

and

it

will

wait

work

stays

at

work

Felicity

I

take

the

train

I

can

only

arrive

at

a

certain

time

and

leave

at

a

certain

time

those

boundaries

are

actually

very

helpful

Ive

never

been

very

good

at

placing

boundaries

so

I

actually

have

to

do

this

physical

boundary

of

Right

the

trains

leaving

and

I

have

to

go

and

thats

worked

quite

well

Deanna

My

deescalating

time

is

driving

home

and

when

I

walk

in

the

door

at

home

work

stays

at

work

and

I

find

that

something

to

be

really

important

to

me

actually

that

the

two

dont

intermix

Winston

Its

not

sustainable

to

give

out

more

than

you

really

can

on

an

ongoing

basis

absolutely

regulating

work

demands

is

important

Cathi

I

take

regular

holidays

Im

not

somebody

whos

got

an

annual

leave

balance

I

always

take

my

meal

breaks

take

my

days

off

and

sick

leave

when

ill

Larissa

I

chose

to

work

parttime

Scott

Its

very

difficult

to

do

selfcare

without

team

support

and

so

you

support

each

other

in

doing

selfcare

at

work

definitely

Doreen

A

mindful

activity

just

grounding

yourself

this

conscious

thing

of

Okay

what

can

I

see

What

can

I

feel

What

am

I

touching

Carmel

Supervision

provides

a

safe

and

guided

reflective

space

that

allows

you

to

talk

about

your

practice

to

think

about

what

is

meaningful

to

you

about

a

time

something

you

did

something

youve

been

experiencing

recently

allow

yourself

to

really

drill

into

not

just

the

story

but

how

did

it

make

you

feel

how

did

you

behave

what

would

you

change

Darrell

informal

debriefing

is

a

sign

of

a

healthy

team

because

thats

selfinitiated

as

opposed

to

organised

or

imposed

Deanna

Its

Friday

Im

tired

A

lot

has

gone

on

and

Im

giving

a

handover

I

get

halfway

through

the

ward

and

then

I

start

wrapping

up

And

they

go

What

are

you

doing

Theres

still

the

other

half

of

the

ward

to

go

yet

and

Im

like

Oh

damn

So

being

able

to

make

a

mistake

and

be

able

to

laugh

about

it

was

important

Being

kind

and

being

compassionate

about

that

Being

able

to

accept

that

you

are

human

Abbie

Weve

all

got

a

very

black

sense

of

humour

so

it

works

really

well

Table

Theme

Barriers

and

enablers

to

selfcare

practice

Cathi

Theres

too

many

patients

and

you

cant

get

enough

done

busyness

contributes

to

poor

selfcare

because

you

actually

dont

stop

to

go

How

has

this

affected

me

What

can

I

do

What

do

I

need

to

make

me

okay

about

it

Patrick

There

is

an

expectation

that

people

wont

take

holidays

but

how

are

people

supposed

to

recharge

so

they

can

keep

working

Scott

Theres

this

culture

sometimes

where

you

just

sort

of

soldier

on

and

do

whats

expected

take

work

home

Merilyn

It

just

follows

you

home

and

it

can

really

impact

on

your

home

life

and

your

health

because

youre

just

stressing

about

things

Gordon

The

biggest

hindrance

to

selfcare

is

organisational

culture

Larissa

Theres

a

big

culture

shift

that

needs

to

ha

in

order

for

people

to

be

able

to

look

after

themselves

properly

Winston

There

is

still

a

lot

of

stigma

around

having

feelings

or

accepting

feeling

or

being

vulnerable

we

do

see

confronting

things

but

there

is

still

that

superhero

you

know

not

letting

it

affect

you

Peggie

People

are

considered

to

be

selfish

if

they

do

something

for

themselves

you

know

if

you

take

a

day

off

because

youre

on

a

mental

health

day

people

think

Oh

shes

so

selfish

because

shes

let

her

team

down

Prudence

Lack

of

selfworth

and

selfvalue

is

a

bit

of

an

issue

I

can

see

that

in

how

my

colleagues

how

people

treat

themselves

and

thats

not

a

judgment

its

an

observation

coming

from

someone

doing

pretty

much

the

same

kind

of

thing

Sandra

Selfcare

always

get

shoved

down

to

the

bottom

that

selfworth

thing

of

you

know

something

else

always

being

much

more

important

Philis

I

certainly

used

to

be

quite

critical

about

myself

which

isnt

a

particularly

helpful

thing

to

do

really

most

of

us

just

beat

ourselves

up

emotionally

and

physically

and

then

eventually

work

out

why

you

cant

keep

doing

that

for

the

rest

of

your

life

Carmel

Selfcare

goes

down

the

toilet

when

its

random

theres

no

effective

random

selfcare

Peggie

Im

very

conscious

of

selfcare

because

Ive

been

a

in

bad

spot

before

with

palliative

care

I

really

didnt

cope

very

well

so

Im

now

highly

vigilant

about

selfcare

Gordon

I

was

young

and

bulletproof

and

I

found

that

to

be

a

fairly

unpleasant

experience

young

and

bulletproof

didnt

work

very

well

But

it

took

me

about

seven

years

to

work

that

out

and

I

became

significantly

burnt

out

So

having

burnt

out

taken

time

off

and

readjusted

Im

now

very

conscious

of

how

important

selfcare

is

Abbie

When

I

do

prioritise

selfcare

Im

calm

and

Im

more

compassionate

Winston

Preventative

maintenance

Yeah

well

it

is

like

having

a

regular

checkup

and

a

tuneup

Reece

I

have

written

selfcare

plans

for

myself

but

I

dont

approach

that

in

a

sense

of

you

know

at

six

months

now

I

need

to

redo

my

selfcare

plan

An

ongoing

planning

process

is

the

critical

element

rather

than

just

the

piece

of

paper

Carmel

Leadership

Its

got

to

come

from

the

top

You

cant

have

someone

at

the

top

who

thinks

that

people

who

need

to

go

for

counselling

are

poor

little

things

Seriously

its

not

going

to

work

Kaleb

Having

a

reasonable

degree

of

selfawareness

is

hugely

important

for

effective

selfcare

particularly

in

our

line

of

work

Cathi

Finding

the

positive

in

situations

also

taking

account

of

things

that

have

negatively

impacted

me

but

still

finding

something

positive

Doreen

intentionally

choose

how

I

want

to

be

each

morning

and

how

I

want

to

leave

work

and

respond

to

events

having

a

mindset

of

gratitude

Reece

Practising

selfcompassion

is

a

really

important

enabler

without

that

Im

not

really

sure

how

authentic

my

selfcare

would

be

Gordon

Being

realistic

about

your

limitations

is

central

to

selfcare

selfcare

involves

being

honest

about

a

whole

host

of

things

and

its

primarily

being

honest

with

yourself

and

being

prepared

to

take

that

up

with

other

people

where

you

need

to

but

its

about

being

honest

with

yourself

in

relation

to

your

limitations

Lucas

Contemplating

my

own

mortality

is

very

important

in

terms

of

selfcare

I

have

to

have

confronted

that

there

but

for

the

Grace

of

God

go

I

and

this

could

be

me

dying

Really

puts

things

into

perspective

and

helps

you

to

live

and

enjoy

your

life

to

the

full

Theme

A

proactive

and

holistic

approach

to

promoting

personal

health

and

wellbeing

to

support

professional

care

of

others

The

meaning

of

selfcare

was

described

in

terms

of

its

positive

relational

context

with

self

and

others

Although

selfcare

was

focused

primarily

on

individual

needs

it

was

informed

by

the

broader

clinical

context

of

capacity

to

engage

in

positive

and

therapeutic

relationships

to

provide

patient

care

Selfcare

meant

fulfilling

a

fundamental

part

of

palliative

care

practice

with

one

participant

commenting

that

selfcare

is

intrinsic

to

the

work

itself

Selfcare

also

meant

balancing

care

for

others

with

care

for

self

with

the

promotion

of

personal

health

and

wellbeing

central

to

its

meaning

Selfcare

was

described

as

a

conscious

and

deliberate

practice

that

meant

much

more

than

just

a

tickbox

checklist

to

be

completed

within

a

set

of

allocated

tasks

Theme

Personalised

selfcare

strategies

within

professional

and

nonprofessional

contexts

Effective

selfcare

practice

was

described

as

a

personalised

and

ongoing

endeavour

In

the

words

of

one

participant

its

a

constant

work

in

progress

Participant

descriptions

of

effective

selfcare

practices

were

consistently

characterised

by

a

variety

of

selfcare

strategies

that

were

maintained

both

within

and

external

to

workplace

settings

Selfcare

in

personal

settings

Effective

selfcare

strategies

used

outside

of

the

workplace

settings

included

a

range

of

health

behaviours

meditation

and

spiritual

practice

A

healthy

diet

adequate

sleep

and

moderation

of

alcohol

intake

were

considered

important

In

addition

to

exercising

for

fitness

other

physical

activities

such

as

yoga

and

massage

were

found

to

be

effective

selfcare

strategies

Rest

and

relaxation

at

home

in

a

bath

were

described

as

effective

selfcare

strategies

when

feeling

overwhelmed

or

needing

to

wash

away

metaphorically

thoughts

of

the

workplace

Socialising

and

maintaining

positive

relationships

with

friends

and

family

was

both

supportive

and

meaningful

Meditation

practice

was

also

an

effective

Finding

harmony

between

personal

and

professional

roles

was

consistently

described

as

an

effective

selfcare

strategy

Some

described

this

harmony

in

terms

of

worklife

balance

Interestingly

others

found

the

concept

of

worklife

balance

to

be

problematic

in

practice

Given

the

elusive

nature

and

individual

context

of

what

constitutes

a

balance

between

work

and

life

most

considered

it

more

important

to

acknowledge

that

different

lifedomains

require

varying

degrees

of

attention

at

any

given

time

and

that

finding

individual

harmony

between

personal

and

professional

roles

was

a

key

strategy

towards

flourishing

in

life

One

participant

explained

Its

never

like

youve

got

this

nice

balance

where

work

finishes

then

youve

got

an

hour

to

sort

of

wind

down

before

the

rest

of

life

begins

its

more

about

just

trying

to

keep

all

the

different

areas

of

life

flourishing

Darrell

Establishing

and

maintaining

boundaries

between

home

and

the

workplace

was

considered

an

effective

selfcare

strategy

Some

boundaries

involved

commuting

to

the

workplace

via

modes

of

transport

that

prevented

overworking

while

for

others

the

commute

time

itself

constituted

a

process

of

unwinding

from

work

so

as

to

separate

from

it

when

arriving

home

Selfcare

in

workplace

settings

Boundaries

were

also

relevant

to

effective

selfcare

within

the

workplace

Awareness

of

boundaries

in

this

context

was

supportive

in

terms

of

not

overworking

due

to

resource

limitations

whilst

also

ensuring

clarity

of

expectations

for

multiple

stakeholders

In

the

words

of

one

participant

The

amount

of

resources

allocated

to

the

palliative

care

service

that

actually

creates

a

certain

set

of

boundaries

within

which

I

can

work

Im

not

going

to

step

over

those

boundaries

if

they

want

additional

work

they

need

to

increase

the

resourcing

Its

about

managing

expectations

around

what

I

will

do

and

what

I

wont

do

and

being

able

to

be

very

upfront

in

relation

to

that

with

management

with

staff

that

I

work

with

so

they

are

aware

of

what

we

can

do

and

what

we

cant

but

more

importantly

with

patients

and

their

families

so

theres

a

very

Gordon

Selfregulation

of

workload

was

important

but

often

difficult

to

achieve

It

involved

being

assertive

about

ones

capacity

in

relation

to

workload

and

wellbeing

Taking

meal

breaks

taking

recreation

leave

for

regular

holidays

and

taking

personal

leave

during

illness

were

also

considered

effective

selfcare

strategies

For

some

choosing

to

work

parttime

was

an

effective

selfcare

strategy

that

provided

ongoing

regulation

of

workload

in

relation

to

other

competing

demands

Selfregulation

as

a

selfcare

strategy

was

often

supported

by

other

members

of

the

team

In

this

way

teamcare

was

considered

an

aspect

of

effective

selfcare

that

contributed

to

a

healthy

team

One

participant

described

an

example

of

teamcare

in

terms

of

checking

in

with

colleagues

about

how

they

are

feeling

as

a

reminder

and

invitation

to

attend

to

selfcare

Having

a

cohesive

team

was

important

and

this

contributed

to

a

supportive

working

environment

Mindfulness

exercises

were

an

effective

selfcare

strategy

in

the

workplace

both

in

individual

and

group

contexts

A

sense

of

allowing

oneself

to

be

human

in

the

context

of

displaying

emotion

in

the

clinical

setting

was

also

part

of

effective

selfcare

practice

Reflective

practice

especially

through

participation

in

clinical

supervision

was

described

by

many

as

an

effective

selfcare

strategy

although

formal

supervision

was

not

available

in

all

participants

workplace

Importantly

respect

and

confidentiality

were

important

components

for

clinical

supervision

to

be

effective

But

formal

supervision

was

not

necessarily

helpful

for

everyone

with

many

finding

informal

debriefing

with

peers

to

be

effective

However

this

also

required

trust

among

colleagues

While

the

use

of

informal

debriefing

among

colleagues

was

considered

a

sign

of

a

healthy

team

formal

structured

debriefing

was

also

common

in

some

workplaces

to

support

selfcare

Use

of

humour

and

laughter

was

Participants

reported

accessing

a

variety

of

professional

supports

as

part

of

effective

selfcare

practice

These

ranged

from

Employee

Assistance

Programs

and

private

counsellors

to

psychologists

general

practitioners

and

other

medical

specialists

For

doctors

it

was

considered

especially

helpful

to

seek

objective

medical

advice

from

a

general

practitioner

Interestingly

choice

of

employer

was

a

selfcare

consideration

in

terms

of

gauging

organisational

commitment

to

support

staff

with

workplace

selfcare

activities

such

as

clinical

supervision

Finally

effective

selfcare

practice

was

described

as

a

shared

responsibility

between

palliative

care

professionals

and

the

health

services

in

which

they

practised

However

there

can

be

a

lack

Theme

Barriers

and

enablers

to

selfcare

practice

Participants

described

the

ongoing

need

to

manage

selfcare

barriers

and

enablers

as

part

of

maintaining

selfcare

strategies

in

both

personal

and

professional

contexts

Selfcare

barriers

Multiple

impediments

to

selfcare

were

identified

in

the

workplace

including

busyness

For

some

this

workload

was

compounded

by

limited

opportunity

to

take

holidays

from

work

Workplace

culture

was

also

identified

as

problematic

where

it

was

not

conducive

to

selfcare

In

some

workplace

cultures

there

was

a

stigma

associated

with

selfcare

making

it

difficult

for

individuals

to

engage

in

selfcare

practice

without

feeling

judged

as

being

selfish

Bringing

work

home

was

described

as

a

barrier

to

selfcare

and

related

to

workplace

culture

and

expectations

Selfworth

was

also

discussed

as

a

common

concern

for

effective

selfcare

where

selfcriticism

and

a

lack

of

Selfcare

enablers

Several

factors

were

described

as

facilitators

of

effective

selfcare

Recognising

the

importance

of

selfcare

was

considered

an

important

enabler

by

all

Some

became

conscious

of

this

through

previous

experiences

of

illness

or

being

unwell

after

having

initially

neglected

selfcare

Prioritising

selfcare

was

an

important

enabler

which

correlated

with

noticeable

benefits

Adopting

a

preventative

approach

to

selfcare

was

important

whilst

recognising

that

additional

strategies

may

need

to

be

implemented

as

required

according

to

context

While

formal

selfcare

plans

were

used

by

some

for

most

participants

it

was

more

important

to

engage

in

reflection

and

selfassessment

as

part

of

an

ongoing

planning

Positive

workplace

cultures

supportive

of

selfcare

were

described

as

vital

to

effective

selfcare

practice

Where

a

supportive

culture

was

absent

the

normalisation

of

selfcare

within

workplaces

was

considered

a

key

enabler

requiring

leadership

from

the

topdown

to

effect

positive

change

towards

a

culture

more

supportive

of

selfcare

One

participant

explained

Normalisation

the

reason

I

bang

on

about

selfcare

is

because

I

think

yes

you

do

need

to

normalise

it

I

think

the

key

thing

is

the

ethos

of

the

unit

and

I

think

thats

set

firstly

through

the

medical

head

but

then

also

the

administrative

or

hierarchal

structure

helps

if

its

normalised

and

supported

from

the

top

then

I

think

that

flows

down

through

the

service

from

my

observation

it

is

the

leadership

group

of

the

team

and

unfortunately

that

is

still

medical

who

set

the

ethos

of

the

unit

So

if

you

want

to

change

the

culture

of

the

Winston

Leadership

and

positive

role

models

were

considered

key

enablers

to

effective

selfcare

This

also

related

to

the

allocation

of

reasonable

workloads

Other

facilitators

of

effective

selfcare

were

more

intrapersonal

These

included

having

a

positive

outlook

selfawareness

and

positive

emotions

Selfawareness

was

described

as

central

to

effective

selfcare

practice

Gratitude

and

taking

a

positive

perspective

even

in

the

face

of

negative

circumstances

enabled

selfcare

Selfcompassion

was

considered

essential

to

selfcare

and

relational

to

compassion

for

others

as

expressed

through

patient

care

One

participant

explained

Selfcare

is

built

on

selfcompassion

If

your

compassion

does

not

include

yourself

it

is

not

complete

it

extends

to

yourself

and

to

your

clients

equally

And

if

youre

not

doing

that

then

somethings

not

working

Carmel

Importantly

selfcompassion

did

not

necessarily

come

naturally

and

in

many

cases

had

to

be

learned

For

some

selfcompassion

was

viewed

as

an

emotion

that

became

more

apparent

later

in

life

and

when

career

achievement

was

less

of

a

priority

Authenticity

and

courage

were

also

described

as

selfcare

enablers

These

encompassed

selfadvocacy

and

selfacceptance

in

terms

of

being

realistic

about

limitations

and

being

in

the

words

of

one

participant

authentically

human

Lastly

reflecting

on

and

having

an

appreciation

of

ones

own

mortality

was

considered

important

and

enabling

for

selfcare

practice

Discussion

This

study

explored

the

meaning

and

practice

of

selfcare

as

described

by

palliative

care

nurses

and

doctors

These

findings

contribute

new

knowledge

in

several

ways

with

implications

for

clinical

practice

research

and

education

A

proactive

and

holistic

approach

to

promoting

personal

health

and

wellbeing

to

support

professional

care

of

others

The

holistic

nature

of

selfcare

as

revealed

in

this

study

is

consistent

with

the

discourse

analysis

conducted

by

Breiddal

Findings

from

the

present

study

extend

this

existing

knowledge

by

providing

new

insight

into

the

meaning

of

selfcare

and

also

through

further

evidence

of

the

relational

context

in

which

selfcare

is

practised

as

voiced

by

practitioners

in

the

field

For

palliative

care

professionals

selfcare

is

not

a

selfish

endeavour

apathetic

to

the

needs

of

others

rather

it

is

a

proactive

and

relational

practice

cognisant

of

practitioners

health

and

human

needs

and

motivated

by

the

professional

context

of

sustaining

compassionate

care

in

therapeutic

relationship

with

patients

and

their

families

This

was

especially

evident

in

the

words

of

one

participant

if

you

dont

feed

yourself

youve

got

nothing

to

give

much

of

what

we

do

in

palliative

care

is

about

human

connectedness

It

also

supports

Kearney

and

colleagues

assertion

that

selfcare

is

not

a

selfish

luxury

but

is

instead

essential

to

clinicians

therapeutic

relationship

with

patients

Personalised

selfcare

strategies

within

professional

and

nonprofessional

contexts

While

most

research

has

to

date

focused

on

strategies

used

to

cope

with

occupational

stressors

these

findings

situated

in

the

broader

context

of

selfcare

reveal

not

only

the

variety

of

effective

strategies

employed

but

also

the

challenges

and

complexities

involved

with

maintaining

effective

selfcare

strategies

in

practice

The

need

for

reflective

practice

to

build

selfawareness

as

well

as

the

management

of

multiple

barriers

and

enablers

to

selfcare

practice

clearly

demand

ongoing

attention

from

practitioners

and

palliative

care

services

That

mindfulness

exercises

were

used

spontaneously

by

participants

in

practice

settings

suggests

that

the

benefits

of

formal

mindfulness

training

initiatives

extend

beyond

the

training

room

and

into

the

clinical

milieu

Clinical

supervision

was

effective

for

many

but

not

for

others

and

in

many

instances

it

was

not

available

at

all

This

seems

to

reflect

in

part

a

different

attitude

to

clinical

supervision

within

the

nursing

and

medical

disciplines

when

compared

to

other

disciplines

such

as

social

work

in

which

supervision

has

long

been

a

cornerstone

As

a

social

worker

Firth

explains

that

many

nurses

may

feel

threatened

by

supervision

whilst

doctors

have

traditionally

avoided

it

Given

the

potential

benefits

to

selfawareness

and

staff

wellbeing

the

provision

of

supervision

should

nonetheless

be

considered

perhaps

with

an

emphasis

on

the

restorative

aspects

of

clinical

supervision

Formal

and

informal

debriefing

was

consistently

described

as

an

effective

selfcare

strategy

and

thus

should

be

encouraged

Similarly

laughter

and

the

use

of

humour

formed

a

fundamental

part

of

selfcare

and

should

be

fostered

as

appropriate

Laughter

has

long

been

considered

a

coping

strategy

to

manage

stress

in

palliative

care

settings

however

this

finding

extends

a

new

context

in

terms

of

selfcare

behaviours

to

support

health

and

wellbeing

Indeed

there

is

evidence

to

suggest

not

only

psychological

but

also

physiological

health

benefits

from

laughter

including

enhanced

cardiac

and

immune

function

Establishing

and

maintaining

effective

boundaries

within

and

outside

of

the

workplace

was

an

effective

selfcare

strategy

for

participants

in

this

study

as

was

worklife

harmony

Whilst

socalled

worklife

balance

was

discussed

by

some

and

has

also

featured

in

other

palliative

care

research

into

coping

mechanisms

this

concept

was

incongruous

to

the

experience

of

others

Overall

it

was

important

to

acknowledge

that

different

lifedomains

require

varying

degrees

of

attention

at

any

given

time

and

finding

ones

individual

harmony

between

personal

and

professional

roles

was

thus

a

key

strategy

towards

flourishing

in

life

This

is

consistent

with

McMillan

and

colleagues

definition

of

worklife

harmony

as

an

individually

pleasing

congruent

arrangement

of

work

and

life

roles

that

is

interwoven

into

a

single

narrative

of

life

It

also

corresponds

with

recent

research

findings

that

worklife

interference

or

conflict

is

associated

with

higher

levels

of

burnout

in

nurses

and

predicts

intention

to

leave

an

organisation

or

the

nursing

profession

Thus

worklife

harmony

is

an

important

aspect

of

effective

selfcare

Given

this

finding

future

selfcare

education

might

usefully

incorporate

this

new

emphasis

on

worklife

harmony

over

the

common

parlance

of

worklife

balance

which

is

illdefined

and

otherwise

problematic

in

practice

for

some

Another

interesting

finding

related

to

participants

electing

to

work

parttime

as

a

selfcare

strategy

While

only

of

participants

worked

parttime

in

the

present

study

the

majority

of

participants

who

had

earlier

completed

a

survey

worked

parttime

Given

these

and

earlier

research

findings

working

a

parttime

load

appears

to

be

a

common

selfcare

strategy

for

palliative

care

professionals

Indeed

one

participant

suggested

that

parttime

roles

should

perhaps

be

encouraged

in

favour

of

a

fulltime

load

given

the

emotionally

demanding

nature

of

palliative

care

However

this

would

need

to

be

weighed

up

by

the

individual

in

relation

to

feasibility

of

lower

income

and

potentially

limited

opportunities

for

career

advancement

in

roles

where

fulltime

work

is

required

Barriers

and

enablers

to

selfcare

practice

While

positive

workplace

cultures

were

discussed

as

enablers

of

selfcare

there

were

many

who

described

their

current

workplace

culture

as

a

barrier

to

effective

selfcare

in

that

it

was

not

supportive

of

selfcare

practice

This

finding

is

alarming

yet

not

altogether

surprising

when

taken

in

the

context

of

selfcare

being

highly

stigmatised

as

either

selfish

or

weak

in

some

participants

workplaces

Perhaps

more

concerning

is

that

this

stigma

may

serve

to

not

only

impede

effective

selfcare

practice

in

the

workplace

it

could

also

discourage

palliative

care

professionals

from

taking

personal

leave

or

seeking

professional

support

when

they

become

unwell

As

a

paediatric

palliative

care

physician

showing

vulnerability

or

seeking

help

is

often

viewed

as

a

sign

of

weakness

and

acknowledging

ones

shared

humanity

and

vulnerability

through

selfcompassion

is

vital

to

selfcare

behaviours

Understanding

factors

that

contribute

to

supportive

workplace

cultures

and

facilitate

selfcare

is

therefore

essential

Some

palliative

care

services

in

Australia

might

benefit

from

the

experience

of

their

counterparts

in

Canada

and

the

United

Kingdom

who

have

focused

on

leadership

to

foster

workplace

cultures

of

selfawareness

selfcare

and

staff

support

Several

enabling

factors

to

selfcare

practice

were

identified

in

this

study

both

interpersonal

and

environmental

Authenticity

courage

and

leadership

were

highlighted

by

participants

Being

authentically

human

in

acknowledging

ones

own

vulnerability

having

the

courage

to

challenge

stigma

or

be

assertive

in

saying

no

when

acquiescing

to

additional

workload

may

compromise

ones

own

wellbeing

and

leading

by

example

in

supporting

and

normalising

selfcare

as

an

essential

aspect

of

palliative

care

practice

Authenticity

courage

and

leadership

have

been

recognised

as

character

strengths

that

can

be

measured

and

cultivated

Development

of

these

character

strengths

in

palliative

care

teams

should

therefore

be

encouraged

to

assist

in

transforming

any

unsupportive

workplace

cultures

In

this

study

positive

emotions

such

as

gratitude

and

selfcompassion

enabled

selfcare

This

is

consistent

with

a

growing

field

of

positive

psychology

research

in

which

positive

emotions

not

only

have

a

biological

basis

for

physiological

health

benefits

but

have

also

been

shown

to

broaden

repertoires

of

positive

thoughts

and

actions

which

in

turn

help

to

build

personal

and

social

resources

that

lead

to

wellbeing

and

flourishing

Whilst

in

the

context

of

psychological

flexibility

negative

emotions

are

not

necessarily

to

be

avoided

awareness

of

and

capacity

for

the

cultivation

of

positive

emotions

should

thus

be

fostered

as

part

of

selfcare

practice

This

may

serve

to

promote

resilience

and

emotional

intelligence

both

individually

and

across

the

palliative

care

team

That

selfcompassion

was

considered

enabling

to

selfcare

corresponds

with

findings

from

a

recent

correlational

study

in

which

perceived

selfcare

ability

was

significantly

associated

with

increased

selfcompassion

in

palliative

care

nurses

and

doctors

Indeed

as

highlighted

by

Vachon

selfcompassion

entails

knowing

and

caring

for

oneself

The

selfcare

barriers

identified

in

the

present

study

provide

a

valuable

context

which

may

also

explain

the

low

levels

of

selfcare

ability

identified

in

some

doctors

and

nurses

from

the

previous

study

Building

from

emerging

evidence

to

support

compassionoriented

training

interventions

in

palliative

care

teams

future

research

should

therefore

investigate

any

causal

relationship

between

these

variables

longitudinally

Potential

studies

could

incorporate

interventions

that

draw

upon

loving

kindness

meditation

or

other

compassion

training

programs

which

have

been

shown

to

enhance

compassion

for

self

and

others

and

may

therefore

contribute

positively

to

both

selfcare

and

compassionate

care

of

others

In

other

research

palliative

care

professionals

reported

selfcare

practices

have

corresponded

with

physical

social

and

inner

domains

of

selfcare

Importantly

findings

from

the

present

study

underscore

the

imperative

that

strategies

from

these

selfcare

domains

are

implemented

and

maintained

in

both

personal

and

workplace

settings

Findings

from

this

study

can

thus

inform

the

selfcare

education

and

training

interventions

recently

called

for

especially

in

relation

to

selfcare

planning

worklife

harmony

and

management

of

identified

barriers

and

enablers

to

effective

selfcare

practice

Educational

resources

might

usefully

draw

upon

this

qualitative

evidence

previously

lacking

in

the

literature

to

articulate

and

foster

the

meaning

and

practice

of

effective

selfcare

in

the

palliative

care

workforce

For

example

clarifying

staff

confusion

about

the

shared

responsibility

for

selfcare

practice

as

identified

in

this

study

The

issue

of

balance

between

individual

and

organisational

responsibility

is

multifaceted

and

requires

careful

consideration

by

palliative

care

services

Clearly

an

organisation

can

not

practise

selfcare

on

behalf

of

its

workforce

however

it

can

enable

and

enhance

selfcare

through

corporate

leadership

and

a

variety

of

structural

supports

to

foster

positive

workplace

cultures

that

are

conducive

to

effective

selfcare

practice

At

the

same

time

individual

practitioners

carry

a

personal

responsibility

for

selfcare

to

maintain

their

health

and

capacity

for

professional

practice

This

was

highlighted

by

one

participant

who

stated

Its

the

responsibility

of

every

team

member

to

look

after

themselves

but

having

management

or

organisational

strategies

in

place

to

support

someone

doing

selfcare

is

incredibly

important

its

a

dual

process

This

collaborative

approach

to

promoting

health

and

wellbeing

in

workplace

contexts

is

reflected

in

the

World

Health

Organisations

WHO

Healthy

Workplace

Framework

While

individual

responsibility

relates

to

implementing

and

maintaining

selfcare

strategies

organisational

responsibility

is

thus

oriented

towards

supporting

staff

in

effective

selfcare

practice

to

promote

health

and

wellbeing

This

support

represents

an

investment

with

a

host

of

potential

organisational

benefits

including

increased

patient

and

family

satisfaction

increased

staff

retention

and

reduced

absenteeism

improved

staff

morale

and

job

satisfaction

Conflict

between

colleagues

can

be

a

common

source

of

staff

stress

and

is

an

important

workplace

concern

where

all

parties

must

take

some

responsibility

While

the

degree

of

responsibility

will

vary

according

to

context

the

use

of

employee

assistance

programs

and

adoption

of

the

WHO

Healthy

Workplace

Framework

can

provide

support

and

guidance

in

this

area

Clarity

may

also

be

lacking

with

regards

to

shared

responsibility

for

selfcare

practice

where

clinicians

experience

chronic

illness

and

or

disability

Health

services

as

institutions

have

the

potential

to

promote

health

and

wellbeing

not

only

for

health

care

consumers

but

also

for

health

care

professionals

Indeed

some

argue

that

hospitals

should

serve

as

exemplars

of

healthy

workplaces

Given

this

context

a

collaborative

approach

encompassing

individual

selfmanagement

and

organisational

support

would

be

consistent

with

the

WHO

Healthy

Workplace

Framework

which

recommends

that

workplaces

be

supportive

of

employees

living

with

chronic

disease

and

disability

Palliative

care

services

might

usefully

draw

upon

this

or

similar

approaches

Given

the

highly

personalised

nature

of

selfcare

palliative

care

services

should

also

consider

ways

in

which

a

variety

of

selfcare

strategies

can

be

supported

For

example

providing

opportunities

for

both

informal

debriefing

and

formal

clinical

supervision

depending

on

individual

preference

as

well

as

scope

for

the

supported

development

of

individual

selfcare

plans

for

those

who

feel

they

would

benefit

from

them

A

novel

finding

from

this

study

was

the

concept

of

teamcare

to

promote

a

healthy

team

As

an

encouraging

sign

of

positive

workplace

cultures

this

highlights

an

additional

dimension

to

the

relational

context

of

selfcare

practice

whilst

underscoring

the

importance

of

supporting

interdisciplinary

teamwork

as

an

integral

part

of

the

philosophy

of

palliative

care

It

also

contributes

to

the

literature

on

positive

relationships

and

workplace

wellbeing

in

the

context

of

selfcare

and

positive

health

Taken

together

the

practice

of

teamcare

as

an

antecedent

to

a

healthy

team

in

palliative

care

represents

a

potential

avenue

of

qualitative

inquiry

for

future

research

This

would

be

enhanced

with

the

inclusion

of

participant

observation

and

patientreported

outcomes

on

any

perceived

benefits

to

the

quality

of

care

provided

Limitations

Limitations

to

this

study

should

be

noted

Sociocultural

considerations

were

not

represented

in

the

demographic

data

collected

or

subsequent

analysis

Whilst

to

our

knowledge

any

significant

impact

of

culture

on

selfcare

has

not

featured

in

the

literature

to

date

we

acknowledge

that

palliative

care

professionals

from

culturally

and

linguistically

diverse

backgrounds

may

understand

and

approach

selfcare

practice

in

ways

other

than

as

described

in

this

study

sample

Additionally

the

sample

was

somewhat

limited

in

terms

of

participants

geographical

location

While

the

study

recruited

participants

from

metropolitan

and

inner

or

outer

rural

regional

locations

of

nearly

all

Australian

States

and

Territories

Conclusions

The

findings

of

this

study

reveal

a

context

and

complexity

of

effective

selfcare

practice

previously

lacking

in

the

literature

Taken

together

the

findings

of

this

research

provide

new

insight

to

support

palliative

care

practice

and

education

Selfcare

is

a

proactive

and

personalised

approach

to

the

promotion

of

health

and

wellbeing

through

a

variety

of

strategies

in

both

personal

and

professional

settings

to

support

capacity

for

compassionate

care

of

patients

and

their

families

Importantly

it

is

a

shared

responsibility

between

palliative

care

professionals

and

the

palliative

care

services

in

which

they

work

with

staff

support

and

positive

workplace

cultures

required

to

Declarations

Acknowledgements

The

authors

gratefully

acknowledge

the

palliative

care

nurses

and

doctors

who

generously

shared

their

time

and

candour

as

participants

in

this

study

JMs

PhD

Candidature

was

supported

by

an

Australian

Postgraduate

Award

from

the

University

of

Sydney

Funding

This

research

received

no

specific

grant

from

any

funding

agency

in

the

public

commercial

or

notforprofit

sectors

Availability

of

data

and

materials

In

accordance

with

the

ethical

approval

for

this

research

the

datasets

generated

and

analysed

during

the

current

study

are

not

publicly

available

Authors

contributions

JM

and

JF

contributed

to

the

initial

conception

and

design

of

the

study

whilst

TW

contributed

to

its

refinement

and

finalisation

JM

conducted

the

data

collection

and

analysis

with

guidance

from

JF

and

TW

JM

drafted

the

manuscript

JW

and

TW

made

critical

revisions

to

the

paper

for

intellectual

content

All

authors

approved

the

final

manuscript

Ethics

approval

and

consent

to

participate

Approval

for

this

study

was

granted

by

the

University

of

Sydney

Human

Research

Ethics

Committee

In

accordance

with

this

approval

informed

written

consent

was

obtained

from

all

participants

Competing

interests

The

authors

declare

that

they

have

no

competing

interests

Publishers

Note

Springer

Nature

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neutral

with

regard

to

jurisdictional

claims

in

published

maps

and

institutional

affiliations

Open

Access

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B I I O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I I O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I 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O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I I O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O

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Family Feud 92414 May 23 2017 G1 Eggeruds v Moffetts DJ Shelita Lorraine Latrecia Cheryl R1 Name something a camel has that a person could also have 1 Hump 46Joe 2 3 4 5 6 7 X That thing in his back DJ Eggeruds Legswobbly knees 6 4 hair BA 3 teeth hot tonguemouth 2 17 nostrils sexy eyeslashes T3 7 bad breath DJ Steal Head Left Toe water retention R2 Name something on his desk a board office worker might try to shove up his nose 1 Pencil64Lyndsey 2 3 4 5 6 7 X Staples Shelita Eggeruds Fingers BA 2 whiteout rubber band paperclips 2 14 scissors DJ Steal 2 Eraser 3 7 Remaining BAs Letter opener Kleenex piece of paper Double Name a place a CHEATING husband might keep a pair of clean undies for emergencies 1 2 Workin desk 20Lauren 3 4 5 X Drawers Lorraine Eggeruds Carglovebox TA 71 toolbox BA 2 other womans home garage briefcase ONE BA LEFT bushes DJ Steal 3 Gym bag Unsaid Pockets TRIPLE Name something a female magician might pull a rabbit out of 1 HatFedora 43Latrecia 2 3 4 Moffetts Cleavagebra 3 21 hair shoe BA 3 skirt purseclutch 23 FM 1 Acc to fathers on the scale how SHOCKED would you be if your child got straight As on their report card 2 A soul food 3 Give me a word that rhymes w bump 4 A part of a womans body that men prefer to be small 5 A kind of ball that would fit in your pocket DJ 7 7 greens 24 hump 17 head tennis 15 Shelita 5 15 fried chicken 21 lump 35 stomach 33 racquet Unsaid 1s 10 golf G2 Siureks v Woods Heather David Daniel Woody Sr Woody Jr R1 Name something it only takes two people to do but its even more fun if more people join in 1 2 3 Bow chika wow wow 11Deleta 4 5 X Pitch a tent Heather Siureks Throw a party BA 4 gamesMarco Polo TA 55 dinner party dance 4 10 drink sportsbasketball 15 CS R2 Name something a husband would be SHOCKED to see his wife wearing 1 2 Birthday suit 19David 3 4 5 6 7 X Makeup Carl Woods Menswearjockstrap 1 27 hot lingeriethong 3 12 jogging pants bikiniswimsuit BA 3 whipped cream chocolate Deleta Steal High heels 4 Dressgown 5 BAs unsaid Miniskirt leatherdominatrix Double Name something a woman might swing 1 2 3 4 Hairponytail 10Daniel 5 6 X Swing Steve Woods Child belt sex life Deleta Steal 2 Purse 1 31 2 Bat 16 T3 Frying pan Both on bottom Golf clubs hipsmoney maker 6 apiece TRIPLE Name something that people are sometimes said to be under 1 The weather 42Jen 2 3 4 Siureks Paid the covers educated Heather Steal Age 2 The gunstress 19 3 The influence 16 BA A spell 10 SD Something a kid would HATE to find in the snow theyre eating Brandon Whizdoody 84 FM 1 Acc to women on the scale how necessary are men 2 A wordphrase that dogs NEVER want to hear 3 Something you buy to go w a guitar 4 If a jellybeans green tell me what the flavor might be 5 Something you should NEVER leave unlocked Brandon 10 34 youre bad 27 pick 34 apple 38 doors 51 Steve 4 out amp 16 watermelon shelving Unsaid 1s NO lime Advertisements Category Family Feud 2 Comments 52317 Quick News Notes Family Feud 21914 This site uses Akismet to reduce spam Learn how your comment data is processed

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Leadership Skills How to Use Leadership Theory to Your Advantage By Christine Funk May 6 2016 Do you want to create a stronger and more competent workforce As an employer you know how important it is to hire workers with strong soft skills especially with strong leadership skills But many employers and hiring managers are not clear about exactly what makes a good leader in the workplace You have probably heard that effective leaders possess personal characteristics and behavioral traits that contribute to their effectiveness As you interview prospective employees you may look for character traits such as maturity confidence and drive However current leadership theory reveals that many distinguished leaders often lack the qualities most often associated with leadership It turns out that good employees without some of these traits can learn to become strong effective leaders A Changing Focus on Effective Leadership Recent studies show that there are many other ways of looking at leadership than socalled trait theories that focus strictly on personality and character traits Experts now believe that leadership behavior can be learned and is not based on intrinsic qualities that a prospective employee may or may not possess Current leadership theories cover a broader range of principles It now appears that there are different leadership styles that fit different situations and circumstances often bring out leadership behaviour in employees Types of Leadership Theories A working knowledge of the leadership theories can help you hire the right people and put together the best possible team enabling you to get the job done with a minimum of drama and delays Project managers can use leadership theory to improve their performance as head of a team Older trait theories provided a list of required personal characteristics associated with leadership and otherwise highly qualified candidates were often discounted if he or she did not possess those particular traits Current theories focus more on what leaders actually do to get the job done Choosing the leadership principles that makes the most sense for your company is up you By acquiring a working knowledge of the more popular leadership theories you can choose to apply the ideas that are most relevant to your situation Trait Theories Under trait theories leaders display honesty emotional maturity strong motivation and drive as well as cognitive ability Experts now recognize that that many great historical leaders did not possess these traits but were effective leaders nonetheless Contingency Theories The underlying principle of contingency leadership theories is that there is no one leadership style that fits all situations The attributes of the individuals involved in the team are also important to the outcome of the project Situational Theories Situational theories emphasize the idea that leaders are prompted to behave in a way that is determined by the circumstances of the task at hand This is true whether they are acting alone or if they are supported by others who also see the path to success Transformational Theories In transformational leadership theory a strong leader inspires followers by emphasizing the significance of the task at hand By enabling team members to feel they are performing an important task the team leader can motivate the team to perform well bookboonbook idf4511177380e4fb5aad4a5ca00f9b4e9 titleThis article is based on the following eBook languageen Underlying Principles of Leadership Current leadership theories state that good leaders reconcile the goals of the project with the interests of team members Making sense of divergent theories means understanding the relationship between the leader and the team the range of management styles and the degree to which team members are allowed to have their voices heard Project managers can make sure that the members of the team are well invested in the project to attain the best result Leadership theories also delve into the project managers ability to define the task communicate feedback to team members along the way and remove obstacles that may come up in order to promote the success of the project without delays Some theories underscore the importance of allowing team members to do what they do best while other theories stress a more goaloriented and authoritarian approach To put leadership in a different light the Zenger Folkmans theory lists leadership flaws that can hinder the success of a project Under this theory leaders are encouraged to analyze their own behaviour to determine if they resisting new ideas using poor judgment or failing to develop the abilities of team members The Importance of Leadership Theories For employers understanding basic leadership principles is key to hiring the right people and placing them in the right positions Studying leadership principles can also help project managers and others improve their leadership skills The payoff is smoother running projects that are completed successful and within an acceptable time framework Professional Development The Bookboon eLibrary Solution benefits employers who want to create a stronger and more competent workforce By tapping into the soft skills topics such as leadership at the Bookboon eLibrary employees can strengthen their knowledge and improve their performance in the workplace The eLibrary Solution at Bookboon provides concise and engaging eBooks on a wide variety of topics More interesting blog articles Flexibility is the Key to a Productive Workforce Coaching Mentoring Why These Soft Skills of Employees Matter Ability to Work Under Pressure Not Just Business Jargon bookboonrecommendations idf4511177380e4fb5aad4a5ca00f9b4e9 titleYou might also find these books interesting Twitter Tumblr EMail Pinterest LinkedIn Reddit XING WhatsApp Hacker News VK Telegram Christine Funk Marketing Social Media Manager More posts by Christine Funk This article was posted in Articles and tagged employees soft skills leadership skills leadership theory soft skill leadership Soft Skills Bookmark the Follow comments with the RSS feed for this post Post a Comment or leave a trackback Trackback URL

O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O B O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O B B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O


Scholarly Monographs how to find them Resources by Subject Research Guides What is a scholarly monograph Scholarly monographs are singlevolume works books providing indepth research into a specialized area of knowledge They contribute to the ongoing scholarship in a particular discipline by offering original insight into their subjects Unlike popular or trade books which are geared toward general readers they are written by faculty or other scholars in a field for an academic audience Although scholarly monographs are selfcontained they can stand on their own they may be part of a series of books covering a wider subject area Scholarly monographs are typically purchased by academic and research libraries for use by scholars including students You wont usually find them on bookstore shelves How do you find scholarly monographs Scholarly monographs can be found scattered throughout the stacks of Booth Library Start by browsing the stacks in the subject area youre interested in Books in the stacks are shelved according to their Library of Congress call number Pictured above Murray R L and Heumann J K 2009 Ecology and popular film Cinema on the edge Albany NY SUNY Press Most monographs will have a single author but some will list coauthors if the authors collaborated on the work Here are some things to look for when examining books to see if they fit the description of a scholarly monograph Does the author have an advanced degree for example a PhD or EdD andor are they associated with an academic institution Is the book published by a university press scholarly society or other scholarly organization Does the book include a bibliography at the end citing all of the sources other books journal articles original documents etc that the author used in their research In the examples above Perry R K 2014 Black mayors white majorities The balancing act of racial politics Lincoln NE University of Nebraska Press The example above comes from Patterson L E 2010 Kinship myth in ancient Greece Austin TX University of Texas Press Please ask a librarian if youd like more help finding and identifying scholarly monographs

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