Chapter 2
Care and Self-Care

SH Cedar

Chapter Overview

This chapter discusses some of the emotional toll that caring work takes on Allied Health Practitioners (AHPs) and how to implement self-care into your daily routines. The job you are about to embark on, or are already involved in, requires that you care for others. You have many existing skills to help service users, carers, and their families, but care is a particular skill. It is a skill that is not just relevant to service users but is an essential part of your own tool kit. As an AHP, it is essential you have the ability to not only care for others but also for your own health and well-being. Caring for others is stressful. If you are doing it professionally, there are extra expectations, skills, and competencies expected of you, as well as additional stress to accomplish tasks and to be caring. One of the Health and Care Professions Council (HCPC) standards is about fitness to practice and it is important for professionals to recognise when their health may impair their fitness to practice and address this by having time away, seeking support, or practicing good self-care. Being caring is an emotional burden on the carer. In patient-centred care those providing the care can find the emotional burden overwhelming.

What Is Care?

This may seem an obvious question, but the amount of poor care of patients and staff in all healthcare sectors has been highlighted in the Francis Inquiry (Francis 2013). Additionally, the fact that many of us have lifestyles that increase our tendency to ill health (Yamada et al. 2012) means ?what is care' is worth asking and answering. Care comes from the same root as careful, being full of care and taking care of anything and everything. Modelling good care shows that you care about yourself and others, and that you are careful in what you do, say, and in how you act. In professional practice we are careful about planning and implementing, undertaking clinical interventions, writing patient notes diligently, and a myriad of other things. The opposite of being careful is being careless, uncaring about things, or dismissive.

Perhaps it is worth reflecting for a moment and thinking about whether you consider yourself careful? Do you take care of yourself, your health, your body, your clothes, your home, your diet, your driving, your family, your environment, your finances, your relationships, and your interactions with others, and your learning and maintenance of knowledge? Do you really care about these things? Are you really careful? In what areas of your life do you need to be more careful? Please also refer to Chapter 1 which clearly outlines the importance of reflection in professional practice.

It should be acknowledged that being careless can lead to a dangerous and high-risk lifestyle, likely to end sooner in comparison to those that care about themselves and others (Cedar 2012). Being caring and careful individuals, and teams, mean you role model this for others and for society at large.

There are many biological arguments about whether we are caring by nature. In other words, do we have a biological makeup that makes us care?

The Science of Care

Does our biology, our nature, programme us to care? Is there a caring gene or a caring physiological pathway? For us to care, in biological terms, there must be a benefit that outweighs the cost of caring. Science has proposed a few models for care, many expanding on the selfish gene hypothesis (Hamilton 1970)

• Inclusive fitness and kin selection - whereby we protect those close to us genetically as they are carrying our genes is one such model. Trivers (1971) developed the theory of reciprocity in a biological model, but as a proposition rather than an experimental proof, similar to Maynard Smith and Price (1973) with models of game theory and altruism. Since then the ideas have been continually discussed and debated.
• Genetic models - propose that there are genes ('altruistic' genes) that promote care for the other. Thus we could argue that families where we see different generations have for example that become AHPs are likely to share the altruist gene due to common descent (Sibly and Curnow 2017).
• Chemical reward in the brain - this is akin to the dopamine affect when seeing many 'likes' on your web/social media page. A chemical, such as dopamine, would be released when you do something nice, such as caring (Filkowski et al. 2016). But, philosophically, what is 'nice', or 'good', or 'caring', and why be any of those characteristics? How does biology set those concepts?

Where the concept of care and caring evolve from are thus hard to discern in any scientifically meaningful manner.

In contrast are proposals for caring, emanating from socio-historical constructs and feminist views on traditional female roles (Dunlop 1986). For some, the distinction is between a caring science and a science of caring.

According to Watson and Smith (2002, p. 459), caring science . makes explicit an expanding unitary, energetic world view with a relational human caring ethic and ontology as its starting point; once energy is incorporated into a Unitary Caring Science perspective we can affirm a deep relational ethic, spirit, and science that transcends all duality.

But this does not give us a science of caring, or understanding of why living things, organisms, care at all. It defines care and gives an ethic to care, without any scientific proof that care is a physiological component of living organisms. It is a sociology of care, but not a scientific proof that there is a biological drive to care.

Vitally, societies that are not caring are doomed to failure. They go against one of the most fundamental aspects of being alive - caring. Caring, therefore, is perhaps the most important characteristic of human life and culture.

Why Self-care Is Important

Many of us are aware of the care we give to heal physical traumas, but care, and indeed health, is more than just physical; it also affects the service users' mental, emotional, pastoral, and spiritual well-being. Many of us can survive the physical demands of professional caring. If we feel a bit physically exhausted or overwhelmed, a good night's sleep and a rest can revive us. But caring for others requires an emotional toll and this is an area of care that is seldom mentioned in training of healthcare professionals. Self-care in this context is the process of managing feelings and expressions to fulfil the emotional requirements of a job (Hochschild 1983). Fitzgerald and Hurst (2017) showed that healthcare staff members' own feelings about service users can also have an impact on how they deliver care (for example holding inaccurate stereotypes).

However, our credibility as AHPs is diminished if we do not take care of ourselves because this makes it harder for us to care about others if we are not in a healthy place and cannot model healthy living. Being aware of our own needs and taking time out for ourselves are important elements of self-care that link with our feelings of self-worth. There are many ways to increase self-care (Sansó et al. 2015). The common problems people experience, however, are finding time for self-care or feeling that we ourselves are worth caring about.

Self-care is also of great value to our workplaces. Data about staff absences can be found on NHS Digital. It is estimated that staff absences cost just over one billion pounds per year. Data from the NHS and from social care found that in 2019/2020 over 6 billion pounds was spent on agency staff to manage work force issues and unplanned absences (Liaison Workforce 2020). The NHS People Plan (NHS England 2020) is focused on how to make healthcare a better place to work, and in reducing staff absences.

Stress and Burnout

People working in health and social care are more likely to suffer from stress and burnout than those in other sectors (The Health and Safety Executive 2019). Much of this can be due to the high emotional aspects of our work rather than from the physical labour, thus leading to mental exhaustion, absenteeism, and attrition (people leaving work). Burn-out is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions (World Health Organisation 2019).

• feelings of energy depletion or exhaustion;
• increased mental distance from one's job, or feelings of negativism or cynicism related to one's job; and
• reduced professional efficacy.

Kumar (2012) listed factors that led to high attrition rates:

• Feeling overworked and unable to manage workload.
• Lack of role clarity and a low sense of control over performance.
• Not feeling respected and valued for contributions and capabilities.
• Poor communication with management around critical issues affecting work.
• Not receiving recognition or rewards for accomplishments.
• Poor career opportunities and support for career development.
• Lack of trust and effective collaboration with co-workers.
• Work schedules that do not match job needs or expectations.
• Work that is too physically demanding.

Caring for oneself, holistically, is therefore of great importance in healthcare staff (Cedar and Walker 2020).

Methods of Self-Care

There are various ways to increase self-care (Sansó et al. 2015). Being aware of...