Caring at Christmas: When Joy and Sorrow Meet

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By Dr Caroline Phelan, Melissa Bruno, Eileen Donoghue, and Sara Fleming, Palliative and End-of-Life Care, Flinders University

Christmas in a hospital brings a unique set of challenges, especially when caring for patients at the end of their lives. For healthcare professionals, balancing the festive atmosphere with the profound sadness of loss requires immense compassion and skill. This time of year can amplify grief for patients, families, and even for us as caregivers.

Christmas is often described as a season of joy, but in the hospital it is common for joy and sorrow to sit side by side. Patients and families might experience bittersweet moments, sharing laughter and tears in the same breath, treasuring small joys while navigating deep sadness.

For health professionals, the emotional landscape is equally complex: it can feel uplifting to help create meaningful, cheerful moments, yet it is also a time when our empathy and vulnerability are heightened. Recognising and embracing these mixed emotions can help everyone, patients, loved ones, and staff, find comfort and meaning, despite in the most difficult circumstances.

Providing support goes beyond clinical duties; it involves creating a space for dignity, comfort, and meaningful moments. This blog offers practical tips for end-of-life care during Christmas, focusing on how to support your patients, their families, your colleagues, and yourself through this sensitive period.

Caring for Someone Who Is Dying

When a patient is nearing the end of their life during Christmas, our role is to honour their wishes and provide comfort. It’s a time to focus on person-centered care, recognising that everyone will have different needs and desires.

A primary rule is to always ask. Never assume what a patient wants. Some may find comfort in Christmas carols and decorations, while others might prefer a quiet, non-festive environment. Ask them directly: "How are you feeling about Christmas?" or "Is there anything we can do to make this time more comfortable for you?" This simple act gives them a sense of control.

Don't be afraid to be creative with time. If a patient’s prognosis is short, you might suggest celebrating Christmas early. “Is there something we can help you with?”. A family gathering can be moved forward. This allows the patient to participate and creates a lasting, positive memory for their loved ones.

It’s also crucial to be honest. Families will often ask, "Will they make it to Christmas?" It is okay to say you don't know. Offering false hope is unhelpful and it is better to just be honest and respond with you are not sure. You can respond with empathy by saying, "It's difficult to say for certain, but we are focused on ensuring they remain as comfortable as possible right now” and "What would be important to you if time was shorter than that?"

Caring for Their Family

The families of dying patients are navigating their own complex emotions. They are often caught between the public expectation of holiday cheer and their private reality of impending loss. Your support can make a significant difference.

Create a welcoming environment for them. Simple gestures, like offering a cup of tea or finding a quiet space for them to gather, can provide immense comfort. Acknowledge their pain with simple, sincere words. Instead of using platitudes like "at least they are not suffering," which can feel dismissive, opt for phrases that validate their experience. Say, "I am so sorry you are going through this," or "This must be incredibly difficult."

Ask what they need. A direct question like, "Is there anything you need, or would you like to do?" opens the door for them to express their wishes. They may want to bring in special food, play music, or have a spiritual leader visit. Facilitating these small, personal traditions can help them feel connected and supported. Encourage them to be present, hold their loved one’s hand, and say what needs to be said.

Caring for Your Colleagues

The emotional weight of end-of-life care is heavy, and it's a burden your colleagues share. Christmas can be particularly tough for staff who may be dealing with their own past losses or feeling the strain of a demanding work environment.

Check in with your team. A simple "How are you holding up?" can open a vital conversation. Acknowledge the difficulty of the situation and create a culture where it's okay to not be okay. If you know a colleague has experienced a personal loss, be extra mindful. Ask them what they need, they might prefer to take the lead on a challenging case, or they might need to step back. Respect their boundaries.

Some staff may prefer not to be at work and have their own ways or plans of honouring an anniversary of their loved ones, so checking if they prefer to have the day off or not is worthwhile. Healthcare professionals often won’t ask, but being reassured that this option is available is always thoughtful and shows compassion and kindness.

When a death occurs on the ward, debriefing after a patient's death is essential. It allows the team to process the event, share feelings, and support one another. These moments of shared vulnerability strengthen team bonds and build resilience. Fostering a supportive work environment is not just good practice; it's a necessary component of compassionate care.

Caring for Yourself

You cannot pour from an empty cup. Providing compassionate care to others requires you to be compassionate with yourself first. The emotional toll of this work, especially during a high-stakes time like Christmas, is significant.

Acknowledge your own feelings. It's normal to feel sad, frustrated, or emotionally drained. Find a trusted colleague or friend to talk to. Voicing your emotions can prevent them from becoming overwhelming. It's important to recognise that your grief is valid, too.

Make time for self-care, even if it’s just for a few minutes. Step away from the unit for a short break, listen to music on your way home, or engage in a hobby that brings you joy. Protecting your emotional well-being is not selfish; it is essential for your longevity in this profession. Remember that the empathy and strength you offer your patients and their families are possible only when you take the time to care for yourself.

Find out more supporting self-help strategies in the End-of-Life Essentials updated Bereavement Care module