Looking on the bright side: Rewards and reframing in the mental health discourses of end-of-life care workers

Abstract

Those working in end-of-life care (EOLC) face death and manage conflict between patients and relatives, and thus, suffer burnout and adverse mental health (Dijxhoorn et al., 2021; Slocum-Gori et al., 2013). Given these difficulties, our project investigates the meanings that EOLC workers give to their mental health. Drawing on data from a project examining the mental wellbeing of EOLC workers in Hong Kong and the United Kingdom, we explore how they construct their mental wellbeing in relation to their work. Drawing on 20 interviews with healthcare professionals and using theme-oriented discourse analysis, we investigate the mental health discourses and narratives of EOLC workers. Data analysis revealed that respondents indeed reflected on the challenges posed to their mental health by EOLC work. Nevertheless, we identified two focal themes in their mental health discourses reflecting positive mental wellbeing. First, interviewees reflected on the personal rewards of working in EOLC. Building close relationships with and supporting patients was framed as a “privilege” that motivated and “energized” EOLC workers. Second, interviewees “rejected the negative”— emphasizing the positive impact of working in EOLC on their mental health. They achieved this through the discursive strategy of re-framing— recasting challenges to their mental health as ‘positives.’ Our paper reconceptualizes mental health discourses in EOLC from a deficit focus to a consideration of how workers give positive meaning to their experiences and wellbeing. Finally, we reflect upon how these rewards and re-framings might form the basis for a strengths-based approach to mental health interventions for end-of-life care professionals.