Caring explored

I was thinking about caring in the context of healthcare (only) for this exploration. There are some elements of care that involve providing services – for example diagnostics, investigations, nursing care, medical procedures and so on. But I needed to look deeper than that. I did not really want to see care as just services and jobs. Anybody could find a list of things that carers need to do to provide care e.g. risk assessments, filling in forms, taking pulse and blood pressure at frequencies to match need, changing linen on time, feeding patients – or even taking people to the bathroom etc. I think that how those things are done, is more important than ‘what is done’.

I wanted to consider caring in the context of motivations to really help people, at the most human of levels. That’s not about wages, resources or jobs because people can be paid to do jobs but still not care about the quality or standards of what they do. In other words care can be reduced to tick box exercises – and not deliver caring.

To be absolutely clear, none of my thoughts here are evidence based. They are based on my level of experience and common sense – nothing more. It is for someone else to do the research and prove me right or wrong. [AC_PRO id=913]

Compassion and dignity

Caring for human beings in illness or disability has to be more than just tick boxes covering what is to be provided according to some protocol or algorithm. The delivery of compassionate high quality care seems to require something extra but I struggled to put my finger on it. I then thought that it must be something to do with the inherent constitution of the carer (the person). After all, delivering care involves managing people’s fears, anxieties, loneliness, separation from relatives, lack of ready access to communication with friends, and knowledge of their rights. Then there is care that has to deal with managing pain (physical or emotional) or disappointments.

In palliative care the common issue is dealing with individuals at the end of life, and providing them with compassion and dignity. A service manager might require a patient to be given emotional support ever hour – and that box can be easily ticked – but  that would be difficult to assess if it was provided and with what true compassion.

Among the most disadvantaged such as dementia services or intellectual disability services, patients are unlikely to assert themselves – and relatives are not there 24/7 to witness the level of caring. Appropriate attitudes and personal factors must count in these areas of work.

Personality disorder mental health services are perhaps the most challenging area to provide caring. Patients in these services are often narcissistic, sadistic, obsessional, arrogant, entitled, self-important, predatory and so on. Those are not the sort of behaviours that readily afford caring and compassion.

Going deeper

I realised that I was looking for the deeper, intrinsic motivations and elements that make health care truly compassionate and effective, beyond just the execution of clinical tasks. This is a complex issue that has been discussed in medical ethics, psychology, and sociology literature. This is not about the requirements of care. I’m really going for the characteristics of one human being to care for another person who is disadvantaged by physical or mental disorder.

The following characteristics emerged from my deep thoughts:

1. Empathy: This is an emotional skill that allows healthcare providers to understand and share the feelings of their patients. It is about being able to put oneself in the patient’s shoes, which can deeply influence the care provided. Empathy helps providers to anticipate patients’ needs and concerns, and to communicate in a way that is supportive and comforting.
2. Compassion: While closely related to empathy, compassion takes things a step further. It is the willingness to relieve the suffering of another. In healthcare, compassion can be demonstrated by going the extra mile to make patients comfortable, spending time listening to their fears and worries, and providing reassurance.
3. Humanity: Recognising each patient as a unique individual with their own life story, rather than just a case or a diagnosis, is crucial. This involves respecting their dignity, values, and choices, even in difficult circumstances.
4. Dedication: A true dedication to the well-being and health of patients often means prioritising their needs, sometimes even above one’s own comfort or convenience. It includes the pursuit of knowledge and skills to constantly improve the quality of care.
5. Altruism: This is a selfless concern for the well-being of others. In a healthcare context, it can drive providers to strive for the best patient outcomes, regardless of the time or effort required.
6. Professionalism: This involves adhering to the high ethical standards of the medical profession, including honesty, confidentiality, and maintaining appropriate boundaries. It also includes a commitment to lifelong learning and skill development.
7. Resilience and Self-Care: Healthcare providers must also take care of their own physical and emotional health, so they can consistently provide high-quality care. This requires resilience in the face of stress and adversity, as well as strategies for self-care and avoiding burnout.

Personality types and traits

The above led me to wonder about which personality types might be best suited to caring roles, which deliver on the standards in real ways with care and compassion. But before getting there I considered the relevant personality traits that I thought might work best.

Traits

I came up with the following:

1. High Emotional Intelligence: This includes the ability to recognise, understand, and manage their own emotions as well as the emotions of others. This underpins empathy, compassion, and the ability to deal with stress and adversity. It also includes strong interpersonal skills.
2. Conscientiousness: This trait is characterised by a desire to do a task well, thoroughness, organisation, and dependability. Conscientious individuals tend to be dedicated to their work and demonstrate a high level of professionalism.
3. Openness: This includes being open to new experiences, ideas, and different perspectives. Open individuals tend to be more understanding and accepting of others, and they often value learning and growth, which aligns with the commitment to lifelong learning and skill development in healthcare.
4. Resilience: Those with high resilience have the capacity to recover quickly from difficulties. In the challenging field of healthcare, this trait is crucial to cope with emotional and physical fatigue and to avoid burnout.
5. Altruism: This trait, a selfless concern for the well-being of others, is key to the motivation of many in the healthcare field. Altruistic individuals are often driven by a sense of purpose and a desire to make a difference in the lives of others.
6. Assertiveness: This includes the ability to express one’s feelings, thoughts, and needs directly and respectfully. In healthcare, assertiveness can help in advocating for patients’ needs and rights.
7. Patience: Healthcare providers often deal with complex cases, difficult situations, and distressed individuals. Patience helps in dealing with these situations calmly and effectively, providing the best care possible despite the circumstances.
8. Flexibility: The ability to adapt to changing situations and challenges is crucial in a healthcare setting, where every patient is unique and circumstances can change rapidly. However, flexibility does not mean an ability to compromise on well established standards.

Types

Then I explored the 16 personality types from the Myers-Briggs Type Indicator (MBTI), a widely used personality assessment tool. The MBTI is often used in health services as part of reflective practice. It posits that people’s personalities can be categorised along four dimensions:

1. Extraversion (E) vs. Introversion (I)
2. Sensing (S) vs. Intuition (N)
3. Thinking (T) vs. Feeling (F)
4. Judging (J) vs. Perceiving (P)

Each individual is understood to lean towards one end of each dimension, leading to 16 possible combinations. See here: https://www.16personalities.com/.

In the context of healthcare and the caring qualities previously discussed, certain personality types may be particularly well-suited, but it is important to emphasise that people of all personality types can and do excel in healthcare. Success depends on many factors, not just personality, and diverse personalities can contribute to a well-rounded healthcare team.

Here are a few personality  types that I think might align well with a caring nature in healthcare:

1. INFJ (Introverted, Intuitive, Feeling, Judging): Often referred to as the “Advocate,” INFJs are typically compassionate, insightful, and committed to helping others. They tend to be good at understanding others’ feelings, which aligns well with the empathy and compassion needed in healthcare.
2. ENFJ (Extraverted, Intuitive, Feeling, Judging): Known as “Protagonists,” ENFJs are often warm, empathetic, and have a strong desire to help others. Their extraversion may help them interact well with a range of patients and colleagues.
3. ISFJ (Introverted, Sensing, Feeling, Judging): The “Defender” personality type often has a strong desire to care for and protect others. They tend to be conscientious, practical, and dedicated, which can align well with the demands of healthcare.
4. ESFJ (Extraverted, Sensing, Feeling, Judging): Known as “Consuls,” ESFJs are typically sociable, caring, and organised. They often have a strong sense of duty and are driven to help others, which may suit the healthcare environment.
5. INFP (Introverted, Intuitive, Feeling, Perceiving): Known as “Mediators,” INFPs are often idealistic and compassionate. They have a strong desire to make the world better and often form deep connections with others, which can align with the compassionate aspect of healthcare.
6. ENFP (Extraverted, Intuitive, Feeling, Perceiving): As “Campaigners,” ENFPs are usually enthusiastic, creative, and sociable. They typically enjoy helping others grow and achieve their potential, which can be beneficial in healthcare settings.

Notably ‘intuition’, ‘introversion’ and ‘feeling’ feature most across the types. I am well aware that it is not all about personality types. The best healthcare teams are often diverse, bringing together people with a variety of skills, perspectives, and approaches to problem-solving.

Problems ahead

But there are problems ahead for some personality types who may be more prone to burnout. I’ll explain below:

1. INFJ (Introverted, Intuitive, Feeling, Judging): INFJs are deeply committed to their work and often place high expectations on themselves. This, combined with their sensitivity to conflict and their tendency to internalise emotions, could make them more prone to burnout if their work environment is highly stressful or does not align with their values.
2. ENFJ (Extraverted, Intuitive, Feeling, Judging): ENFJs are typically highly empathetic and driven to help others, which can lead to emotional exhaustion in a difficult environment. They may also struggle if their efforts to improve the situation are met with resistance or apathy.
3. ISFJ (Introverted, Sensing, Feeling, Judging): ISFJs are typically diligent and conscientious, but they may have a tendency to overwork and neglect their own needs, especially in a setting where they feel others are depending on them. They may also struggle in environments with a lot of conflict or change.
4. ESFJ (Extraverted, Sensing, Feeling, Judging): ESFJs tend to be sociable and caring, but they may take on too much responsibility for others’ well-being, leading to emotional exhaustion. They may also be particularly sensitive to criticism or lack of appreciation in their work environment.
5. INFP (Introverted, Intuitive, Feeling, Perceiving): INFPs are often idealistic and may become disillusioned or stressed in a dysfunctional work environment. They may also struggle with the practicalities and routines of work in a healthcare setting, which could contribute to burnout.
6. ENFP (Extraverted, Intuitive, Feeling, Perceiving): ENFPs are typically passionate and driven by their values, which could lead to burnout if their work environment is not supportive or does not align with their ideals. They may also struggle with routine and structure, which are often part of healthcare settings.

Readers may have noticed that the very types who are best suited in my estimations are probably more prone to burnout in dysfunctional health service organisations. Not surprisingly organisations never admit that they are dysfunctional. From my long experience over 20 years, dysfunctional health service organisations rarely pick themselves up and transform on their own steam. Instead they either default for special assistance from their regulators (the range of those is beyond my scope here), or they are punished after a serious investigation of some matter thrown into the public domain. Yes other things happen but that’s not in my scope of exploration here.

Back to the point, it seems that the very traits that may predispose individuals to excel in caring roles – such as empathy, high emotional sensitivity, a strong sense of responsibility, and an inherent drive to help others – can also potentially make them more susceptible to emotional exhaustion and burnout, especially in extraordinarily challenging or dysfunctional environments.

It is a paradox that is not limited to healthcare but can be seen in other high-stress, high-empathy professions as well, like social work, counselling, and education. Individuals who deeply care for others can often end up putting the needs of those they are helping above their own, leading to a depletion of their own emotional resources over time. This is especially true if their work environment does not provide sufficient support, recognition, or opportunities for self-care and recovery.

Dysfunctional healthcare services often have various systemic issues such as a poor organisational culture, high-stress workloads, inadequate resources, and lack of support for staff. High level managerial staff tend to kiss the hands of the purse string holders higher up the tree. This was not only seen in the Mid-Staffordshire debacle and reported on in the inquiry of 2013. These issues can indeed exacerbate the risk of burnout, especially for individuals who are naturally more sensitive, empathetic, and altruistically motivated – the very qualities that make them exceptional caregivers.

The unfortunate reality is that these systemic issues can create a vicious cycle. High levels of burnout can further contribute to dysfunction within healthcare services, as burned-out healthcare providers are more likely to make errors, less likely to engage in effective communication and teamwork, and more likely to leave the profession, leading to staff shortages and additional stress for remaining staff members.

Take away summary

1. Caring in Healthcare: Beyond simply performing tasks and services, true caring in healthcare involves empathy, compassion, humanity, dedication, altruism, professionalism, and resilience. These qualities allow healthcare professionals to deliver high-quality care that respects and prioritises the patient as a unique individual.
2. Personality Traits: Personality traits that often align with these caring qualities include high emotional intelligence, conscientiousness, openness, resilience, altruism, assertiveness, patience, and flexibility. However, everyone brings their own unique strengths to their work, and these traits can be developed over time.
3. MBTI Personality Types: Certain Myers-Briggs Type Indicator (MBTI) personality types, like INFJ, ENFJ, ISFJ, ESFJ, INFP, and ENFP, may be particularly well-suited to the caring nature of healthcare due to their natural inclination towards empathy, compassion, and a desire to help others.
4. Burnout Risk: The very traits that make for exceptional caregivers can also make individuals more susceptible to burnout, particularly in challenging or dysfunctional work environments. This can be exacerbated by poor organisational culture, high-stress workloads, and lack of adequate resources and support in these settings.
5. Solutions: Systemic changes, including policies promoting work-life balance, access to mental health support, sufficient staffing and resources, and a positive work culture, are crucial in mitigating burnout risks. Individual strategies for managing stress and prioritising self-care also play an important role, but should be seen as complementary to systemic solutions, not a replacement.

In conclusion, while the personality traits that contribute to high-quality, compassionate care can also make individuals more susceptible to burnout in dysfunctional environments, the solution lies in a combination of systemic changes to healthcare services and individual stress-management strategies.