The subject of this article is the dark or “shadow” side of working with dying and bereaved people in hospice and palliative care services, and the interplay of complex personal, professional, and organizational issues that can influence both the quality of patient care and the well-being of staff. Examples of how support needs have been identified and managed are drawn from the author's extensive experience as a social worker, educator, and consultant. It is argued that current understandings of staff stress lack insight into the dark side of hospice care and fail to appreciate the depth of emotional anguish that repeated exposure to human suffering can bring.
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