© 2014 MA Healthcare Ltd International Journal of Palliative Nursing 2014, Vol 20, No 5 233 Abstract Background: The need for empathy and the dificulties of coping with mortality when caring for the dying and the bereaved can cause psychological, emotional, and spiritual strain. Objective: The aim of this study was to examine the effectiveness of art-therapy-based supervision in reducing burnout and death anxiety among end-of-life care workers in Hong Kong. Methods: Through a quasi-experimental design, 69 participants enrolled in a 6-week, 18-hour art-therapy-based supervision group, and another 63 enrolled in a 3-day, 18-hour standard skills-based supervision group (n=132). Pre- and post-intervention assessments were carried out with three outcome measures: the Maslach Burnout Inventory—General Survey, the Five Facet Mindfulness Questionnaire, and the Death Attitude Proile—Revised. The data was analysed using paired sample t-tests. Results: Signiicant reductions in exhaustion and death anxiety and significant increases in emotional awareness were observed for participants in the art-therapy-based supervision group. Conclusion: This study provides preliminary evidence that art-therapy-based supervision for end-of-life care workers can reduce burnout by enhancing emotional awareness and regulation, fostering meaning-making, and promoting relection on death. Key words: Hospice l Palliative care l Supervision l Burnout l Art therapy T he need for empathy and the dificulties of coping with mortality when caring for the dying and the bereaved can cause psychological, emotional, and spiritual strain among nurses, social workers, and other profes- sional caregivers (Demerouti et al, 2000; Peterson et al, 2008). Such stress can lead to burnout, which is a feeling of persistent diminished energy and pervasive doubt in one’s professional role (Maslach et al, 1996). The effects of burnout can also affect the caregiver’s patients, colleagues, family, and friends (Bakker et al, 2005; Schaufeli et al, 2008). This paper reports an examination of the effectiveness of art-therapy-based supervision in reducing burnout and death anxiety among end-of-life (EoL) care workers in Hong Kong. Background Burnout and supervision One way to assist EoL care workers is to strengthen their self-competence, which includes enhancing autonomy and ensuring availability of support (Chan and Tin, 2012). This trait also includes hardiness, coherence, and meaning- making (Ablett and Jones, 2007). Of particular importance are opportunities to periodically reflect on one’s own attitudes, feelings, and anxieties related to death (Bluck et al, 2008). Single-session stress-management training (Kravits et al, 2010), ongoing team-building programmes (Swetz et al, 2009), and supervision (Pereira et al, 2011) have been shown to be effective in reducing burnout. Supervision entails a mentor-type relationship that ensures ethical practice, imparts clinical skills, and provides opportunities for reflection on thoughts and emotions related to patient relationships (Wheeler and Richards, 2007). Speciic attention to emotion-focused coping skills (emotional awareness and regulation) proved more effective in reducing burnout than problem-focused strategies (skill development) in a study by Sardiwalla et al (2007). Burnout, supervision, and art therapy Emotion-focused supervision requires profession- als to consider and communicate feelings and experiences that may be difficult to verbalise. Although making art provides a means to express oneself through images and metaphors (McNiff, 1992), art therapy offers a professional relation- ship in which to create art for the purpose of increasing understanding of one’s emotions and stress (Slayton et al, 2010). Supervised art ther- apy allows the making of art to take a central role in professional self-understanding (Franklin, 1999; Lahad, 2000). Several art therapists have documented how their work with EoL care workers prevented and reduced burnout by managing stress, fostering collegial connections, emphasising self-care, and enabling the Research Can art therapy reduce death anxiety and burnout in end-of-life care workers? A quasi-experimental study Jordan S Potash, Andy HY Ho, Faye Chan, Xiao Lu Wang, Carol Cheng For a full list of author afiliations, see Box 1. Correspondence to: Jordan S Potash jspotash@hku.hk tional Journal of Palliative Nursing.Downloaded from magonlinelibrary.com by 147.008.204.164 on February 4, 2015. For personal use only. No other uses without permission. . All rights re