3.2.1. Support

Throughout the group discussions, a significant emphasis on the role of peer and managerial support in professional self-care surfaced. As the findings were further examined, it became apparent how this support network at work held crucial importance in managing the emotional and physical demands of this challenging work environment. A study conducted by Arantzamendi et al. [37] emphasizes the essential role of coping skills in PC and proposes a five-step process, highlighting the importance of teamwork, particularly within “micro-teams of strength,” and self-care as key factors.

Consoli et al. [38] and Moe and Thimm [39] indicate that therapy has emerged as an indispensable resource. It is known that personal psychotherapy can be a central element of ongoing self-care. For many, this platform for reflection and dialogue offers a necessary respite from the intricacies of the work environment. The chance to converse with an external figure, someone not directly associated with the unit, became a fundamental tool for addressing discomfort and discovering a realm for emotional recuperation. However, Ecuador does not have the appropriate sociostructural conditions to guarantee proper mental health services, and the lack of financial resources is a barrier to accessing them [40]. The provision of free therapy within work units could lessen the burden for those unable to afford it independently. This disparity uncovers the significance of ensuring that self-care opportunities are accessible to all, irrespective of financial capacity.

Another theme was supervision. Previous research has argued that clinical supervision is not always available and may be effective for many, but not for others [23]. In our sample, supervision was positioned as a crucial support element in complex situations. The opportunity to share and receive guidance from more experienced colleagues or supervisors provided a valuable perspective and the chance to integrate a deeper understanding of the emotional implications of work. The testimonies underlined the need to sustain this practice in the workplace over time. One participant expressed the importance of supervision given that, “it taught you that what happens in your life affects what you do. And you can only work here if you give your vision of what all this means in your life, who you are” (FG10-P5).

Peer support is another fundamental pillar of self-care at work. Formal and informal debriefing appears as an effective strategy for self-care [23], and coaching seems to have significant advantages [41]. As seen in previous research [8, 12, 18], the existence of a strong work team, where members can trust each other and share their feelings and experiences, creates an environment that fosters belonging and mutual support. These bonds strengthen decision-making, problem-solving, and coping with daily challenges. For participants, collaboration and emotional support were essential tools in the fight against isolation and burnout. In fact, a participant highlighted that “the most enriching thing (…) it’s knowing that I have my partners for the decision-making or when something goes wrong in my life” (FG2-P8).

3.2.2. Professional Development

A limited number of respondents (3 out of 71) held a specific perspective on training within the context of self-care. These professionals emphasized how acquiring specialized knowledge and skills within their field of work significantly contributes to their well-being and proficiency in their roles. For them, training surpasses the acquisition of technical skills; it also signifies a personal commitment to enhancing their self-confidence and the caliber of their work. This view is supported by previous research that shows that professional courses for improving clinical abilities might serve as a good coping strategy because they could increase self-efficacy [42].

Another aspect highlighted by one participant was the concept of training future professionals and mentioned “You are responsible for giving them a solid foundation so that PC continues to improve” (FG2-P1). This perspective extended beyond the individual level and was framed by the notion of leaving a legacy and contributing to the advancement and continuity of the profession. Investing in training and mentoring students evolved into a form of long-term care. This notion relates to how finding deep professional meaning can be a coping mechanism for PC professionals [17].

3.2.3. Making Time for Self-Analysis

“Recognizing and responding to the nuanced situations” [2] is essential when working in PC. Our participants’ accounts unveiled a network of interconnected strategies, highlighting self-awareness as a fundamental self-care instrument. Researchers argue that self-awareness is the best tool one can cultivate [19]. As some participants pointed out, having time for checkups and paying full attention to yourself to know how you are and how different situations affect you is fundamental. “It would be like knowing your emotions and seeing how your body is physically. Because, in the end, the body speaks for us” (FG2-P8).

These components (personal self-awareness, self-reflection, self-analysis across various moments, and awareness of one’s own discomfort) are interwoven in a reflective process demanding time and commitment to comprehend, recognize, and adeptly tackle distress [11]. As in Cañas-Lerma et al. [6] research, in this line of work, the awareness of one’s own reality and that of others who might be living a complex medical situation might help put their problems into perspective. Research with PC nurses also points out how working in PC positively affects their lives due to the daily hard situations they care for [18].

Awareness has been identified as a buffer for the negative impacts of working in PC [11]. It has also been previously noted as a predictor for competence in coping with death, high compassion satisfaction, and lower compassion fatigue and burnout [11]. Higher awareness might be related to having more experience in PC, which has been shown to increase compassion satisfaction [16, 20]. On the other hand, research with volunteers in PC shows that the suppression of their own emotions is a common practice [6]. Recognizing that professionals and volunteers are human beings with lives and vulnerabilities is the foundational step for any successful intervention. This receptiveness to comprehending their emotions and acknowledging the cues their bodies convey establishes a groundwork for self-regulation and emotional care.

3.2.4. Workload

Previous research [12] has noted that nurses’ perceptions of their bad state of health might be due to organizational time constraints, such as work schedules and leaves. Institutional policies and poor working conditions, including heavy workloads, are risk factors for PC professionals [17]. In our research, various factors that shape the work environment, including the patient load, the strict protocols to be followed, and the distribution of holidays and vacation periods, constitute elements outside the direct influence of employees and volunteers and affect how they practice self-care.

Nevertheless, the results uncovered one aspect that falls within the employee’s control: whether to bring work home. Throughout the participants’ accounts, there was a strong sense of the importance of establishing a solid boundary between the work and personal spheres. For many, this differentiation has become a crucial foundation of self-care. Avoiding bringing work issues home was a fundamental strategy for maintaining balance and emotional health. In sum, the statement “I don’t particularly take work home” (FG6-P7) was central for this workload management.

3.3.1. Biological Aspects

Within the realms of social health sciences and PC, the need for care centered on physical self-care emerges. This practice extends beyond medical considerations, positioning itself as a pivotal facet of holistic well-being. Physical and mental rest emerged as an additional key component of self-care. Participants’ voices emphasized the significance of granting themselves moments of disconnection, rest, and recovery that nourish the essence of the individual and promote optimal readiness to confront the challenges posed by occupational and personal obligations. These practices also encompassed components like physical activity, a well-rounded diet, and adequate rest. Although the physical dimensions of self-care are sometimes not statistically related to compassion fatigue or burnout [43] or have a small effect on well-being variables [44], participants in our study underscored the significant role of these elements in effectively addressing the challenges inherent to their work and environment. One expressed how it helps him, “On a physical level, I do physical activity to get rid of the overload or the bad mood. I do a lot of running, and that lowers my stress levels. The stress level goes down, and so do the headaches” (FG4-P3).

In the sphere of physical care, a striking diversity in participants’ preferences became apparent, influenced by the broad array of activities ranging from high-intensity sports to more serene approaches. Certain participants opted for vigorous pursuits such as running or cycling, while others discovered equilibrium through contemplative practices like yoga or walking. The array of choices within this spectrum is contingent upon individual factors, encompassing considerations ranging from time limitations to personal inclinations. Notably, it is intriguing to emphasize the emergence of dance as a liberating avenue for numerous participants, affording them a fleeting yet impactful release through the fusion of movement and music, elements deeply rooted in Latin American culture. As a participant mentioned, “I love to dance. I create my own choreographies, I dance at home, and it relaxes me” (FG6-P7). Dancing has also been suggested as a creative way to relieve stress [45].

The significance of nutrition is acknowledged regarding dietary practices, although it is accompanied by nuanced challenges in execution. Certain participants recognized the prevalence of poor dietary habits as an inherent cultural and systemic element entrenched within their surroundings. Despite the challenges, there was a collective recognition of nutrition’s vital role as a foundational component of self-care [44]. Awareness of its impact on health and well-being encouraged the search for solutions that balance everyday demands with more conscious food and dietary decisions.

3.3.2. Psychological Aspects

Internal self-care acts as a protector against the inherent stressful characteristics of PC work [12]. The testimonies highlighted how attention to personal image, from makeup to hair care, is presented as a way of renewal and relaxation. The time invested in these practices reflects an investment in oneself, a space in which an internal reboot is allowed. A participant indicated, “Putting on make-up, always being well presented. Sundays are sacred, and in my house, they already know that I lock myself in my room, and I put on the mask, I put on the oil, I do my eyelashes, and nobody interrupts me; it’s my moment. It renews me” (FG8-P1).

Beyond the physical dimensions that may affect self-concept and self-esteem, participants also sought mental relaxation in their daily lives. Relaxing activities such as painting, listening to music, or playing a musical instrument were indispensable to alleviate stress and divert the mind from constant pressures. These instances of respite furnished a space for emotional catharsis and the pursuit of inner tranquillity. To “disconnect” a participant shared that “when driving, I distance myself from what I was distracted by, and I felt that it relieved me of the discomfort I was going through” (FG1-P4).

The concept of personal reward also surfaced as a motivator for confident choices and self-kindness [46]. Participants acknowledged the significance of indulging in personal pleasures, even when these do not align with conventional notions of health. Sweets, alcohol, and food emerged to commemorate small victories and counterbalance less enjoyable experiences. This aspect of personal reward evolved into a self-care strategy that harmonizes momentary gratification with a cognizance of self-regulation.

The cultivation of an inner life is also a buffer against vicarious trauma and could enhance job satisfaction and therapeutic effectiveness among PC professionals [11]. Participants in our study acknowledged the necessity of allocating time for the mind to unwind and reclaim a state of tranquillity. This approach held fundamental significance in reinstating inner equilibrium and fostering readiness to confront everyday obstacles from a fresh perspective. Here, a connection between music and emotional expression constituted a profoundly meaningful bond. Music evolved into a conduit for release, enabling individuals to establish a connection with their emotions and channel their encounters. This proactive method of self-exploration and self-regulation emerged as a valuable instrument.

3.3.3. Social Aspects

How healthcare activity is organized involves great personal and social sacrifice [12]. Previous research has shown that structural variables interfere with self-care development, especially in the physical and social dimensions [12]. In the absence of supportive elements within the work environment, participants sought connections beyond this setting. Friends and family emerged as crucial figures with whom they share their instances of professional unease or discomfort. Having a support network external to work served as a mechanism for emotional relief and liberation, demonstrating how the need to share and express is intrinsic to self-care.

Building and maintaining social relationships emerged as crucial cornerstones of self-care strategies [47]. Within this research, the significance of cultivating relationships or connections with friends and family held relevance, particularly when emotional challenges must be faced. A participant exemplified how she felt relieved by having someone to talk to and mentioned: “Unload, yes, yes, unload; when you leave the hospital, you need to talk to your family or friends. Talking [helps]” (FG1-P3).

The aptitude to share moments with cherished individuals translated into a profound feeling of belonging, furnishing an emotional refuge amidst the stresses of the work environment. The social network is consolidated as a realm of understanding and support. Participant’s accounts mirrored how, within the inherent stress of PC work, the chance for de-escalation and relaxation through engagement with friends and family emerges as a vital avenue for rejuvenation, furnishing emotional and mental recharging. Engaging with family and friends served as a conduit for releasing and exchanging thoughts and emotions. Conversations and personal interactions gained a therapeutic essence, enabling professionals to express their worries and experiences. This, in turn, aided in releasing the emotional weight that accompanies their labor. A participant said, “in the most challenging moments, my friends help me to know how to escape (…) [PC] is beautiful work but it is exhausting” (FG2-P2).

3.3.4. Spirituality

Exploring spiritual aspects revealed a significant link between self-care and the spiritual dimension, whether within the Catholic religious framework rooted in Ecuadorian culture or through broader approaches such as meditation and nonreligious spirituality. As participants described, these perspectives provide a crucial space for the search for meaning, comfort, and peace during the challenges of PC.

Research with informal caregivers in Latin America has not found associations between religious involvement and quality of life [48]. Other studies have found an association between negative spiritual/religious coping, such as dissatisfaction with a religious representative and negative revaluation of God or meaning, and depressive symptoms in informal caregivers [49]. In our sample, however, for those participants who embraced the Catholic religious practice, spirituality emerged as a refuge and comfort amid moments of pain and suffering. A participant felt comfort through praying and said, “When I pray, I ask, I give thanks, and I talk, this catharsis diminishes [my anxiety], and I feel much better” (FG5-P8). Religion seemed to offer a belief system that provides a lens through which to understand and cope with the discomfort inherent in painful situations. Establishing a connection with a divine entity evolved into a method of releasing and praising pain, providing a sense of love and care in adversity. Seeking divine intercession and release from earthly expectations is perceived as a supreme act of love and surrender in the face of the unknown.

Spirituality is not limited to the religious sphere. Spirituality takes on a profound meaning even for those not identifying as religious. It emerged as a source of inner peace and connection to aspects beyond the material. A participant showed other aspects of spiritual self-care and mentioned, “Meditation, reading books on spiritual matters, self-help, and a positive attitude have helped me a lot. A change in my view of what death is” (FG10-P4). Participants found in spirituality a path to reflection and serenity, independent of religious affiliation, which is defined as a personal search for meaning and inner well-being. Meditation is also established as a spiritual vehicle in itself, a self-care technique that surpasses religious barriers. Through meditation, individuals found a space for inner dialogue and connection with their thoughts and feelings. Meditation acted as an avenue for emotional release and catharsis, providing a respite from daily concerns. Meditation and mindfulness exercises have also been identified as useful in other PC contexts [23].

Through self-analysis, self-reflection, and self-awareness, professionals deepen their experience, anticipate challenges, and foster emotional balance and resilience. These strategies empower and authenticate, laying a deep foundation for self-care in this demanding work environment. Other researchers point out that self-care itself should not be understood as a practice to alleviate professional burnout but as the cultivation of self-awareness or a high level of consciousness, which helps transform the experience of patients’ suffering, to be realistic and consistent with personal values and vocation, and to develop the spiritual dimension as professionals [19].