By Helen Fitzgerald, CT
People drawn to hospice work have an abundance of caring concern for those they serve. Boundaries may be hard to set when responding to a request from a patient or a patient’s family: “Of course, I can make that middle of night trip out to their home to comfort and assist,” or “One more stop on my way home can’t make that much difference.” Hospice workers are faced with the pressure to sacrifice their own well being for their patient’s needs. The love and caring that make hospice workers so special can also serve as a major source of stress in their lives.
Because compassionate care giving is an essential component in hospice care, the hospice worker has a unique challenge of coping with loss on a regular basis. It is fully expected that every hospice patient will die and leave behind a grieving family. Providing hospice care requires staff and volunteers to become an intimate part of their patients’ lives. Sharing one’s dying, making the remaining time meaningful, providing care for the entire family, and giving so much of oneself is an immense undertaking.
In the midst of intimate and intense caregiving, hospice workers often forget to take care of themselves. In order to continue doing this wonderful work, attending to oneself is crucial. It is not enough to take vacations. It is essential to have a lifestyle that incorporates manageable stress-reducing techniques. This article suggests a variety of ways this can be accomplished.
Life is full of beginnings and endings, hellos and goodbyes. It is easy to say hello, portending a pleasant beginning that is filled with hope for a special relationship. Conversely, saying goodbye is hard. It implies loss inevitably followed by grief. In hospice work, it is essential to say goodbye properly. Indeed, part of hospice work is to teach others how to say goodbye forever. The importance of saying goodbbye lies in the closure of one relationship to welcome the next. Hospice workers regularly say hello to new patients, knowing a goodbye will soon follow. These workers must have several avenues through which to say goodbye.
Some people rely on funeral or memorial services to find emotional and spiritual solace. At these services, there are many ways one can actively say goodbye. It may help to recollect a meaningful story or read a poem that celebrates the life of the person who has died. Giving the grieving family a yellow flower often symbolizes peace for the deceased and hope for those left behind. Another way of saying goodbye is through an exchange of small gifts such as a photo, plant, book, or some other small item. Remember, gifts can also be intangible and they do not need to be expensive.
When someone is dying, it is important that all parties say good-bye, including the patient. The ways of saying goodbye after somebody has died can be experienced with people who are dying as well. For example, sharing special moments with the dying patient can contribute to a peaceful time near the end. I had a delightful conversation with a dying woman who told me that before she met me, she was wondering what I would look like. She decided that I would be old and stuffy, and would sit on the edge of the bed speaking in one-word sentences. She did not expect to like me. We had a good laugh over her image of me and we became fast friends during the little time we had together.
One of the best gifts for dying patients is reassuring them that they will be fondly remembered. When my father was dying, I realized that I had not said “goodbye” to him yet, so I went to visit him. During that visit we talked about our life together: our horseback riding days and square dancing on our horses. I recounted the important things he taught me, which I passed on to my children who are now teaching their children. When I left him, I had a lasting feeling of peace.
In my book, The Grieving Child, I wrote about a 10-year old dying girl whom I was counseling. One day she said, “I need to talk to you in private.” She confided that she didn’t have a will. She believed that everyone should have a will, no matter his or her age. She had wonderful toys she wanted to leave for certain family members and friends. We took care of this request by making a list to assign all her important belongings to people she carefully selected.
The little girl’s second concern was more challenging. She regretted that she would never be a bride and wear a beautiful, white bridal dress. I told her that I thought we probably could take care of this wish too, but first we would need to share her concern with her mother. The girl agreed and her mother immediately took her shopping for a white dress. Many pictures were taken of her in this beautiful dress while she was leaning on a fence, because she could no longer stand. As her mother wished, she was buried in that dress. In this instance I was able to say “goodbye” by helping her carry out a dream for the future. The girl’s gift to me was her trusting me enough to share such a secret; my gift to her was figuring out how we could carry it out.
In hospice work it is especially important to acknowledge and appreciate one’s own grief. Since hospice workers often become like a part of the patient’s family, their grief can be personal. Just as the family needs to mourn, so do hospice workers or their capacity to mourn can be compromised over time.
Keeping a journal can help in allowing grief. Journaling allows free expression of feelings and confidential documentation about patients and their families. It is also an opportunity for creating a diary to share with others later on. Other forms of free expression of grief can be through sculpture, painting, drawing, and music.
Tending to Basic Health Needs
Rest, exercise, and proper nourishment are three top priorities for a healthy life. For hospice workers sufficient rest can be challenging, because the work requires a lot of emotionally charged time with patients. Short naps during the day may help the lack of wholesome sleep and self-hypnosis techniques are effective when personal time is scarce.
Exercise programs have a way of disappearing when schedules get busy, yet vigorous activity is one of the best ways to reduce tension and manage stress. It is important to find one or more activities that are enjoyable and easy. Walking is one of the best exercises; it can provide time to think, reflect, discharge anger, and make plans.
Nourishment is essential to keep up strength and motivation. Too often meals are skipped or shortchanged. There are some creative ways to incorporate three nourishing meals a day in to busy schedules. Eating yogurt works beautifully in a busy day, even during phone calls, because no chewing sounds can be heard! Some organizations hold brown bag staff meetings at lunchtime. This allows the staff to get some work done while sharing a meal. For dinner, there are many prepared foods available in the grocery stores that enable preparation that is quick and easy. Alternatively, each family member could take charge of planning and making dinner on one day each week. This relieves the pressure on one individual to make all meals. This approach can also teach every family member to work in the kitchen and to feel good about the accomplishments of preparing a meal.
Sustaining Family Support
Even though most hospice workers have family support, there are still times when one’s family feels cheated and resentment builds up. In this situation, it is helpful to find ways that the family can become a part of hospice work. In my own family, my children enjoyed it when I attended their school classes to talk about my work. They also learned to screen my calls and occasionally accompanied me when I was presenting a lecture. Listening to me in professional settings opened many doors for private discussions over donuts and chocolate milk at the local donut shop. Proactively inviting your family to talk with you about their needs and complaints can also help air concerns before they become bigger problems.
It is important for hospice workers to have friends apart from work. All too often, when colleagues get together they primarily talk about work, because that is their main connection. Friendships that exist separate from work provide opportunities to share experiences unrelated to work stressors. To nurture work friendships, it may be relaxing to take a class together on something totally unrelated to work. There is also the possibility of joining a health spa together. These alternative settings provide opportunities to share common interests aside from work.
Relaxation is very personal, so there are countless suggestions for ways to relax. One activity that people commonly find relaxing is reading a light book. When reading for relaxation, it is important to avoid books on hospice work, death, and dying. Meditation, walks, hobbies, sports, and quality time with family and friends all provide wonderful opportunities for relaxation.
Attending In-House Meetings
Attending regular in-house meetings or debriefing sessions are a must. These meetings offer an opportunity to talk about the day’s problems with people who share common experiences. In very tough times, it helps to have at least one trustworthy co-worker with whom to share personal feeling.
Minding Personal Stress
When work-related problems hit too close to home, the stress can be overwhelming. For example, a hospice worker may be asked to serve a family with a mother dying of cancer when his/her own mother is gravely ill. If taking on this patient may add substantially to the normal stress level, alternatives should be considered. Perhaps someone else can take on the case. Failing to manage these stressful situations before they become overwhelming can cause burnout. When burnout happens, both the hospice and the hospice worker lose. Hospice workers can help each other by volunteering to take cases that may be unduly stressful for co-workers with family crises.
Doing Something Nice For Yourself
We are often too generous in taking care of others and forget to add our own name to the list of people who need attention. A bath with candles and soft music or a massage my be a lovely treat. Some might relish a leisurely trip to the bookstore to sip coffee and skim through a book. It is important to treat yourself.
Developing basic, good mental and physical health care should become a daily routine. Practicing good stress management is easy and does not require a lot of effort or expense. Permission to take care of oneself is the first rewarding step that will prove invaluable throughout life. There is no better time to start than now!
For hospice workers, there is an additional challenge of working with dying and grieving people on a daily basis while maintaining this good mental and physical health. Remaining calm and collected is essential in order to respond to such a demanding job. Maintaining good health is a gift to the patients and families, because they need to learn how to manage their own stress in a time of crisis. Hospice workers can serve as a good example of effective stress management!