With Love and Gratitude

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For Caregivers and Hospice Angels, Self-Care Is Not Optional

Acknowledging one's own vulnerability helps caregivers provide valuable support.


Helsinki garden, Wiki Commons

Caring for people at the end of life can be filled with blessings, meaningful experiences, and peace of mind, but also exhaustion that can lead to depletion. We know the toll that care giving takes on families during short or long term illnesses. However, hospice workers often experience the same stresses on a daily basis.

At the 66th Annual Gerontological Society’s Scientific Meeting in New Orleans last month, Dr. Sally Hill Jones, Ph.D., Texas State University School of Social Work, explained the importance for hospice workers to maintain motivation because, as a group, they are  at risk for burnout and secondary trauma

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In our conversation, she reiterated thoughts that she had also addressed in A Delicate Balance: Self-Care For the Hospice Professional

Dr. Jones said: “Most professionals enter hospice work envisioning the ideal death, which often includes the healing of relationships, resolution of regrets, peaceful and pain-free death for clients, and manageable grief for families. When reality falls short of the ideal and goals are unattainable or different from those of clients, what happens to motivation?” 

She pointed out that for hospice professionals to provide valuable healing or peace to clients it is key that they acknowledge their own vulnerability and the need to process their feelings, particularly grief, along with the associated pain and enrichment it includes.

“Self-care gives professionals reservoirs of resources with which to respond empathetically and clearly to clients’ needs,” she said.

When self-care takes a back seat

It seems that when self-care takes a back seat, there is a  danger that hospice workers and caregivers will distance themselves from clients or over-invest as a way to protect themselves from further exhaustion. It is helpful to be aware of how stress manifests itself in the body, as well as emotionally, cognitively, relationally, and spiritually. 

Dr. Jones proposes emotional and cognitive self-care 

Key to emotional self-care is making time to routinely express, soothe, and release emotions, including grief. She says, “Identifying individual emotional stress indicators, such as increased crying, irritability, anxiety, numbness, self-doubt, or addictive behaviors, is important.”

Expressing and Soothing: Cry when you must even if a movie or music is needed to “jump-start” a good cry.  Other methods include writing, creating, listening to music, talking with confidants, enjoying hot baths, being held, or cuddling a pet, aromatherapy, massage, meditation, mindfulness, prayer, gardening, and even cleaning.

Soaking up joy:  Treasure the joyful times and successes you experience, as well as pleasurable activities and laugh often – these will fill up your resource reserves.

Be mindful of warning signs: Relational warning signs include: Overextending one’s self, inability to set limits, and instead of handling conflicts focused on solutions – you find yourself blaming or personalizing.

Spiritual Self-Care 

Dr. Jones noted:End-of-life work is often spiritually rejuvenating, since it involves clients’ big-picture concerns.  However these can get lost in the details of paperwork and finding resources.  As such, staying attuned spiritually is important.  This includes reading sacred texts, praying, attending services, connecting to nature, listening to music, meditating, and engaging in creative endeavors.”

 Dr. Jones added that self-care is not optional. “Those in hospice work who tend to the source of their gifts will find a long career of privilege as a compassionate sojourner in many clients’ unique lives. However, this gift must be protected. Hospice workers are often there as clients approach their final passage, she said.”

Poster session at GSA

Dr. Jones presented in a poster session at the GSA Meeting: “Maintaining Motivation of Hospice Workers: Burnout, Secondary Trauma and Job Satisfaction.”  It was based on a sample of 16 hospices in 14 states. In pre-test results most hospice workers had average scores for burnout, about a third were in the high category of emotional exhaustion, and about a fifth were considering leaving their jobs. 

She is currently working to determine the effectiveness of self-care planning, and added, “Hospice workers need support from hospice organizations and governmental policy regulating hospices.  Hospice workers need manageable caseloads that allow them to spend the time they need with patients and families and still have personal lives.”  

Rita Watson, MPH, is a 2012 MetLife Foundation Journalism Fellow through the Gerontological Society of America and New American Media and a 2013 travel grant recipient.

 NOTE: Loss: 4 Ways to Move Forward and Counter If-Only Guilt (Mother's photo) / With sincere thanks to Lori Schneider, RN-BSN at EPOCH Senior Healthcare, Chestnut Hill, MA. It was she who suggested Hospice. With the compassion of Murali Ramadurai, MD, CMD, Senior Healthcare Associates, and the Asera Care team of Wellesley, we found peace in our mother's travels to join her husband of 69 years. This was our first Christmas without Nanny and Poppy.

Rita Watson is an Associate Fellow at Yale's Ezra Stiles College and a columnist for The Providence Journal.

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