Dear Barbara, What are ways to provide support to hospice staff (RN's, CNA's, SW's, CP's) who see death on a nearly daily basis? What actions would be meaningful in an industry where death is an integral part of our lives?
Working with end of life in the medical field often leaves us feeling like outliers. The medical model is designed to fix people. Working with dying generally isn’t addressed in training. (It’s getting better in our medical schools but we’ve still got a long way to go.)
Because of this lack of education, it is up to the individual hospices to provide training. It isn’t enough to send a new employee to shadow for a week and then give them a caseload of patients. Forget a whole caseload, they're not going to be ready for even one patient.
The agency must provide education to each employee on the signs of approaching death, what to look for, and what to do. Teach conversation skills, listening skills, medication and pain management skills. These are not skills generally focused on in medical or nursing schools. Social work and chaplaincy programs tend to focus more on communication and listening skills. So be sure to include the entire team in all facets of the education the agency is giving.
Next, teach them how to take care of themselves. Develop a closure ritual so they can move forward following each death. Daily or weekly journaling is helpful.
Create a buddy system. Each employee is teamed with another to call, talk and unload following any stressful situation. A buddy is a listener, someone to share concerns with and an “it goes no further” support person.
It’s not enough to tell staff they can talk with the agency social workers or chaplains or their supervisor if they are having a problem. Staff generally will not talk with administration for fear of looking weak or having people they work with think they are having challenges.
Even though everyone dies at some point, we as a society tend to view death as bad, fearsome, something to be avoided. For those people who fill the important and often avoided job of the caregiver at end of life, their needs for well-being are unique. Agencies need to be responsive to those special needs.
Something More… about Supporting Hospice Caregivers and their daily encounters with death
Hospice Caregiver fatigue is of great concern especially when staffing is at an all-time low. I have a booklet, YOU NEED CARE TOO and a DVD Care for the Caregiver that I encourage agencies to use at least once a year. Care For The Caregiver (28 minutes) - focuses on creating a fulfilling work environment, staying balanced and healthy amid constant sadness, and maintaining a happy, engaged personal life. Intended for professionals whose responsibilities include supporting, educating, and guiding a person and their family through the dying process.
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Thank you so much Barbara for the reminder of how important it is for those of us in the EOL field to have those we can share our experiences and bounce ideas off of.
I’m an EOL Doula who has my own practice in a small mountain town in Colorado. Us Doulas are far and few between so I have worked hard to skillfuly build relationships with other EOL workers in my community such as hospice nurses, Palliative care Doctors and Chaplains. I trust them and their wisdom and often reach out to them for best practices or to process after a client has died.
I feel very fortunate and could not do my work without their support and guidance. They are my “ buddy system”.
With Gratitude
Akaljeet Khalsa
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BK Books replied:
Thank you for sharing. Sounds like you are taking good care of yourself so you can continue helping others. Blessings to you in the work you are doing. Barbara
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