Doula Certification

[Debra Heinzelman]

Anyone aware of how to achieve "Doula" certification in the hospice field?

 

Also, those of you who are 11th Hour Volunteers, End-of-Life Volunteers or Vigil Volunteers, or work for a  hospice organization, how do you prepare to go to a patient's home; i.e., do you bring a selection of music, books, etc., ?

Thank you.

 

Debra

[Greg Schneider]

Hi Debra,

I think it is worth saying a few words about the concept of a "doula" in end-of-life care. The term Doula comes from the Greek word for a woman who personally serves another, a woman's servant. Doula has traditionally been associated with a Birth doula, or someone who stays with a woman through her labor, birth and beyond.

An End-of-Life Doula is defined as a volunteer who provides companionship and comfort for people whose life expectancy is 18 months or less. Doulas often serve those who have limited support from family and friends, providing emotional, spiritual and social support as well as comfort and companionship.

End-of-Life Doulas work with one person at a time. They can help to minimize the sense of isolation, provide emotional comfort, assist with practical concerns and advocate on behalf of people with life limiting illness.

Some who serve the dying have chosen this term to describe their role because hospice volunteers are very much like midwives to the dying. While this description may be appropriate for women who choose to specifically serve other women in this capacity, today's hospice volunteer force is more gender and age diverse than what the term doula connotes. For this reason, my experience is that hospices do not commonly use this term.

There is further confusion on the use of this term because it is sometimes interpreted to represent those who serve the dying in their final hours. In the hospice community the more commonly used terms for volunteers who support those who are actively dying (i.e. death is imminent) are 11th Hour Volunteers or Vigil Volunteers. Additionally, some hospices do not have such a program to offer their patients.

RE: 11th Hour Volunteers, End-of-Life Volunteers or Vigil Volunteers, or work for a hospice organization, how do you prepare to go to a patient's home; i.e., do you bring a selection of music, books, etc., ?

Good question...one that may have a variety of answers depending upon the philosophy of the hospice in supporting patients who are actively dying. My personal philosophy is the less you bring the better. While a volunteer may feel more prepared by bringing a tool box with them, the principal tool that is needed is their presence. Typically a volunteer's first inclination (this is not unique to volunteers, I have seen clinical staff do the same in this situation) is to enter a patient's room and start doing something with one of the tools in toolbox, such as picking up a book and starting to read.

The first thing I would suggest is walking into the room and connecting with the patient (and family if they are present). As far as the patient is concerned, this can be accomplished in a variety of ways. The more subtle the better. Allowing your intuition to be your guide is best. It can be a challenge for a volunteer to just arrive and sit by the patient's side without feeling the need to be actively doing something. However, by doing so and sitting quietly for 10 or 15 minutes, consciously sitting can provide all the guidance you need.

Here is an illustrative experience of the first patient I was with who died in my presence.

Listening To Your Inner Guide
When I first began volunteering in 1996, I was trained by Frank Ostaseski, the founder of the Zen Hospice Project. Zen Hospice had a residential facility with 5 beds called the Guest House, which is where I served the evening shift from 5:00pm - 10:00pm. Zen Hospice was unique in that volunteers served a very active role in the care of patients from sitting at the bedside to cooking, bathing and washing their clothes to name a few. This is rare in today's hospice environment, sadly which is becoming more rigid by the day for reasons described as liability, limits the roles that volunteers may assume in caring for patients.

I had arrived on my shift one evening to find that Philip was actively dying. At that time, the hospice assigned one volunteer per shift. There were three 5-hour shifts from 9am to 10pm. Each shift overlapped by an hour so when I had arrived Margaret, who did the 1pm-6pm shift, was still on shift and two other volunteers who wanted to support Philip, were in his room singing to him and holding his hand.

I came into the room and sat at the end of Philip's bed in a chair. Margaret was sitting on sofa against the wall not far from me. The other two volunteers who were singing to him were at the left side of his bed. Philip was non-responsive, laying there with a wash cloth over his eyes. Philip had done this before, while laying in his bed. It gave him a degree of privacy and solitude, yet he could still experience the presence of the volunteers without having to make eye contact.

I sat in my chair observing the actions of the two experienced volunteers. At the time Margaret and I had only been volunteers for a couple of months. After sitting there for about 20 minutes, Margaret said to us "Wait, I think I have the perfect music for Philip. In fact the song I want to play is already cued up in my car. I'll go get it and be back in a few minutes." Margaret returned and put the tape (Donovan's Sutras) into the tape player and it softly began to play. Within a few minutes of starting the music, Philip's body moved and his facial expression changed after being perfectly still for the duration of time the two volunteers had been there. There was a noticeable change in him. He seemed to be more at ease. During the second song Philip died so very peacefully. What was most interesting about this experience was that the title of the first song was "Give It All Up" and the second song was "Sleep."

Such a divine example of letting your intuition guide you.

The caution here is not to let the tools get between you and the patient. Your calming physical and spiritual presence is very important. I struggle with this, as I have been playing the harp as a vigiling volunteer for 7 years now. I find the focus required to play the harp can disconnect me from the patient. So use the tools only as needed, not as a tool to alleviate the helplessness that you may feel with the situation.

Frank Ostaseski, my hospice volunteering teacher, says we need to be 50% present with the patient and 50% present with ourselves in order to serve the patient fully.

Hope that is helpful.

Greg Schneider
HCF Creator
President, HVA

[Debra Heinzelman]

Thanks, Greg. You are right. Presence and even silence is powerful. I will seek out "Donovan's Sutras" -- the volunteer gave the patient a beautiful gift of song. It's good to learn about your actual experiences. I often times, in my volunteer experiences, have to keep myself from thinking that I need to say something or do something. I often wonder if the patients long for volunteers to just be there and to be silent, especially if there are many coming and going. I have even noticed that some really don't want another volunteer there, but tolerate it because the family wants it or they think the patient needs it.

To quietly and gently walk into the room first is very good advice. I thought that I needed to bring a bag filled with various types of music, something to play it on, a Bible (when appropriate) and other things that may seem sterile. I do take non-allegenic lotion with me if someone would like their hands massaged, but I always ask the medical staff or family before I do this. Sometimes the family likes to apply the lotion after the patient has passed as I am preparing them for the funeral home. Closurer.

I am finding out through my research that there are no real "certification programs" for doulas other than additional volunteer training. Hopefully, I will be able to develop a program like that in my area.

Don't know what I would do without this site. I am truly grateful. Thanks again.