Hospice Work: How Do You Cope With Compassion Fatigue and Burnout?

[Frances Shani Parker]

Hospice work is not for everyone. Those who continue to be involved on some level with direct care of patients, as volunteers or paid staff, stay for various reasons. In spite of all the good things said about hospice work, there is always the possibility of compassion fatigue or burnout. How do you deal with this reality? It would be helpful if we shared coping strategies with one another, so we will have more choices if and when we need them. Frances Shani Parker, Author "Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes” "Hospice and Nursing Homes Blog"

[Linda Daniels]

I was looking online for information on Compassion Fatigue and found: Awareness Project
www.compassionfatigue.org [e-mail]
she has done research on the subject.
There are also seminars on the subject. Look up Pesi.org -the company who contracts with different professionals who go around the country lecturing about it and other important subjects. Hope that helps.

[brittany bennett]

Yes compassion fatigue can be problem. It causes a person to neglect themselves.

[brittany bennett]

I will tell you my way gardening,reading ,time with pet and 2 per year I treat myself to day at spa. With hobbies most stress melts away and my batteries are recharged. We must master somethng in order to feel good. We need to be expert in something. This is my opinion what do you think?

[Frances Shani Parker]

Each person has to decide what works best at a personal level. It's good you have discovered your way.

[Frances Shani Parker]

I wrote “Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes” after I became aware of serious concerns that needed to be addressed regarding eldercare, hospice, and nursing homes. Most books on these combined topics do not include urban settings or the often-missing voices of people of color. I decided to write an inclusive book of stories, general information, and original poems that would be a literal guide for becoming dead right. Any future books I write would have to come from a similar passion.

I don’t keep a journal, but I do freelance work, consulting, and write a blog called “Hospice and Nursing Homes Blog.”

[Elizabeth Holliday]

Nice. I should read your book. Writing is a wonderful process. There is much solace and clarity that can be found in writing. I agree with you that writing can be challenging, pleasurable and therapeutic. Do you keep a journal? Are you planning on writing any more books?

[Frances Shani Parker]

Probably my best coping strategy is being conscious that I need coping skills to create harmony in my life. I understand that I am responsible for providing myself with opportunities for my own happiness. Like you, I try to be in the present for patients and myself. I nurture an awareness of what their needs are and satisfy them the best ways I can.

While I make regular efforts to experience people and situations I enjoy outside of hospice work, writing about my hospice-related experiences and insights is an especially good coping skill for me because it allows me to express both positive and negative concerns. I write not only to share interesting stories, but also to make improvements in eldercare, hospice, and nursing homes.

Of course, another reason I write is that I really don’t have much choice. I get swept away by inner images and voices concerning what I know, including hospice work. From places inside, words rise that affirm my oneness with others, make sense of nonsense. Stringing thoughts together into written words can be challenging, pleasurable, and therapeutic.

[Elizabeth Holliday]

Frances,

What are some of your coping strategies for avoiding and/or managing burn-out?

[Frances Shani Parker]

Thanks for writing, Elizabeth. I don’t know a lot about massage volunteering, so I read your comments twice for better understanding. Your attention to knowing what you need, finding a focus and knowing when it's done, knowing that you’ve done your best, and going on to the next thing seem to be good coping strategies for you. You incorporate your coping strategies within the process of your actual hospice work.

[Elizabeth Holliday]

Wow, this is a subject close to my heart. I'm a body worker, and have been a massage volunteer for about a year. I have seen many talented body workers drop out because of burn out, and so I have given this a lot of thought. How can I avoid this? I can only share what has worked for me so far. I'm still very new. Maybe this will translate for the non-bodywork aspects of hospice care. I'll be interested to see what Irene has to say on this subject since she has been providing massage to hospice patients for many years!

Just tonight I was talking to a friend who is an occupational therapist (trauma center) who is always looking for strategies for what she also calls Compassion Fatigue. In terms of Chinese Five Element Theory, this business of compassion fatigue is an Earth issue, and an Earth query. Having this conversation with others and sharing the information (Fire) nourishes the Earth aspect of compassion fatigue. Fire is the parent element of Earth, looking after it, and nourishing it. So this is a great thread to start!

My strategy around this is bringing all of the following to a session: Knowing what I need, finding a focus and knowing when it's done, knowing that I've done my best, and going on to the next thing with the happiness that this work gives me.

The more adept I become at finding my focus in the session, the more sensitive I become to discovering when the session is over.

A little bit about my focus: I'm an acupressurist, so in my work I discern which meridians am I working on with this person, which points to use, which elements am I working with in them where they are right now in this moment...sometimes it's as simple as holding the hand and the wrist and a point or two on the chest. Sometimes I'll hold the points for a long time, sometimes I'll travel the body more. Sometimes the focus is on the legs, or the feet. It depends on them. Lately I'm discovering that I only work with my hands for 20-30 minutes, or even 10-15 minutes. It's part of the presence and intimacy of the session to feel when we are finished, as opposed to working on and on, out of my own sense of wanting to do more, wanting to accomplish more. Knowing when it's done, and honoring that. With massage, to do more is sometimes to come to a place of overstimulation, which is contrary to the peace and beauty of the session that is "just right" for them, and for me. I'm so glad that my area of specialization requires me to find a focus - I need that.

I try to be in the habit of being present for myself as I am for my patients, in order to know myself, and know what I need. As a bodyworker, that means providing for myself what I need so that I'm not distracted. So that I can focus, and give my best. I bring in my water. I have everything I need. I take my time getting comfortable with the person, becoming comfort so that I can bring comfort. Becoming the pool so that I can give them the peace of the pool, etc. This is a tough one - my bigggest problem with this work is getting to the body through the hospital bed. Body mechanics are a big issue...and I think that's a serious component of burn out with bodyworkers in hospice care, because we are accustomed to the relative luxury of our massage tables, or chairs, or the mat on the floor, whatever it is. Working with someone in a hospital bed is just a different animal, and hard on the body...(thank you Irene for teaching about this - this has been a great help.)

It is this awareness of how to provide what I need, finding focus in the session, and how to sense when it's over, that adds to the peace and happiness I feel from doing this work.

I must say, as a volunteer I'm only doing 1-3 sessions per week. If I had a big caseload of patients my story of how to avoid/cope with burnout would be a different one.

I'm so glad you brought up this topic, thank you!