Over the past few months, I have experienced a steep decline in volunteers. Some of graduated from college and are going in a different direction in life, others just stop showing up and some are getting back into the workforce because the economy hasn't been too friendly to them. Is anyone else experiencing the same type of decline and if so, what are you doing to retain your volunteers? I have encouraged as much as I can my people to stay with us as well as offered to change their assignment to something less patient related if that would help. Any suggestions would be greatly appreciated.
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As a hospice massage practitioner for over three decadesI find that full-body sessions are rare with hospice clients due to physical, emotional and environmental restrictions and limitations. Many sessions will involve one or two areas of the client’s body. Sessions that usually present themselves in a hospice setting are:
(1) legs and feet, (2) feet, (3) head and neck, (4) face, (5) back, (6) arms and hands or (7) hands.
I call this piece work. Gentle stroking, holding as in acupressure or Reiki and sometimes rocking these areas of the body for short periods of time, prove to be comfortable hospice sessions.
As your client approaches the end of his or her life, your touch sessions may become shorter and return to basic forms of family touch such as stroking the forehead or holding a hand.
For me this is the most difficult form of touch to provide. It requires me to put technique aside and to simply, without fanfare, be present with another human being in touch. It is as if all the previous massage practice was to build my confidence for this one moment of just being.
This is truly the advanced practice; an advanced practice in the ability to be intimate without attachment. For me this is the healing, the big reveal in hospice work.
Please paste the link below into your browser to view a short video snippet of providing a head massage to a hospice client, CB. The intimate contact in this short piece speaks volumes. This video appears in my new interactive book ‘Massage In Hospice Care” now available in your iBooks store on your iMac computer or iPad .The video snippet includes a short introduction to the book before the head massage. I welcome and treasure comments.
https://www.youtube.com/watch?v=vlOZBYwoa0w
Blessings and Gratitude,
Irene Smith www.everflowing.org
As I walked into Sara’s room I was halted by the vision of large pink organdy butterflies dancing over Sara’s bed. Long pale pink ribbons trailed down about six inches moving ever so delicately in the slight breeze coming through the open window. Against the wall two three foot wide hot pink organdy butterflies with sequined tipped wings lay flat, ready to be witnessed and loved. Behind Sara’s bed hung two plaks. One read Laugh and the other, Dream. I paused as tears rolled down my cheeks. Sara lay looking into the butterflies overhead touching the ribbons with awesome joy. She then looked at me and broke into laughter.
How did I cultivate the opportunity to share in this depth of a daughter’s love and her devotion in keeping the end of her mother’s life filled with beauty? How did I ever create a professional life that looks like this. It is truly a blessing.
The blessing, however doesn’t come without challenges. The skill base required to go into private homes and health care facilities to provide massage for dying persons and communicate with the families and health care professionals is multifaceted. It requires specialized in person training.
Currently I have nine clients. All clients are in the final stages of their lives. Five clients are in hospice care. Two clients are in private homes and seven clients are in health care facilities. Three of my clients can speak, and two of the three are able to carry on a conversation. Six of my clients are non verbal.
*I am challenged to assess the outcomes of my sessions kinesthetically, by listening to the client’s body, observing the body’s animation and by being quiet and centered enough to hear my intuition.
*I am also challenged by having clients who can not move. I have to be creative and find positions that allow me to touch my client without hurting myself. The challenge of attending to my physical body onsite requires a deep level of commitment to honor my own comfort. Having compassion for myself has been a difficult kindness to learn.
*Adapting massage techniques to work in varied positions, with a client who can not move requires constant modification, patience and letting go of concepts of what massage is supposed to look like.
The session with one of my clients includes her neck, and the arm ,shoulder, leg and foot on my side of the bed. Her bed is against the wall and her body is rigid. The opposite leg can not be moved over without great stress. It frightens her. My challenge is to let the other side of the body go. I have had to learn that the greatest outcomes from touch are deeper than the sum of body parts I can reach.
*Gathering information on my clients as a private practitioner can be challenging because health care facilities are bound by confidentiality guidelines. I have to make sure I take the time to gather all the information I need from my contracting agent before I arrive onsite. That might be a family member, care organization, conservator, a nurse, or all four contacts. Each contact will have a different level of information. Gathering sufficient information takes time, patience and skill.
*Working as a private practitioner rather than for any specific organization allows me to set my preferred fees, adjust session length and gives me scheduling flexibility. My greatest challenge is reporting to my contracting agents who serve in a wide range of roles. Dialogues are different with family members than with nurses and conservators.
I send written reports once a month to my contractors which include touch techniques utilized, the clients receptivity, outcomes , including physical and emotional response and an assessment of any props or care strategies that might support the comfort of my client. Family members will often want me to call after sessions to report verbally as well, especially at the beginning of the relationship and at the end. I have to keep in mind that the family is grieving. Time, compassion and skill are required.
Family members will often want to be involved in sessions. Guiding a son or a daughter in gently touching or holding their mother at the end of her life are moments that I treasure. The challenge is being comfortable with this depth of intimacy. The questions I ask myself are,“Am I soft enough? Am I vulnerable enough? Am I honest enough?”
Blessings and Gratitude,
Irene Smith www.everflowing.org
Death rattle sounds refer to the rattle-like breathing noises caused by respiratory tract secretions during the final days of life. The following blog post addresses myths regarding this experience, a recording of actual death rattle sounds, and the impact on hospice caregivers and others:
http://hospiceandnursinghomes.blogspot.com/2013/09/death-rattle-sounds-myths-and-facts.html
Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes
You’re a hospice-palliative care volunteer coordinator with a volunteer quota you’re always striving to maintain. Can secrets to keeping them be found in this research on how volunteers rated their decisions to continue?
A couple of Sundays ago I was given the opportunity to speak at a Unity Center that I frequent these days. The minister of that community is very supportive of my work and was eager to have me speak. I was delighted to be speaking in such a supportive and loving community. I've posted the Youtube below. Or, if you like, here's the link: https://www.youtube.com/watch?v=E4SAFaTLOug. I'm planning to put together a brochure with similar info in it. Please help me spread the word! And if you could use some of the brochures, let me know and I'll some to you when they're ready!
Blessings of Light, Maria dancing heart
Recently I was asked to give a presentation on touch as a viable service to the dying. In my reflection of this topic, I realized that a primary outcome that keeps me at the bedside is I get to assist those I touch in remembering their loveliness. I have the opportunity to remind those in pain and suffering of their beauty. In turn, I am reminded of mine.
“M” was on of my clients in the nursing home many years ago. Her story however, is still vivid.
Our communication was primarily non verbal and M’s eyes spoke loud and clear. M enjoyed having her feet massaged while in the day room in her geri chair. The only comfortable way for me to do this was to sit on the floor and put a pillow in my lap and place M’s feet on the pillow. A very conservative woman, M often found a curious humor in my sitting this way.
One day while massaging M’s feet, she began to lean forward. Her eyes had taken the expression of awe and her mouth was beginning to open slightly. I remember distinctly that I was massaging the big toe. Her expression became more exaggerated and I became excited for her. She was loving this session. She really looked to be involved with the beauty of the hand motions.
I wanted to enter into her excitement. “Oh yes” I said, “Massage is so beautiful.”
With great pleasure and realization M spoke. “No!” she said, looking at her foot “ my toe!”
What greater gift can I deliver than the gift of remembering one’s loveliness?
I believe it is said very well in one of my favorite pieces of poetry:
Saint Frances and The Sow by Galway Kimmel
for everything flowers from within of self blessing
though sometimes it is necessary to reteach a thing it’s loveliness
to put a hand on it’s brow
and retell it in words and in touch it is lovely
until once again it flowers from within of self blessing.”
I look forward to you sharing your stories and comments.
Blessings,
Irene Smith
www.everflowing.org
Recently I had the opportunity of facilitating an inservice for Maitri Aids Residential Care nurses. The inservice was on Comforting and each nurse brought their own special way of comforting into the room. Witnessing them sharing their personal comforting strategies and comforting each other with touch, triggered a deep conversation within me on the topic of comforting.
I realize that my mission in life is to comfort. It seems no matter where I am I am seeking comfort, whether it is to comfort another or to receive comfort. I also realize that comforting another gives me a sense of comfort.
Today my first client in the nursing home had a difficult time integrating my presence and it was more difficult than usual for him to sit up and get into the chair. He wanted to focus on me but his eyes couldn’t. Turning off the TV is usually the first thing he does, however today he didn’t turn it off.
As he was struggling to focus on me, the TV caught his attention and he started to watch it. I was going to suggest we turn it off however, I noticed that he was using it as a focusing tool. I then noticed his anxiety start to calm. The TV was bringing him a sense of comfort.
As the session progressed I couldn’t help but hear the very dramatic dialogue on the soap opera. Every few minutes my client and I would have non verbal communication with eye contact and facial animation in regards to what had just been said. The communication between us became easy, and intimate, and a different level of bonding took place. I noticed that the family like intimacy was very comforting to both of us.
What I usually viewed as a limitation had become a tool for comforting for both my client and myself. I left feeling easy and nurtured.
As I got to the elevator I heard loud vocalizing coming from another floor in the community and recognized it as one of my clients in seeming distress.
I wasn’t scheduled to see this client and got on the elevator to go to the lobby and leave. I heard the vocalizing in the elevator as I went to the lobby and continued to hear it as I was signing out. My thoughts were strong. I was on my way home. It wasn’t my day to see her. I paused. I made a choice, not as a massage therapist but as a human being, wanting to comfort a person in distress.
As I arrived upstairs, I saw my client in her wheel chair facing the window . She was expressing herself through loud tones, which is her only way of communicating.
As she continued to express herself, I sat down beside her, said a few words, reached out, and laid my hand on her shoulder looking at her, although her eyes were closed. Each time she was going to vocalize her forehead became a bit flushed. I continued to touch her.
Then I cupped the back of her head with my hand and cradled it like you would a baby’s head.
A passer by might have thought I was a family member. We sat this way a few minutes.
Continuing to look at her and just breathe, I laid my hand on her forearm and shoulder. We sat quietly for about 15 minutes before she seemed to drift into sleep. I left.
I realize I was not with my client as a massage therapist. I had answered a call of the heart to comfort a being in distress. This is how it used to be for me. This is the place that brought me into this field. This is the connection to humanity that I want to check in with in my practice. This is where the comfort lies for me.
In both of these sessions I reached past the massage session boundaries into a deeper sense of connectedness. I chose to be a comforter.
How do we as practitioners integrate this deeper human need into our practice. How do we stay connected to our humanity. No right, no wrong; just something to notice.
I would love to hear your comforting experiences and your strategies for integrating your deeper needs into your practice.
Blessings
Irene Smith www.everflowing.org
The purpose in creating the audio resource, Graceful Passages: A Companion for Living and Dying, co-created with film composer Gary Malkin, was to help reduce anxiety around the dying process, for both the dying, family members and care providers. As such, it has served as a spiritual and musical resource for many people, including hospice volunteers across America, for over ten years.
As I enter into filmmaking, the initial motivation behind Graceful Passages continues into another dimension. Shining Night, a film about one man's connection to music and how it touches people around the world, is a resource for helping remind the viewer of their inherent connection to the 'Great Song' behind personality and appearances.
This song we may hear more clearly as we are dying- thus to hear it while living helps reduce our apprehension of what we refer to as the 'end', whenever and however that may come. This song has been singing before we came into this world, and will be singing after we leave. To allow and actively participate in artistic expression, in any form, is a primal way of feeling our connection to life and reducing- if not evaporating- our fear of death.
Author, Crystal Hickerson Hopes to Bring Awareness to Hospice Volunteering with her new Novel, “The Volunteer” Never before has a fictional work taken on the challenge of delving into the inner workings of hospice volunteering. Only a seasoned author with over 14 years of hospice experience is able to capture the essence and behind the scenes looks at the world of hospice volunteering. Crystal Hickerson, three time published writer, decided her next novel had to be close to her heart. She wanted to bring not only a dramatic fictional work, but an awareness to hospice care.
“The Volunteer” follows Jenna Steele, a woman whose mother died on hospice. She was compelled to give back, so she donated to a local hospice; however that was not enough for her. Jenna decided to volunteer and this is where her emotional journey begins. If you ever wanted to know what it would be like to volunteer for hospice, this novel will take behind the scenes and give you an inside peek into the real world of hospice volunteering. Not only will you discover the highs and lows of a volunteer but also the often unseen world of the managers who supervise them. You will not be able to put this book down!
Not only is Crystal Hickerson a published author, she is also a strong believer in end of life care, still working in the field. She is dedicated to assisting those in their final stages of life. “I manage volunteers, but let me tell you that, each day I find myself sitting back in my chair feeling such joy and pure awe at what each volunteer gives to our families.” Crystal says. Her latest novel, “The Volunteer”, has been dedicated to all hospice volunteers around the world. The novel can be purchased online through her distributer, http://www.lulu.com or on her official website: http://www.crystalhickerson.com.
This novel would be benefit anyone who does not understand what hospice is. It would be a wonderful gift for those who love a dramatic tale, and most assuredly a perfect gift for your volunteer. Crystal Hickerson’s latest work is definitely her greatest triumph.
Being a great hospice volunteer can be a powerful and rewarding experience. Consider using these ten steps from Hospice and Nursing Homes Blog by Frances Shani Parker as a guide on your hospice service journey. The first step is a reminder to remember why you serve.
1) Remember why you serve.
There’s a reason you feel compelled to enhance lives of the terminally ill. Cherish that inspiration. Move forward committed to an amazing and rewarding healthcare adventure.
How/what do you train your hospice volunteers that helps to increase family caregiver confidence on dying process and knowing what to do at time of death?
Being With Family
Margaret was in the final days of her life and each visit was a gift for both of us. Although Margaret was wide eyed and interested in my presence, I felt like this would be our last visit. Her breathing was calm and even and she kept her eyes open throughout the session.
When I left I thanked her for her receptivity and for the opportunity to express such tenderness. I stroked her forehead and held the side of her face for a moment. It felt complete when I left.
Two days later on my regular scheduled day to see Margaret I called the nursing home. The wellness co ordinator told me Margaret was actively dying and her daughter had asked if I would come. I said yes.
When I arrived Lauren and her husband were in the room with Margaret. Margaret’s breathing was fast as if she were going up hill. Lauren explained that the hospice nurse had come by and told her Margaret would probably die that evening and gave Margaret pain medication to ease the difficult breathing.
Lauren expressed gratitude for my presence and said she trusted me to do whatever I thought was appropriate.
Although Margaret’s breathing was fast it wasn’t labored or anxious. Margaret seemed peaceful; no anxiety. Her face was open and unfurled. I didn’t want to interfere. I sat by the bed, spoke softly and gently and touched Margaret’s arms, hands and legs. It felt perfect to just gently touch.
Lauren sat by the head of the bed and I sat at the foot. She observed and commented on the tenderness and closeness of the relationship. Lauren also touched her mother and spoke to how peaceful her mother seemed.
After a few minutes I offered Lauren a neck and shoulder massage and she accepted. Lauren sat by the bed touching her mom while I gave her a massage. I talked with Lauren’s husband throughout the session. The room began to settle.
Lauren asked about the process of dying ; what to expect, and about the breathing. I was glad to be able to respond with basic information that she had not been told.
Before leaving the room I made the suggestion that Lauren stay the night; to just relax as much as possible and stay by her mother’s side. I also showed her how to swab her mother’s mouth and dab her lips with water.
This practical bit of information gave Lauren some insight of how to care for her mom on that last night; how to stay connected. It seemed grounding for both of us.
As I left the room I expressed my gratitude for the years of experience with hospice that allowed me to share in this sacred time with a daughter supporting her mother through the dying process.
I recently returned from a Winston Churchill Fellowship which enabled me to explored international palliative care volunteer models in Singapore, England, Canada and the United States. As a result I am currently developing a statewide palliative care volunteer strategy for Victoria, Australia, and am promoting the development of a national palliative care volunteer strategy.
Both nationally and internationally the profile and required skill set of the palliative care volunteer workforce is now being shaped by changing demographics, patterns of disease, increasing demands for quality care and regulation, system-wide shortage of health care professionals and reforms to health care. A key to the ability of palliative care services to deliver on this extended role will be the strengthening and expansion of palliative care and end of life volunteer services.
To view my full report and recommendations
Caring for anyone who can’t care for himself opens a door to your soul that I don’t think is opened by any other activity. The person who allows you to do so is saying, “I’m totally vulnerable and I’m placing myself in your hands.” After eight years of caregiving, I’m still learning and, I hope, still growing.
Read the entire excerpt from my new book Leaning Into Sharp Points: Practical Guidance and Nurturing Support for Caregivers. (to be released in March, 2012 by New World Library)
I have added three video clips from my presentation before the Tennessee Hospice Organization a few years ago. They will give you a taste of the moving and inspiration presentation based on my first book, From Fear to Faith, A Caregiver's Journey (available via my website). It is a tribute, also, to hospice and home care staff and volunteers who so beautifully came into our lives with love, support and encouragement.
I end the session (not on the video) with the song, Because You Loved Me, because it was their faith in me as a caregiver, tired and torn, which lifted me up and kept me going.
Enjoy!
I would be pleased to speak with you regarding bringing a retreat, workshop or conference to your agency. Although my experience is related to hospice and home care, the sessions are individually inspiring in a very personal way.
Blessings,
Joy
Joyce Marie Sheldon
Endorsed by Hospice International and Dr. Christiane Northrup, author and advocate for women's health, this book is the result of two years of journaling during my husband's illness. It takes the reader from fear to faith, from tears to triumph, along the journey of care giving. Chapters, or "cities" as I call them, are Disbelief, Despair, Acceptance, Farewell and Triumph - cities we all visit during any kind of loss - loss of job, relationship, financial security. Think about it ... it is true. And we move from one city to another, sometimes backtracking, but always visiting one city or another - or a village in between.
This book is the basis for many of my workshops, retreats and conferences presented to hospice and home care staff and volunteers across the country, as well as family caregivers.
Please visit my website - www.myjoytoday.com, and sign up for my weekly newsletter which provides insight and inspiration. And feel free to forward my writings to your staff and families.
Blessings,
Joy
Joyce Marie Sheldon
author, inspirational speaker,
specializing in keynotes, conferences,
workshops and retreats for hospice and
home care organizations
I just discovered Carolyn Brent and her book that's coming out next month titled: Why Wait? A Baby Boomer's Guide to Preparing Emotionally, Financially and Legally for a Parent's Death. Carolyn has written a book to inspire us all to have those difficult discussions that we tend to "put under the rug" for a future date and get better prepared for the issues that are going to come up, sooner or later, in our families' lives.
You can read more (of this article) at: http://www.examiner.com/transitions-grief-in-national/why-wait-a-new-book-coming-to-help-baby-boomers-prepare-for-parents-death
Blessings of Hope! Dancing heart~~~~
Touch is our organic language; therefore you would assume that touch is an easy communication. There are however, very challenging aspects to being fully present with the touch component to caregiving.
Although touch is our original communication, we are taught, as soon as possible, verbal language to replace touch and at the same time taught many conditions about the negative use of touching. It seems that during various stages of our development we learn more reasons why not to use touch than positive reinforcement for it’s value in our lives.
As professionals we learn that boundaries are primary to the professional relationship and learn the caution of becoming intimately involved with those who seek our care and counsel. We learn not to become emotionally involved.
As a care provider we are touching those in our care during vulnerable times. The heart is exposed. The core factor in the act of touching is the bonding that takes place; the connection between two beings. This connection coupled with the vulnerable heart is an emotional place. Touch elicits emotion. To be fully present to the touch experience elicits our momentary emotional involvement, To separate from this feeling does not allow us to be fully present and authentic.
We as caregivers, have a double jeopardy when it comes to being fully present to this emotional bond during touch interactions. We have our early learned cautions about touching; some healthy and some unhealthy, and we have our professional boundaries. How then do we bring ourselves fully into the touching aspect of our caregiving relationships? How do we allow our heart to be present?
Being present in my touch relationships with clients requires me to be receptive not only to my clients experience but to my experience as well. When my heart is fully present so is love. When I feel love I also feel the conditions I’ve been taught about loving and about feeling love as a professional. If I am going to keep my heart available then I have to be open to all the feelings I am experiencing. Sometimes I feel shame, sometimes embarrassment about feeling love. I can’t hide from these aspects of myself because I will be closing down to my experience. When I close down to my own experience I am no longer whole.
So , what to do? I try and observe what is going on inside of me and witness it with compassion.
I feel my grounding....my feet on the floor. I feel my center... breath in my belly and I exhale fully. I try and allow my body to be as comfortable as possible and feel the body that I am touching. I bring myself back to the texture and form and temperature of the body I am touching. This grounding will sometimes allow me to discern between old information and current experience and allow me to respond from current information in the current moment.
Three components of Therapeutic Presence as described by Bugenthal[1987] are;
Being open and present to all parts of the client experience
Being open to all of one’s own experience as one is with the client
Being able to respond from the immediacy of that experience.[authentic]
Being authentic requires deep trust. I have to trust what I feel in my heart, what I sense through my body and trust my ability to assess clearly from this current information. I also have to trust that the person I am touching will receive my touch in the wisdom in which it is delivered, and with eyes open, I have to trust in the moment. Cultivating trust is the way to cultivating presence in the touch relationship.
Irene Smith www.everflowing.org
CAREGIVERS STORE
Those who companion suffering daily, such as hospice nurses and volunteers, will surely appreciate this beautiful work. With 62 original art collages by Rashani Réa, five beautiful chapters by Kathy Douglas, and a foreword by Jean Watson, this exquisite book is a peaceful refuge for contemplation, inquiry, reflection and inspiration for those who traverse the joys and sorrows of nursing.
Kathy Douglas, RN, MPH-HA is a nationally recognized nurse leader, filmmaker and entrepreneur.
Rashani Réa is a prolific artist and musician, a creatrice of sanctuaries and a respected spiritual mentor.
“This is a beloved book and beyond a book. It is an evocative, poetic, ecstatic, and inspirited sacred, experiential calling. A calling to you--YES, YOU.”
— Jean Watson, PhD, RN, AHN-BC, FAAN, Living Legend (AAN)
“Those who companion suffering daily need to turn inward to metabolize what they have witnessed. This exquisite book, filled with beautiful images and poetic wise words, is the inspiration and support needed to grow a wise heart.”
— Frank Ostaseski, founder and director of the Metta Institute and author of The Five Invitations: Discovering What Death Can Teach Us About Living Fully
“In this unique time of the COVID-19 pandemic, this book should be considered a tribute to the tremendous courage being displayed by nurses around the world. There is much wisdom conveyed throughout by those who have been there serving others with such grace.”
— Greg Schneider President, HVA, co-author of The Changing Face of Hospice Volunteering in Hospice and Palliative Care
