By Sally Hill Jones, PhD, LCSW.(Continuation of A Delicate Balance: Self-Care For the Hospice Professional)

Key to a hospice professional’s self-care is the ability to fully enter into relationships with patients while maintaining one’s personal life and well-being. Challenges to this balancing act include preserving the professional relationship framework and managing powerful emotions evoked in hospice work.

Susan, a rural hospice professional, gradually started visiting and running errands for widowed spouses of clients after hospice services ended. As this unofficial caseload grew, her family complained. When attempts to change were unsuccessful, she considered changing jobs. Susan used journaling and a peer support group to explore the reasons for her trouble and concluded that she was attempting to avoid feelings about past personal losses by not finalizing her relationship with clients. Addressing this issue enabled her to manage endings with clients and continue hospice work. She gained valuable skills in helping clients with loss because she had experienced and survived similar pain herself.

Several aspects of hospice work with older adults may result in making exceptions to usual professional limits, making the relationship more personal. These include the sense of urgency and finality of death or being with patients in their homes during this significant life juncture. Patients’ expectations, desire for a mutual relationship, or quest for companionship may also result in extending the usual limits.

Professionals can feel pulled to give or receive gifts, extend the time of visits, or share more personal information than usual. Training that includes practice handling such situations is particularly helpful.

Hospice work with older adults sometimes taps into feelings and unresolved issues from many sources. Emotions may be evoked regarding parents, grandparents, or other older adults in the lives of professionals. Some professionals may unconsciously enter this field partly to fulfill unmet childhood desires for approval, love, or recognition or to access someone to admire and emulate. While hospice work sometimes results in feeling loved and appreciated by clients, this unconscious motivation can also lead to overinvolvement in an attempt to fill a void.

It’s reported that Mother Teresa said burnout is “always hunger, and the hunger is for love” (Armstrong, 1995). In addition, hospice professionals face daily realities usually kept at a comfortable distance, especially the inevitability of a loved one’s dependency, loss, grief, and death, as well as one’s own (Greene, 1986). Current grief experiences must also be considered in self-care, such as commonly triggered feelings from personal losses, especially if fresh or unresolved. Professional or helper grief (Larson, 1993) from client deaths is another ongoing reality for hospice workers who need time and ways to grieve and find meaning in every client’s death, even those they’ve known only briefly.

Emotions evoked in hospice work hold the potential to enhance helpers’ skills or, if kept outside awareness, interfere with a clear view of patients and their needs. Therefore, hospice professionals must acknowledge their own vulnerability and the need to process their feelings, particularly grief, along with the associated pain and enrichment it includes. This improves professionals’ self-care because they have reservoirs of resources with which to respond empathetically and clearly to clients’ needs rather than distancing themselves from clients or overinvesting to meet their personal needs.

Fringe benefits also accompany this journey, since self-knowledge makes for deeper, richer personal lives. Hospice work can develop an “old soul” life perspective, stemming from the privilege of witnessing many life paths and their results, as well as what ends up being important to people when all is said and done.

A hospice nurse once called me to the nursing home because a client was very close to death and had no family or friends. Ms. Wilson was a new client in a coma and could not communicate her wishes. Intent on finding a family member, I discovered that her nephew visited occasionally, so I called and left a message.

As Ms. Wilson neared death, my anxiety about her dying without family members grew, despite my not knowing whether this was an issue for her. When the nephew arrived in time to say good-bye and to be with his aunt as she died, I experienced great relief. Upon reflection about the especially strong feelings I had about this client’s death, I became aware of my own fears of dying alone since I have no children. To have this occur on my birthday, a milestone in my own aging, added to the feelings. I did some deep breathing and listened to calming music. I later sat with painful feelings and came to a deeper understanding of my fears, enabling me to distinguish clients’ issues from my own and contributing to more peace about my own death.