By Sally Hill Jones, PhD, LCSW. (Continuation of “A Delicate Balance: Self-Care For the Hospice Professional”)
The challenges of hospice work make self-care planning a wise choice and another fringe benefit. It involves mapping out a plan that addresses individual physical, emotional, cognitive, relational, and spiritual strengths and challenges (Jones, 2005), serving as a guide through the ups and downs of a hospice career to prevent burnout, maintain motivation, and address obstacles.
Physical Self-Care — Listening to the Body
Since stress is experienced physically, it is important to identify where stress manifests itself in the body, routinely check vulnerable areas, and find effective ways to counteract physical stress with relaxation. A variety of methods exist, including simple breathing techniques (Weil, 1990), progressive muscle relaxation, acupressure, massage, exercise, yoga, and meditation (Benson, 1995; Davis, Eshelman, & McKay, 2000; Kabat-Zinn, 1995; Keating, 2002). Attending to ongoing difficulties, such as depression or insomnia, is included.
New hospice professionals are susceptible to anxiety that they or loved ones have a terminal disease (Larson, 1993). Professionals need to recognize this as a common attempt to integrate heavy exposure to terminal illness and channel these worries into preventive action based on their own or loved ones’ specific disease predispositions.
Emotional and Cognitive Self-Care — Express, Soothe, Release
Emotional self-care includes maximizing energizing emotions and processing grief, routinely letting it in and out of one’s life. Identifying individual emotional stress indicators, such as increased crying, irritability, anxiety, numbness, self-doubt, or addictive behaviors, is important.
Key to emotional self-care is routinely expressing, soothing, and releasing emotions. Allowing for more frequent crying may be appropriate for hospice professionals, even if a movie or music is needed to “jump-start” a good cry. Other methods include writing, creating, listening to music, talking with confidants, enjoying hot baths, being held, or cuddling a pet. Aromatherapy, massage, meditation, mindfulness, prayer, gardening, and cleaning offer other emotionally soothing outlets. Allowing time to soak up joyful times and successes or engaging in pleasurable activities and humor is energizing.
I recommend a simple, brief, daily release ritual to intentionally let go of emotions that professionals often carry home from clients, particularly the heavy emotion of grief. The ritual includes acknowledging the detriment of carrying others’ emotions, reviewing the day’s situations, and letting them go. This can be done while listening to music on the drive home or before sleep, changing clothes after work, meditating or praying, visualizing the day’s concerns going down the drain while showering, or getting farther away while running or walking.
Since thoughts affect emotions, self-care includes healthy internal dialogue. Keeping a log of thoughts for one week identifies harmful patterns that, for example, polarize, self-denigrate, blame, or expect perfection, especially related to challenging hospice situations. Distorted thought patterns are then replaced with reasonable alternatives or at least with challenges to the veracity of destructive thoughts. Supervisors and peers can offer valuable feedback. Professionals may also model their internal dialogue on how they talk to loved ones or valued colleagues.
Relational Self-Care — Support, Support, Support
The emotionally demanding work of hospice care makes a strong support system essential. Stress responses include increased irritability, distance, or dependence. Finding those able to listen and support is crucial. It is helpful to educate significant others about work stresses, when “it’s about work, not about you,” and ways they can offer meaningful support. This means knowing what you need and being able to ask for it, which is often difficult for professionals. In addition, self-care requires setting healthy limits in personal and professional relationships. Helpful tools include identifying warning signals of overextending, practicing setting limits, and handling conflicts by dealing directly with the person when an issue first arises, while remaining focused on solutions without blaming or personalizing.
Regularly scheduled supervisory and peer sessions are vital to preventing burnout and compassion fatigue, to the extent they provide positive, constructive feedback that assists in managing emotions, maintaining confidence and self-esteem, normalizing experiences, and developing new resources and coping methods (Leon, Atholz, & Dziegielewski, 1999; Keidel, 2002; Poulin & Walter, 1993). In addition, participation in political advocacy to address gaps in care is an outlet for frustration over inadequate resources.
Spiritual Self-Care — Tuning In to the Bigger Picture
End-of-life work is often spiritually rejuvenating, since it involves clients’ big-picture concerns. Sometimes, the big picture gets lost in the details of paperwork and finding resources, requiring renewed attention to one’s connection to the meaning of life and hospice work. Staying attuned spiritually includes reading sacred texts, praying, attending services, connecting to nature, listening to music, meditating, and engaging in creative endeavors.
Since hospice work with older adults involves a heavy focus on the end of life, it is important to balance this with involvement in other aspects of life, such as being with children and healthy older adults. Opportunities to hold babies are thoroughly relished at hospices.
Self-Care Is Not Optional
Professionals often say that although they know self-care is important, they feel selfish when setting a limit or caring for themselves. I ask hospice professionals to think about an older client’s caregiver whose self-neglect has reached the point where she will soon need care herself, a common problem. Then I suggest that they will be unable to help that caregiver until they do what they are asking her to do. I propose starting with one small step and considering an accountability partner for support.
Since the professional’s self is the vehicle for serving clients, self-care is similar to musicians caring for their instruments, an occupational responsibility. Tending to the source of one’s gifts results in a long career of privilege as a compassionate sojourner in many clients’ unique lives as they approach their final passage.
— Sally Hill Jones, PhD, LCSW, is an assistant professor at Texas State University School of Social Work in San Marcos.
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