Living With Serious Illness

Most people working with the seriously ill and their families feel privileged to do so and acknowledge the many rewards of this meaningful work. We learn wisdom from our clients. We are moved by their profound journey and the poignant moments of courage and forgiveness that we are honored to witness and facilitate. They regularly prompt us to appreciate the moment and find hope in even the most dire circumstances. We learn to be grateful and to value the preciousness of life.

That said, while being in the constant presence of pain, illness, and death, we are challenged to cope with multiple losses. Our beliefs about life and the world are tested daily. We are at risk for professional distress in the form of burnout, chronic bereavement, and compassion fatigue. To continue giving high-quality service, we need to be mindful of our own vulnerabilities and use strategies that prevent burnout and replenish our resources.

Research in professional self-care suggests many techniques. You might want to review this list and select a few that have meaning for you.

• Understanding your past
• Coping with emotions
• Spiritual health
• Physical self-care
• Workplace support
• References

Understanding your past
Many of us have been called to this work because of events in our personal lives that have given us special insights. These experiences can help us be more compassionate. But they can also leave us with blind spots or areas of extra sensitivity that can cloud our ability to address the needs of our clients. We all have vulnerabilities. Self-awareness is the key to managing our past so it yields the benefits while minimizing the drawbacks.

• What were you taught about death and dying? About pain?
• How were you taught to process grief?
• How do these teachings differ from those your client(s) have been taught?
• What are some of your early losses? How might these trigger you now?
• What self-care strategies have you used in the past that you want to retain? Any that you would like to change?

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Coping with emotions
We wouldn't be human if we weren't affected by the emotions of others. But swimming in a soup of feelings all day can take its toll. We need to consciously use strategies that can help us stay open and positive despite the pain and sadness that accompanies our work. Although we cannot control our emotions, our thoughts and our actions can have a profound impact on our feelings.

• What do you do to retain a sense of hope or optimism about life?
• How do you nurture your sense of humor?
• What activities do you engage in that help you see the "bigger picture" of your life?
• What do you do to manage or minimize stress?
• Do you have a means of creative or emotional expression?
• How do you expand your horizons beyond your work life? What are your non-work-related interests and how do you foster them?
• Do you take vacations periodically to get away from your daily chores and worries for three days or more?
• How would you rate yourself in terms of compassion? How would you rate your self-compassion?
• Name three pleasant activities you engaged in yesterday (they do not need to be time consuming, simply three things that made you feel good). Studies show that people who engage in pleasant activities are better able to manage or ward off depression. Make a list of activities that bring you pleasure and be sure to incorporate a few every day.

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Spiritual health
It seems to be a basic part of human nature to assign meaning to life events to understand "why" life is the way it is. Some people receive their answers through the teachings of organized religion. Others address the existential questions that inevitably arise in this work through less-structured means.

• What helps you feel connected to others?
• Are there activities that bring you to a peaceful frame of mind (e.g., meditation, walking in nature)?
• When was the last time you extended forgiveness to another? When was the last time you asked another for forgiveness?
• Whom do you admire spiritually? How might you spend more time with them?
• Do you keep a journal or do some other spiritually reflective writing?
• When was the last time you expressed gratitude?
• With whom do you discuss your larger, spiritual questions? Do you have a confidant?

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Physical self-care
Daily we witness the mind-body connection in our work. Nevertheless, we often forget to support it in our personal lives. We need to practice physical self-care for our emotional well being. Studies have inextricably linked increased physical activity, for instance, to decreases in depression, anxiety, fatigue, stress, and tension.

• What do you do to honor your body?
• Are you getting enough sleep at night (7-8 hours), or do you skimp on sleep to "get everything done"?
• When did you last get a massage?
• What stress reduction techniques do you use when you feel tense (e.g., deep, slow breathing; progressive relaxation; guided imagery)?
• Are you current on your medical exams and screenings?
• What do you do to release tension?
• What foods do you give yourself for fuel when you are under stress? Caffeine? Sugar? Proteins?
• What do you do to stay limber and flexible?

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Workplace support
How your work environment supports you in processing the stresses of your job may not be in your control. Still, there are things you can do to ease the strain of dealing with people in life-crisis day in and day out.

• Who in your workplace might be interested in joining in a support group to talk about and process the grief that arises when a beloved patient dies?
• Is there a place where the staff can create a memory board and post pictures or memorabilia of patients with whom they felt especially connected?
• Can you ask for time off to attend the funeral of a special patient?
• Do you have a colleague whom you can ask to step in if a situation is especially tender or likely to trigger your own sensitive areas? (You can, of course, make it reciprocal and offer to return the favor.)
• Are there objects or pictures that remind you of healing? Of nature? Of God or a Higher Presence? If so, consider collecting them and creating a spiritually restorative space for yourself at work. It doesn't have to be big-it can be on the corner of a shelf or on a windowsill.

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References:
Much of this article is adapted from the social work teachings of Nancy Hooyman and Betty Kramer. Hooyman, N. R., & Kramer, B. J. (2006). Living through loss: Interventions across the life span. New York: Columbia University Press.

Other Resources include:
Gentry, J. E., Baranowsky, A. B., & Dunning, K. (2002). ARP: The Accelerated Recovery Program: ARP for compassion fatigue. In C. R. Figley (Ed.), Treating compassion fatigue (pp. 123-137). New York: Routledge.

Gamble, S. J. (2002). Self-care for bereavement counselors. In N.B. Webb (Ed.), Helping bereaved children: A handbook for practitioners. New York: Guilford Press.

Baker, E. K. (2003). Caring for ourselves: A therapist's guide to personal and professional well-being. Washington, DC: American Psychological Association.

Morrisette, P. J. (2001). Self-supervision: A primer for counselors and helping professionals. New York: Brunner-Routledge.

Skovholt, T. M. (2001). The resilient practitioner: Burnout prevention and self-care strategies for counselors, therapists, teachers and health professionals. Boston: Allyn & Bacon.

Olson, M. (1997). Healing the dying. Albany, NY: Delmar.

Mutrie, N. (2000). The relationship between physical activity and clinically defined depression. In S. J. H. Biddle, K. R. Fox, & S. H. Boutcher (Eds.), Physical activity and psychological well-being (pp. 46-62). London: Routledge.

Plante, T. G. (1993). Aerobic exercise in the treatment of psychopathology. In P. Seraganian (Ed.), Exercise psychology: The influence of physical exercise on psychological processes (pp. 358-379). New York: Wiley.
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Please Note: Community Nurse and Hospice Care does not specifically endorse the activities of these organizations, but offers their information as a sample of the kinds of materials and services that are available.