Compassion beyond fatigue: Contemplative training for people who serve others

Teachers and others in helping professions or social service are taught the importance of listening with full attention, relating to students and clients in their deep worth, and discerning their hidden strengths. They are also cautioned to avoid burn-out. But how are such professionals to access in themselves the capacities of motivation, connection, discernment, and equanimity that are needed to fulfill those tasks? This article describes a contemplative training program designed by Makransky for those who serve others: such as educators, social workers, therapists, healthcare providers, hospice workers and social justice activists. Meditation practices from Tibet are adapted to help people of all backgrounds and faiths ease into a state of simple presence and compassionate connection with others, both for their own replenishment and to be more effective in their work with students and clients.

Characteristics of Resilient Hospice Workers From Their Administrators’ Perspectives: A Qualitative Study

This study explores hospice administrators’ perceptions of the characteristics of resilient hospice workers. This qualitative phenomenological study included ten participants from five hospice organizations in rural and urban Southwest Missouri communities. All participants were current hospice administrators. Administrators identified six characteristics of resilient hospice workers. These characteristics included (a) relationship building with clients, (b) having a supportive team, (c) ongoing education, (d) positivity, (e) strong boundaries, and (f) the importance of spirituality. Authors suggest identifying and encouraging these characteristics in hospice workers may lead to less employee turnover, healthier employees, and a better work environment.

Ethnographic Methods, Music, and Aging

Qualitative methods are proving to be important tools for studying the multi-faceted experience of living with aging, with a focus on the arts. Ethnographic methods are productive ways to discover and examine music in everyday life. Systematically studying the normal and often taken-for-granted ways aging adults experience music, in the full range of settings where they can be found, can abide by the first rule of translational science research: to design and conduct research in order to facilitate the efficient and timely development and application of clinical and caring interventions. This presentation will review a series of ethnographic studies of music experiences in residential facilities, dementia respite groups, family, and hospice. We will suggest ways to apply findings from these studies to enlighten volunteer hospice workers’ protocols for care.

Hospice Employees’ Perceptions of Their Work Environment: A Focus Group Perspective

Burnout in healthcare professionals can lead to adverse effects on physical and mental health, lower quality of care, and workforce shortages as employees leave the profession. Hospice professionals are thought to be at particularly high risk for burnout. The purpose of the study was to evaluate workplace perceptions of interdisciplinary hospice care workers who provide care to patients at end of life. Six focus groups and one semi-structured interview were conducted with mixed group of social workers, managers, nurses, hospice aides, chaplains, support staff, and a physician (n = 19). Findings from the groups depicted both rewards and challenges of hospice caregiving. Benefits included intrinsic satisfaction from the work, receiving positive patient and family feedback, and teamwork. Challenges reflected issues with workload, technology issues, administrative demands, travel-related problems, communication and interruptions, difficulties with taking time off from work and maintaining work-life integration, and coping with witnessing grief/loss. Hospice workers glean satisfaction from making meaningful differences in the lives of patients with terminal illness and their family members. It is an expected part of the job that certain patients and situations are particularly distressing; team support and targeted grief support is available for those times. Participants indicated that workload and administrative demands rather than dealing with death and dying were the biggest contributors to burnout. Participants reported episodic symptoms of burnout followed by deliberate steps to alleviate these symptoms. Notably, for all except one of the participants, burnout was cyclical. Symptoms would begin, they would take steps to deal with it (e.g., taking a mental health day), and they recovered. At an organizational level, a multipronged approach that includes both personal and occupational strategies is needed to support professional caregivers and help mitigate the stressors associated with hospice work.

Death

Death is the ultimate transformative experience. “Death” here means not the state of being dead but rather the whole process of dying, culminating in the end of a person’s life. Death is “epistemically transformative,” because you cannot know what it is like to die until you experience dying, and this experience can enable you to understand things in a new way. Death is “personally transformative,” because it changes how you experience yourself in ways that you cannot fully grasp before these changes happen. At the same time, death is unlike any other transformative experience. It is final, all-encompassing, and has fundamental significance. Its power to reveal new truths about your self and your life is exceptional. It offers prospective and retrospective perspectives that differ from those of any other experience. This chapter examines death by describing its unique characteristics as the ultimate transformative experience. The practical benefit of this perspective is to suggest new philosophical resources for physicians, hospice workers, policy-makers, and family members who care for dying loved ones.

Integrating work and home when patients are dying: a mixed-methods study of hospice care workers and work–family conflict in the US

Scholars of work and family have argued that flexibility in hours and location may support integration between work and home. Home-based hospice care is a type of work that has a great deal of flexibility but it is not clear that it is used to support workers. Using interview and survey data from 179 US hospice workers, we show that the speeding up of care and culture of self-sacrifice make integration difficult. Almost a third of workers report that work takes too much time from home life, which is associated with higher turnover intention, higher burnout and lower life satisfaction.

La percezione degli operatori sanitari sulle cure palliative come mezzo per promuovere la qualità di vita dei pazienti e prevenire le richieste eutanasich / Healthcare workers’ perception of palliative care as a means to foster patients' quality of life and to prevent euthanasia requests*

Nel 2010 è stata emanata in Italia la Legge 38, che punta a migliorare formazione e tirocini nel campo delle cure palliative, sebbene al momento non esista un sistema nazionale di monitoraggio di tali pratiche su scala nazionale. A livello internazionale l’eutanasia si è andata sempre più configurando come trattamento possibile fra le cure di fine vita, mentre in Italia resta formalmente illegale. Esistono alcuni studi italiani sulle prospettive dei pazienti rispetto alle cure palliative e all’eutanasia, ma la letteratura relativa alla percezione degli operatori sanitari palliativisti è esigua. Scopo del presente studio è l’indagine di tali percezioni, sia rispetto alla qualità delle cure palliative sia al potenziale ruolo dell’eutanasia nelle cure di fine vita in Italia. La ricerca è stata condotta in tre hospice romani. È stato sviluppato e somministrato un questionario con 75 item graduati secondo la scala Likert a 5 punti, utilizzando come metodi di analisi l’analisi fattoriale e, per la parte statistica, SPSS. Il questionario è stato completato da 56 soggetti. Nella percezione dei partecipanti, i fattori rilevanti per la qualità delle cure palliative sono risultati sette: sofferenza fisica e sociale, benessere psicologico e spirituale, benessere emozionale, partecipazione alle decisioni, compassione, speranza ed empatia. Inoltre, le cure palliative ridurrebbero il desiderio di morte e di eutanasia. I fattori più importanti che emergono dal lavoro sono la sofferenza o il benessere sociali, fisici e psicologici. Gli operatori sanitari coinvolti nello studio non sostengono l’ipotesi dell’eutanasia e anzi ritengono che le cure palliative riducano il desiderio di ottenerla. ---------- In 2010, the State Law no 38 was enacted in Italy, seeking to improve palliative care education and training. There is currently no national monitoring system for palliative care practices in Italy. Euthanasia has become increasingly available internationally as an alternative amidst end-of-life care options, although in Italy this is not the case, and it is formally illegal. Although there are a few studies regarding patients’ perspectives regarding the issue of palliative care and euthanasia in Italy, there is limited literature focused on the perspectives of palliative care health care professionals. The purpose of this study is to explore the perspectives of hospice workers regarding both the quality of palliative care and the potential role of euthanasia in end-of-life care in Italy. This research was conducted with hospice clinicians in three hospices in Rome. A 75 item 5-point Likert scale questionnaire was developed and administered. Factor analysis was used, and descriptive statistics were performed using SPSS. Fifty-six respondents completed the questionnaire. From participants’ perspectives, there are seven significant factors explaining the quality of palliative care in Italy: social and physical suffering, psychological and spiritual well-being, emotional well-being, participation in decision making, compassion, hope, and empathy in care, while reducing patients’ desire for death and euthanasia. The most important of these factors regard social, physical and psychological suffering and well-being. Hospice workers in this study did not support euthanasia and felt that palliative care decreases the patient’s desire for euthanasia. * The manuscript was presented as an abstract in an International Congress on Palliative Care.

A szakmai élet minőségét mérő kérdőív (Professional Quality of Life Scale) magyar változatának validálása

Introduction: The Professional Quality of Life Scale, measuring the quality of professional life, has been developed to examine the positive and negative changes in the work of those who have undergone extremely stressful experiences. The quality of life of the personnel of palliative-hospice teams may be influenced physically as well as emotionally by their every-day experiences of suffering, death, dying and the patients’ traumas. Aim: The aim of the study was the examination of the psychometric features and factor structure of the Hungarian version of the Professional Quality of Life Scale questionnaire, which can measure compassion fatigue and satisfaction, secondary traumatisation and burnout. Our long-term objective is the development of formative and intervention strategies for hospice workers in order to increase their satisfaction, physical and mental well-being and their willingness to work in hospice. Method: The cross-sectional, questionnaire study was made with hospice workers. The questionnaires were available in an anonym, printed form. We used the Hungarian versions of the Shortened Maastricht Vital Exhaustion Questionnaire and of the Shortened Beck Depression Scale, of the CES-D Depression Scale and of the Shortened WHO General Well-Being Scale to validate. Statistical analysis: IBM SPSS 23.0© software was used for the analysis. To explore the factor structure of the measurement scale, explorative factor analysis was made (analysis of the main component, Varimax rotation); subsequently, 4 scales were prepared the Cronbach-alpha values of which were suitable for further examination. Results: 188 questionnaires were sent back (female 86.2%, male 13.8%); the majority work as nurses and in home hospice care (94 people). The inner consistency of the created 4 scales is acceptable according to the Cronbach-alpha values. The inner consistency of the questions regarding burnout is low. The correlation of our measurement scales with the standardised scales for outer validity has sufficient strength and direction. Conclusions: Our questionnaire can measure the phenomena under examination according to the expected values, with suitable consistency on the basis of the inner and outer indicators. Orv Hetil. 2018; 159(35): 1441–1449.