Learning from extremes: hospices
In my exploration of resilience, I’ve become interested in what we can learn where this quality is tested to an extreme. Death is a pretty severe test of resilience, not only for the person dying, but for family and professionals, and my research with hospices has been fascinating.
Seeding our Future’s groups on Nourishing the Front Line, aiming to build resilience for health and care workers, has brought me into contact with staff from several hospices. I’ve also learnt a lot from the book The Art of Dying by Peter and Elizabeth Fenwick, which draws on large-scale, structured research with hospices.
My early management training means that I still risk slipping into simplistic problem-solution mode in tough situations. I’ve been impressed at the very different, organic resilience which hospice staff bring to their work. It felt like a continually evolving response, guided by observation not prejudgement.
I was touched by the huge compassion and tolerance which hospice professionals have for their patients and their families. Clearly, this situation brings up intense fear, denial, guilt and many other strong feelings. The key response by staff is what several of them called ‘simple presence’: witnessing feelings with respect and sympathy. One told me, “we always say to student nurses, focus on what you can do, not what you can’t do. It’s the sensitive little things that make a difference.”
Another topic that fascinates me about hospices is how staff sustain their resilience when facing such emotional demands almost continually. It seems that the quality of community and mutual care among staff is central to this: one nurse told me how they will juggle rotas to relieve someone who’s exhausted by an abrasive patients.
Maintaining your emotional boundaries is also key, for example, with the Green Door image: “Your patient can only come so far: beyond that you need to protect yourself.” But I was glad to hear that staff do express their feelings: to each other, when it’s safe. And one nurse said, “we sometimes drive home in tears. We have huge expectations placed on us, and we know we’ll never meet them all.”
An explicit part of resilience in hospices is the spiritual dimension. One chaplain talked to me about ‘centering prayer’ and mindful silence, as practices which could help with staff, patients and families. And it was clear that some deaths are uplifting to be with: where patients reach a calm place about passing over, and feel a contact with loved ones in the afterlife. The Art of Dying confirms that these experiences are quite common.
I believe one reason why hospice staff are resilient is that facing death can help us all value each moment of our life more fully. This was born out on a recent retreat I co-led, Exploring the Soul’s Journey, where we invited our group to try this, and saw how it helped.