By Liese Groot-Alberts
“Make your choices based on love, not fear”, Dr. Elisabeth Kübler-Ross
In my work as a mentor and clinical supervisor of healthcare staff, I am currently hearing expressions of grief, frustration, anxiety, concerns, and sometimes a sense of powerlessness in this COVID-19 pandemic. Staff are talking about feeling clumsy and inadequate in their communication of compassionate care to patients through layers of PPE. This combined with a high-powered, stressful, anxious working environment makes it paramount for staff to commit to time for self-care and self-reflection, increasing their awareness of how they are in body, mind, heart, and soul, in order to be able to practice compassionate care.
I repeatedly hear: “I don’t have time for self-care or reflection, I am too busy juggling work and home, I feel like I am running all the time.”
I totally agree, life before COVID-19 was busy enough and now is for most – in essential services especially- even more pressured. However, I also would like to challenge your statement of “no time” with a simple exercise to do at work that takes about 15 seconds, can reduce some stress and anxiety, and be helpful in reconnecting you with your compassion.
Unless you are on your way to an emergency of course, then just take one deep breath and run!!!
The practice of being present to your patient with compassion:
Before you move on to your next patient — stop for a moment and disconnect in a kind manner when you move away from the patient you just cared for.
Put one hand on your sternum, take 3 slow breaths in and out, in and out, in and out. Feel the touch of your hand and the rhythm of your breath. Use your breath to connect with yourself- be present. Here and now.
Next, prepare yourself to fully connect with your next patient, in turn giving them total attention.
When you have finished your care, take a moment to gently disconnect from that patient, reconnect with yourself, and then bring your whole attention to your next patient.
The more you practice being fully present at work, the more you will connect with your compassion, and the less you will be in the grip of fear and anxiety.
“How little can be done under the spirit of fear”, Florence Nightingale
Communication in full PPE:
Here are some simple suggestions to enhance communication through voice, eyes, and body language. Pick and choose, because not all of these will appeal to everyone.
The pantomime of non-verbal communication in PPE:
Your body is a wonderful tool of meaningful non-verbal communication.
Practice using your body language at home in front of a mirror, you can then put those expressions in your toolkit of compassionate care at work!
The first step is to focus consciously on your body posture and movement.
How abrupt or gently am I moving towards my patient?
How is my posture when I speak to them? How am I holding my head? My hands?
Am I leaning in to the patient quickly or can I do that slower to give them time to “see me coming”?
At what pace am I withdrawing from the patient? Abrupt or gently?
Am I giving them time to realize I am moving away?
To bring comfort:
Connect with your eyes, embrace/hug yourself loosely, then stretch out your arms with open hands as if carrying a gift and pass that gift to the patient.
When you sense there is sadness, simply look at them with kindness and gently touch your heart with one hand. Be present. Don’t interrupt. Be witness to the sadness. Healing comes when people feel seen and heard.
Connect with your eyes, fold your arms loosely around your body, and with one hand stroke your own arm gently, a rhythm of around 60 movements per minute (a calm heart rate). A soothing movement for the patient as well as calming yourself.
Hug yourself loosely and while you do that gently rock a tiny bit from side to side.
Use the signals that in nowadays are so commonly expressed in hand-emojis. Examples: the ok sign, two hands applauding, thumbs up, a gentle wave, fingers crossed, palms together in prayer sign, two arms raised in a hurray gesture. Be creative, find your own sign language.
Consciously breathe at a slower pace, it calms you and the patient both. And above all, be fully present when you are with them, whether that is for hours or just 30 seconds.
Using your voice:
When your patient is fearful and anxious, use the tone of your voice as you would when you are soothing a small frightened child.
That does not mean you need to coocoo to them 🙂
Attune to the mood of the patient. Be careful with your use of humour, don’t try to “jolly” your patient out of their feelings. They are in charge of when they are ready to “come up for air”.
We soothe children by singing lullabies. It works with adults too. Consider gently singing while you are performing your interventions or care.
Create a repertoire. Find some gentle songs that you can sing quietly to them.
If you have small children at home, check what songs calm them down, and bring a sense of peace and quiet.
Practice your songs on your way to work or on the way home. Why? Because we know that singing brings out the endorphins, dopamine, etc very quickly and singing soothes the arousal response of fear, it lowers cortisol and adrenaline. Therefore: while practicing the songs you would like to sing to your patients, you are singing to yourself, soothing yourself.
And if you have decided that you can’t sing, gently hum.
In some departments, there might be time restrictions around length of contact. Communicate at the start of the period of time that you will be with them eg 15 minutes. That gives clarity and security to the patient and lessens expectations. When you are fully present, it is not the quantity of time that will be remembered, it is the quality of time. Also, feel free to state clearly to them that you would rather work without the restrictions of PPE.
In Te Reo Maori the proverb/ whakataukī is: “he waka eke noa”.
Meaning: “a waka (canoe) we are all in together, with no exception”.
We rise together, we fall together, work together, keep going together.
Selfcare and self-reflection:
Fear and anxiety block the flow of love and compassion between you and your patients.
Neuro-scientific research shows that anxiety and despair are contagious. Because you care, you attune to the state of emotional being of your patient. That affects your own mood. Pay attention to that. Make sure that, when you are witnessing anxiety and despair, you consciously hold onto your own hope. And sometimes you can communicate that to your patient: “this is so tough, may I hold the hope for you right now?”.
Caring for yourself will reflect positively in your care for others. Be as kind and compassionate to yourself as you are with your patients.
Remember: “all true benefits are mutual.”
Thank you for all you do with all that you are. Go gently, go well.
Kia kaha, stay strong,
Palliative Care Educator,
Mentor and Clinical Supervisor.
Waiheke Island, New Zealand.
With my heartfelt thanks to: Mirte Groot, Dr. David Brumley, and Associate Professor Dr. Ghauri Aggarwal for their great feedback, editing, and encouragement.