For the past year, I have been studying to be an End-of-Life Counselor. This training was to be the capstone of my long nursing career, a goal I had aspired to for many years: to be a midwife to the dying. I ventured to San Francisco to be a part of an innovative program to prepare practitioners as educators, advocates, and guides for the dying. Frank Ostaseski, founder of the Zen Hospice Project, developed the program and maintains a vision of training a network of midwives to the dying throughout the country. I first became acquainted with Frank and his work when he appeared on the Bill Moyers series, On Our Own Terms. When I saw him and how he worked with patients, I knew I wanted to do similar work; so when the course was opened, I hastened to apply.
I have always been fascinated with dying and have had the opportunity to be with many persons at the end of their life. I thought this training would teach me something new about how to facilitate the process. I couldn't have been more wrong! Indeed, I did learn a lot about cultural and religious differences, about altered states, transitions, rituals, counseling techniques, and end-of-life care planning. I sat at the feet of many great teachers: Ram Dass, Rachel Naomi Remen, Charlie Garfield, and Norman Fisher, to name a few. But most of all, I learned a new way of living-a way that can transform all aspects of daily life, not in just dealing with death.
The program is steeped in the Zen practice of meditation. One was not required to be Buddhist to be in the program; participants in the program were diverse in their faiths, but we were all required to have a daily "practice" of meditation or contemplative prayer. During our sessions, which lasted a long weekend seven times during the year, we often spent several hours in meditation. We had two 10-day retreats, one that was a silent retreat with days filled with sitting and walking meditation.
I learned during this time that even if you are not Buddhist, a daily practice of mindfulness meditation could give calmness, stability, and an anchor to your life. Mindfulness just means paying attention, listening precisely and intimately to our own experiences and to the world around us (Kabat-Zinn, 1994). It is not necessary to sit cross-legged on a cushion to reap the benefits of daily practice, but ritual does aid in the experience. If you are Christian or Jewish, a time of meditation allows you to become more open for your prayer time. Zen practice focuses on cultivating the "don't know mind"(Suzuki, 2001, p. 21). It is an opening to experience fully whatever is happening.
Frank Ostaseski (personal communication, February 1, 2002) outlined the five basic precepts at Zen Hospice Project for being at the bedside of the dying. These precepts can very well be applied to any interaction in daily life. They are as follows:
1. Welcome everything. Push away nothing. Create an environment of fearless receptivity.
2. Bring your whole self to the experience.
3. Don't wait.
4. Find a place of rest in the middle of things. You can't just stop the experience but rather bring attention fully to whatever you are doing.
5. Cultivate a "don't know mind." Stay really close to the situation and allow it to inform your actions.
Apply these precepts to situations in the work place: counseling an employee, interviewing a candidate, presenting the budget, or sitting in a meeting. Try it and pay attention to how you feel and the results you get. Mindfulness in action in the workplace!
In healthcare we are taught to be objective, show no tears or feeling toward patients; essentially, to harden ourselves to our patients' suffering. This is what leads to burnout. We become hardened and empty inside. If we turn toward patient suffering, open our hearts to our patients, and work with compassion, we are more able to be in touch with our own suffering. This is related to another Buddhist teaching-suffering is a fact of life (Ostaseski, personal communication, February 1, 2002). There is nothing wrong with letting our patients know we care about them. The meaning of compassion is to "suffer with others" (Flower, 2002). We need to change the culture of caring in our institutions. Give staff permission to be compassionate.
In the work place, more emphasis needs to be placed on sharing experiences, modeling compassionate care to new nurses, and teaching methods of stress relief such as mindfulness practice. It doesn't need to take a great deal of time; a few minutes before the start of a shift with the staff sitting in stillness, perhaps a guided meditation to lead them into a satisfying, fulfilled work day. There should be a quiet spot on each unit where a nurse could go for moments of meditation during the hectic workday. This helps keep the nurse centered and focused. There should be people available to teach these techniques. There may be volunteers already on your staff. There are many people who meditate!
On units where deaths occur frequently, teach the value of being at the bedside, sitting quietly with the patient. There is great healing for both the caregiver and the patient in the shared suffering. Every hospital should have someone available to be with the dying and support the nursing staff through this process. Many facilities have chaplains, social workers, or nurses trained especially to work with the dying. These roles should be adjunctive to the bedside nurses' role. It is very important to not make the dying a separate part of caregiving. Encourage the nurses to open their hearts to caring for the patients. This is not going to burn them out. It's the closing off of emotions that causes burnout. This seems contrary to what the nurses say, but I believe there is validity to this and well worth advocating for. From a personal point of view, this is what brings me joy in nursing.
We are now working harder than ever with fewer resources and sicker patients. Our lives have gotten so hectic, both at work and at home. We only have so much time; we can't get any more. Spending 30 minutes (or less) a day in meditation expands the day. It enables you to focus on what's important, to not get caught up in the trivialities of the day and to keep it clean. These suggestions are not radical, don't cost anything, and are simple to do, but they will be met with resistance at every turn. I am quite familiar with, "I don't have time," "It's not my style," and "It's against my religion," All I can say is this: it works for this busy nurse and has made a difference in my professional and my personal life. My desk is clear. My work is caught up. I don't feel the frustrations as keenly as before. I make time for what I enjoy doing. I even had a meditation hut built in the woods at my mountain cabin! I think it can make a big difference in returning the joy to nursing and finding the real meaning in your life's work. Try it and see. To get you started, I recommend the book Wherever You Go, There You Are by John Kabat-Zinn. If you can breathe, you can meditate.
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