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Impact of a contemplative end-of-life training program: Being with dying

Published online by Cambridge University Press:  26 November 2009

Cynda Hylton Rushton ,
Deborah E. Sellers ,
Karen S. Heller ,
Beverly Spring ,
Barbara M. Dossey  and
Joan Halifax
Cynda Hylton Rushton*
Affiliation:
Johns Hopkins University School of Nursing, Baltimore, Maryland
Deborah E. Sellers
Affiliation:
Education Development Center, Inc., Newton, Massachusetts
Karen S. Heller
Affiliation:
Consultant, Framingham, Massachusetts
Beverly Spring
Affiliation:
Vancouver General Hospital, Vancouver, British Columbia, Canada
Barbara M. Dossey
Affiliation:
Holistic Nursing Consultants, Santa Fe, New Mexico
Joan Halifax
Affiliation:
Abbott, Upaya Institute, Santa Fe, New Mexico
*
Address correspondence and reprint requests to: Cynda Hylton Rushton, 2312 Henslowe Dr., Potomac, MD 20854. E-mail: [email protected]
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Abstract

Objective:

Health care professionals report a lack of skills in the psychosocial and spiritual aspects of caring for dying people and high levels of moral distress, grief, and burnout. To address these concerns, the “Being with Dying: Professional Training Program in Contemplative End-of-Life Care” (BWD) was created. The premise of BWD, which is based on the development of mindfulness and receptive attention through contemplative practice, is that cultivating stability of mind and emotions enables clinicians to respond to others and themselves with compassion. This article describes the impact of BWD on the participants.

Methods:

Ninety-five BWD participants completed an anonymous online survey; 40 completed a confidential open-ended telephone interview.

Results:

Four main themes—the power of presence, cultivating balanced compassion, recognizing grief, and the importance of self-care—emerged in the interviews and were supported in the survey data. The interviewees considered BWD's contemplative and reflective practices meaningful, useful, and valuable and reported that BWD provided skills, attitudes, behaviors, and tools to change how they worked with the dying and bereaved.

Significance of results:

The quality of presence has the potential to transform the care of dying people and the caregivers themselves. Cultivating this quality within themselves and others allows clinicians to explore alternatives to exclusively intellectual, procedural, and task-oriented approaches when caring for dying people. BWD provides a rare opportunity to engage in practices and methods that cultivate the stability of mind and emotions that may facilitate compassionate care of dying patients, families, and caregivers.

Keywords

End of lifeProfessional educationContemplativeInterdisciplinary
Type
Original Articles
Information
Palliative & Supportive Care , Volume 7 , Issue 4 , December 2009 , pp. 405 - 414
Copyright
Copyright © Cambridge University Press 2009

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References

REFERENCES

American Association of Critical Care Nurses. (2004). Moral Distress Position Statement. Aliso Viejo: Author.Google Scholar
American Nurses Association. (2001). ANA Code of Ethics for Nurses. Silver Spring, MD: American Nurses Association.Google Scholar
Back, A.L., Arnold, R.M., Tulsky, J.A., et al. (2003). Teaching communication skills to medical oncology fellows. Journal of Clinical Oncology, 21, 2433–2436.CrossRefGoogle ScholarPubMed
Barnard, D. (1995). The promise of intimacy and the fear of our own undoing. Journal of Palliative Care, 11, 22–26.CrossRefGoogle ScholarPubMed
Bednash, G. & Ferrell, B. (2000). End-of-life Nursing Education Consortium (ELNEC). Washington, DC: American Association of Colleges of Nursing.Google Scholar
Behnke, M., Reiss, J., Neimeyer, G., et al. (1987). Grief responses of pediatric house officers to a patient's death. Death Studies, 11, 169–176.CrossRefGoogle ScholarPubMed
Browning, D.M. & Solomon, M.Z. (2005). The initiative for pediatric palliative care: An interdisciplinary educational approach for healthcare professionals. Journal of Pediatric Nursing, 20, 326–334.CrossRefGoogle Scholar
Browning, D.M. & Solomon, M.Z. (2006). Relational learning in pediatric palliative care: Transformative education and the culture of medicine. Child and Adolescent Psychiatiric Clinics of North America, 15, 795–815.CrossRefGoogle ScholarPubMed
Chen, S.M. & McMurray, A. (2001). “Burnout” in intensive care nurses. Journal of Nursing Research, 9, 152–164.CrossRefGoogle Scholar
Clark, L., Leedy, S., McDonald, L., et al. (2007). Spirituality and job satisfaction among hospice interdisciplinary team members. Journal of Palliative Medicine, 10, 1321–1328.CrossRefGoogle ScholarPubMed
Cohen-Katz, J., Wiley, S.D., Capuano, T., et al. (2005). The effects of mindfulness-based stress reduction on nurse stress and burnout, Part II: A quantitative and qualitative study. Holistic Nursing Practice, 19, 26–35.CrossRefGoogle Scholar
Connelly, J. (1999). Being in the present moment: Developing the capacity for mindfulness in medicine. Academic Medicine, 74, 420–424.CrossRefGoogle ScholarPubMed
Connelly, J.E. (2005). Narrative possibilities: Using mindfulness in clinical practice. Perspectives in Biology and Medicine, 48, 84–94.CrossRefGoogle ScholarPubMed
Davidson, R.J., Kabat-Zinn, J., Schumacher, J., et al. (2003). Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic Medicine, 65, 564–570.CrossRefGoogle ScholarPubMed
Doka, K. (2002). Disenfranchised Grief: New Directions Challenges and Strategies for Practice. Champaign, IL: Research Press.Google Scholar
Duerr, M. (2004). A Powerful Silence: The Role of Meditation and Other Contemplative Practices in American Life and Work. Northampton, MA: Center for Contemplative Mind in Society.Google Scholar
Emanuel, L.L., Ferris, F.D. & von Gunten, C.F. (2002). EPEC: Education for Physicians on End-of-Life Care. American Journal of Hospice and Palliative Care, 19, 17–18.CrossRefGoogle ScholarPubMed
Epstein, R.M. (1999). Mindful practice. JAMA, 282, 833–839.CrossRefGoogle ScholarPubMed
Ferrell, B.R., Dahlin, C., Campbell, M.L., et al. (2007). End-of-life Nursing Education Consortium (ELNEC) Training Program: Improving palliative care in critical care. Critical Care Nursing Quarterly, 30, 206–212.CrossRefGoogle ScholarPubMed
Ferrell, B.R., Virani, R., Grant, M., et al. (2005). Evaluation of the End-of-Life Nursing Education Consortium undergraduate faculty training program. Journal of Palliative Medicine, 8, 107–114.CrossRefGoogle ScholarPubMed
Figley, C.R. (1995). Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized. New York: Brunner/Mazel.Google Scholar
Fins, J.J., Gentilesco, B.J., Carver, A., et al. (2003). Reflective practice and palliative care education: A clerkship responds to the informal and hidden curricula. Academic Medicine, 78, 307–312.CrossRefGoogle Scholar
Fredriksson, L. (1999). Modes of relating in a caring conversation: A research synthesis on presence, touch and listening. Journal of Advanced Nursing, 30, 1167–1176.CrossRefGoogle Scholar
Fryer-Edwards, K., Arnold, R.M., Baile, W., et al. (2006). Reflective teaching practices: An approach to teaching communication skills in a small-group setting. Academic Medicine, 81, 638–644.CrossRefGoogle Scholar
Galantino, M.L., Baime, M., Maguire, M., et al. (2005). Association of psychological and physiological measures of stress in health-care professionals during an 8-week mindfulness meditation program: Mindfulness in practice. Stress and Health, 21, 255–261.CrossRefGoogle Scholar
Geller, G., Bernhardt, B.A., Carrese, J., et al. (2008). What do clinicians derive from partnering with their patients? A reliable and valid measure of “personal meaning in patient care.” Patient Education & Counseling, 72, 293–300.CrossRefGoogle Scholar
Gundersen, L. (2001). Physician burnout. Annals of Internal Medicine, 135, 145–148.CrossRefGoogle ScholarPubMed
Gunther, M. & Thomas, S.P. (2006). Nurses' narratives of unforgettable patient care events. Journal of Nursing Scholarship, 38, 370–376.CrossRefGoogle ScholarPubMed
Gutierrez, K.M. (2005). Critical care nurses' perceptions of and responses to moral distress. Dimensions of Critical Care Nursing, 24, 229–241.CrossRefGoogle ScholarPubMed
Halifax, J. (2008). Being with Dying: Cultivating Compassion and Fearlessness in the Presence of Death. Boston: Shambhala.Google Scholar
Halifax, J., Dossey, B. & Rushton, C. (2006). Compassionate Care of the Dying: An Integral Approach. Santa Fe, NM: Prajna Mountain Publishers.Google Scholar
Hamric, A.B. & Blackhall, L.J. (2007). Nurse-physician perspectives on the care of dying patients in intensive care units: Collaboration, moral distress, and ethical climate. Critical Care Medicine, 35, 422–429.CrossRefGoogle ScholarPubMed
Han, P.K., Keranen, L.B., Lescisin, D.A., et al. (2005). The palliative care clinical evaluation exercise (CEX): An experience-based intervention for teaching end-of-life communication skills. Academic Medicine, 80, 669–676.CrossRefGoogle ScholarPubMed
Institute of Medicine. (1997). Approaching Death. Washington, DC: National Academy Press.Google Scholar
Institute of Medicine. (2003). When Children Die: Improving Palliative and End-of-Life Care for Children and Their Families. Washington, DC: National Academy Press.Google Scholar
Jezuit, D.L. (2000). Suffering of critical care nurses with end-of-life decisions. Medsurg Nursing, 9, 145–152.Google ScholarPubMed
Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present and future. Clinical Psychology: Science and Practice, 10, 144–156.Google Scholar
Kelly, K., Ersek, M., Virani, R., et al. (2008). End-of-Life Nursing Education Consortium. Geriatric Training Program: Improving palliative care in community geriatric care settings. Journal of Gerontological Nursing, 34, 28–35.CrossRefGoogle ScholarPubMed
Koener, J.G. (2007). Healing Presence: The Essence of Nursing. New York: Springer.Google Scholar
Kvale, S. (1996). Interviews: An Introduction to Qualitative Research Interviewing. London: Sage Publications.Google Scholar
Liao, S., Amin, A. & Rucker, L. (2004). An innovative, longitudinal program to teach residents about end-of-life care. Academic Medicine, 79, 752–757.CrossRefGoogle ScholarPubMed
Marshall, C. & Rossman, G.B. (1989). Designing Qualitative Research. Newbury Park, CA: Sage.Google Scholar
Mealer, M.L., Shelton, A., Berg, B., et al. (2007). Increased prevalence of post-traumatic stress disorder symptoms in critical care nurses. American Journal of Respiratory Critical Care Medicine, 175, 693–697.CrossRefGoogle ScholarPubMed
Meier, D.E., Back, A.L. & Morrison, R.S. (2001). The inner life of physicians and care of the seriously ill. JAMA, 286, 3007–3014.CrossRefGoogle ScholarPubMed
Meltzer, L.S. & Huckabay, L.M. (2004). Critical care nurses' perceptions of futile care and its effect on burnout. American Journal of Critical Care, 13, 202–208.CrossRefGoogle ScholarPubMed
Meyer, E.C., Sellers, D.E., Browning, D.M., et al. (2009). Difficult conversations: Improving communication skills and relational abilities in healthcare. Pediatric Critical Care Medicine, 10, 352–359.CrossRefGoogle Scholar
Miles, M.B. & Huberman, A.M. (1994). Qualitative Data Analysis: An Expanded Sourcebook (2nd ed.). London: Sage Publications.Google Scholar
Mobley, M.J., Rady, M.Y., Verheijde, J.L., et al. (2007). The relationship between moral distress and perception of futile care in the critical care unit. Intensive Critical Care Nursing, 23, 256–263.CrossRefGoogle ScholarPubMed
Moss, M.S., Moss, S.Z., Rubinstein, R.L., et al. (2003). The metaphor of “family” in staff communication about dying and death. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 58, S290–S296.CrossRefGoogle ScholarPubMed
Oberle, K. & Hughes, D. (2001). Doctors' and nurses' perceptions of ethical problems in end-of-life decisions. Journal of Advanced Nursing, 33, 707–715.CrossRefGoogle ScholarPubMed
Ogle, K.S., Mavis, B. & Thomason, C. (2005). Learning to provide end-of-life care: Postgraduate medical training programs in Michigan. Journal of Palliative Medicine, 8, 987–997.CrossRefGoogle ScholarPubMed
Paice, J.A., Ferrell, B.R., Virani, R., et al. (2006). Appraisal of the Graduate End-of-Life Nursing Education Consortium Training Program. Journal of Palliative Medicine, 9, 353–360.CrossRefGoogle ScholarPubMed
Papadatou, D. (2000). A proposed model of health care professionals' grieving process. Omega, 31, 59–77.CrossRefGoogle Scholar
Papadatou, D., Bellali, T., Papazoglou, I., et al. (2002). Greek nurse and physician grief as a result of caring for children dying of cancer. Pediatric Nursing, 28, 345–353.Google ScholarPubMed
Papadatou, D., Martinson, I.M. & Chung, P.M. (2001). Caring for dying children: A comparative study of nurses' experiences in Greece and Hong Kong. Cancer Nursing, 24, 402–412.CrossRefGoogle ScholarPubMed
Pederson, C. (1993). Presence as a nursing intervention with hospitalized children. Maternal-Child Nursing Journal, 21, 75–81.Google Scholar
Pettigrew, J. (1990). Intensive nursing care. The ministry of presence. Critical Care Nursing Clinics North American, 2, 503–508.CrossRefGoogle ScholarPubMed
Power, K.G. & Sharp, G.R. (1988). A comparison of sources of nursing stress and job satisfaction among mental handicap and hospice nursing staff. Journal of Advancde Nursing, 13, 726–732.CrossRefGoogle ScholarPubMed
Rashotte, J., Fothergill-Bourbonnais, F. & Chamberlain, M. (1997). Pediatric intensive care nurses and their grief experiences: A phenomenological study. Heart and Lung, 26, 372–386.CrossRefGoogle ScholarPubMed
Redinbaugh, E.M., Sullivan, A.M., Block, S.D., et al. (2003). Doctors' emotional reactions to recent death of a patient: Cross sectional study of hospital doctors. British Medical Journal, 327, 185.CrossRefGoogle ScholarPubMed
Reich, W.T. (1989). Speaking of suffering: A moral account of compassion. Soundings, 72, 83–108.Google Scholar
Rice, E.M., Rady, M.Y., Hamrick, A., et al. (2008). Determinants of moral distress in medical and surgical nurses at an adult acute tertiary care hospital. Journal of Nursing Management, 16, 360–373.CrossRefGoogle ScholarPubMed
Ruopp, P., Good, M.J., Lakoma, M., et al. (2005). Questioning care at the end of life. Journal of Palliative Medicine, 8, 510–520.CrossRefGoogle ScholarPubMed
Rushton, C.H. (1992). Care-giver suffering in critical care nursing. Heart and Lung, 21, 303–306.Google ScholarPubMed
Rushton, C.H. (1995). The baby K case: Ethical challenges of preserving professional integrity. Pediatric Nursing, 21, 367–372.Google Scholar
Rushton, C.H. (2004). The other side of caring: Caregiver suffering. In Palliative care for infants, children, and adolescents. A practical handbook, Carter, B.S. & Levetown, M. (eds.), pp. 220–243. Baltimore: Johns Hopkins University Press.Google Scholar
Rushton, C.H., Reder, E., Hall, B., et al. (2006). Interdisciplinary interventions to improve pediatric palliative care and reduce health care professional suffering. Journal of Palliative Medicine, 9, 922–933.CrossRefGoogle ScholarPubMed
Scherwitz, L., Pullman, M., McHenry, P., et al. (2006). A contemplative care approach to training and supporting hospice volunteers: A prospective study of spiritual practice, well-being, and fear of death. Explore, 2, 304–313.CrossRefGoogle ScholarPubMed
Serwint, J.R., Rutherford, L.E. & Hutton, N. (2006). Personal and professional experiences of pediatric residents concerning death. Journal of Palliative Medicine, 9, 70–81.CrossRefGoogle ScholarPubMed
Shapiro, S.L., Astin, J.A., Bishop, S.R., et al. (2005). Mindfulness-based stress reduction for health care professionals. Results from a randomized trial. International Journal of Stress Management, 12, 164–176.CrossRefGoogle Scholar
Shapiro, S.L., Schwartz, G.E., & Bonner, G. (1998). Effects of mindfulness-based stress reduction on medical and premedical students. Journal of Behavioral Medicine, 21, 581–599.CrossRefGoogle ScholarPubMed
Stanley, K.J. (2002). The healing power of presence: Respite from the fear of abandonment. Oncology Nursing Forum, 29, 935–940.CrossRefGoogle ScholarPubMed
Strauss, A. & Corbin, J. (1999). Basics of Qualitative Research (2nd ed.). Newbury Park, CA: Sage.Google Scholar
Sullivan, A.M., Lakoma, M.D., Billings, J.A., et al. (2005). Teaching and learning end-of-life care: Evaluation of a faculty development program in palliative care. Academic Medicine, 80, 657–668.CrossRefGoogle ScholarPubMed
Sundin-Huard, D. & Fahy, K. (1999). Moral distress, advocacy and burnout: Theorizing the relationships. International Journal of Nursing Practice, 5, 8–13.Google ScholarPubMed
Ulrich, C., O'Donnell, P., Taylor, C., et al. (2007). Ethical climate, ethics stress, and the job satisfaction of nurses and social workers in the United States. Social Science and Medicine, 65, 1708–1719.CrossRefGoogle ScholarPubMed
Wasner, M., Longaker, C., Fegg, M.J., et al. (2005). Effects of spiritual care training for palliative care professionals. Palliative Medicine, 19, 99–104.CrossRefGoogle ScholarPubMed
Weiss, R.S. (1994). Learning from Strangers: The Art and Method of Qualitative Interview Studies. New York: Free Press.Google Scholar
Weissman, D.E., Ambuel, B., von Gunten, C.F., et al. (2007). Outcomes from a national multispecialty palliative care curriculum development project. Journal of Palliative Medicine, 10, 408–419.CrossRefGoogle ScholarPubMed
Whippen, D.A. & Canellos, G.P. (1991). Burnout syndrome in the practice of oncology: Results of a random survey of 1,000 oncologists. Journal of Clinical Oncology, 9, 1916–1920.CrossRefGoogle ScholarPubMed
Williams, M.A., Lipsett, P.A., Shatzer, J.H., et al. (2001). Experiential, interdisciplinary training in end-of-life care and organ donation. Critical Care Medicine, 28(Suppl): A204.Google Scholar
Zimmerman, J. & Coyle, V. (1996). The Way of Council. Las Vegas: Bramble Books.Google Scholar