Chapter 3: Preparing to Care 29 Preparing to Care Preparing to Care—a Personal Journey I came to hospice and palliative care nursing as a curi- ous child. My earliest recollections of death include a dead rat and a lovely transparent leaf. I tried to nurse both back to life, with no success. When my siblings and I found a dead bird, we opted for burial. As a teen- ager I lived with my Aunt Frankie. Frankie, a nurse, was the master family caregiver. She cared for many family members and friends through aging, illness, and dying. I learned that death is part of life. During high school and university, I encountered death and learned that even the young die. I learned that people die from cancer, accidents, and suicide. When I was in my 20s my father, uncle, and a few dear friends died. I saw severe pain that went untreated and res- piratory congestion that led to distress and anguish. My compassion for the dying grew. While the hospice movement spread globally, I com- pleted my nursing degree. In 1988 I began working at Victoria Hospice, on the west coast of Canada. As a nurse working on the inpatient unit and then as a member of the Palliative Response Team, I worked with health care providers who showed me their incredible skills and compassion. I cared for people who died in the hospice and palliative care unit and those who died at home. I learned to prepare to care as I also learned more about diseases, disease progression, symptom management, and the dying process. I also learned from the dying and their families. They taught me how to be more comfortable talking about death, as well as the importance of sharing informa- tion, responding to questions, and having difficult con- versations. And in walking with dying people on their journey, I learned to put aside my agenda and to try instead to address their concerns and their needs. I learned that I could not fix, but I could companion and I could “be with” suffering. They taught me how to pre- pare for dying. From my colleagues, in particular the nurses, counsel- ors, and physicians, I learned about best practices in symptom management, ways of being, communication skills, and humor. I was fortunate to have colleagues who debriefed after visits and were happy to reflect together to fine-tune and improve care. These inter- actions continue to help me as I prepare to provide care. From early childhood and on through my nursing years, I have been passionate about learning and curious about people, and yearn to provide excellent and com- passionate care—in particular, excellent care for the dying person and their family. Through my practice I have learned the importance of preparing to care. Preparing to Care—an Essential Practice The “journey of the dying” is a metaphor frequently used to describe the path a person follows as they die. Nurses are often companions for people on their journey of dying. As the companion, nurses need to prepare for the journey—to prepare to care. Consider what you need to know, to be, and to have for this particular journey, with this particular person. You might ask yourself, “What will be supportive? Helpful? Needed?” You might wonder, “How do I need to be within myself so that I am able to support this person in their journey and do not try to take them on my journey?” To be a companion on someone’s journey you will need to gather information, acquire skills, and learn ways of being that together will develop into best practice. This chapter will help prepare you to be a companion on some- one else’s journey, by providing the knowledge to develop these skills and ways of being. While this preparation may sound simple, it can profound- ly enhance your capacity to provide care with compassion, confidence, and competence. When health care providers (HCPs) prepare to provide hospice and palliative care, the dying person and family receive excellent care, and the professional minimizes stress and avoids burnout (Caus- ton, 2016; Davies et al., 2016). 3