Chapter 8: Caring for You! 255 Caring for You! Providing Care for the Dying Will Change You Caring for the dying will touch you and change you. In her book Kitchen Table Wisdom: Stories That Heal, Rachel Naomi Remen says, The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet. (Remen, 1997) There are both positive and negative consequences to pro- viding hospice and palliative care. On the positive side, be- ing with people during their dying process may enhance your enjoyment of living, increase your appreciation of simple things, strengthen your ability to empathize, and increase your awareness of the challenges that people experience. These benefits may increase your capacity to care and may inspire you to face your own challenges with renewed strength and determination. On the negative side, there may be times when your work and the sorrow you witness leave you grieving, sad, and feeling exhausted. You may find yourself grieving the dying person’s losses as though they were your own. You may feel guilty that you are mobile while the person you care for is immobile, and that you are living while they are dying. The purpose of this chapter is to stress the importance of caring for you! You do invaluable work, and you need to care for yourself as well as you care for others. Activities that may nurture and strengthen you include developing strong social support networks; learning and growing through education; and seeking out supervision, counsel- ing, and coaching. In addition, activities that may help you to refuel include stepping back, reflecting, shaking things up, and practicing mindfulness strategies. If your compas- sion is in alignment with your intentions and the work that you do, then your work can energize you rather than deplete your energy. Considering Compassion Fatigue Françoise Mathieu, a mental health counselor and com- passion fatigue specialist, and author of The Compassion Fatigue Workbook (Mathieu, 2012), encourages health care providers (HCPs) to care for themselves as well as they care for others. She works with organizations to help them develop ways to better support their staff. I am hon- ored by Mathieu’s significant contribution to this chapter and thank her for it. Nurses require self-care in order to prevent burnout and compassion fatigue. The term “compassion fatigue” en- compasses the emotional and physical exhaustion that can occur when a nurse (or any other HCP) is unable to refuel and regenerate quickly enough to meet the emo- tional and physical demands of her or his work. Nurses doing this work—providing care for the dying person and their family, and witnessing suffering day after day and year after year—are at high risk of developing compas- sion fatigue. In addition to the demands of the work itself, challenges such as high workloads, insufficient staffing, and policies and procedures contribute to compassion fa- tigue. Self-care can help you withstand the negative ef- fects and benefit from the positive effects of caring for the dying. Without the buffer provided by self-care, you may lose your capacity to provide excellent care for the dying. For example, nurses with compassion fatigue may be impatient, cynical, and irritable, be less sensitive to or less able to empathize with people, and be neglectful or dismissive of the suffering of the dying person and family. Ethics Touchstone Part 1:G. Being Accountable, 5 Nurses maintain their fitness to practice. If they are aware that they do not have the necessary physical, mental or emotional capacity to practice safely and competently, they withdraw from the provi- sion of care after consulting with their employer. Nurses then take the necessary steps to regain their fitness to practise, in consultation with ap- propriate professional resources. Code of Ethics for Registered Nurses (CNA, 2017) 8