The widely accepted meaning of compassion is to recognize the suffering of others and then take action to help. Compassion embodies a tangible expression of love for those who are suffering. The concept of compassion involves feeling another person's pain and having a desire to alleviate their suffering. It is related to empathy, sympathy, and altruism, but compassion specifically includes the motivation to help.
In theory, every healthcare professional should not only have the feelings and desire to help reduce another person's suffering but also act on those feelings to “take action to help.” Even so, one of the specialties of nursing where we have the greatest opportunity to help is the field of hospice. Hospice staff meet patients, their families, friends, loved ones, and caregivers (who may be a family member, friend, or loved one) in their darkest hours. Imagine being told by one healthcare provider, “There is nothing more we can do for you; you have less than six months to live” (often less for cancer patients). Can you put yourself in their shoes?
I've had hospice patients and their families tell me the following:
We have no hope now… hospice is all we have left.
There's no one to stand by me; my doctor abandoned me. They told me there was nothing more they could do for me.
No one told me what dying is like. Will I suffer? Will I be in pain? Will I be a burden to my family? I don't want to be a burden to my family. What do I do now?
Why me?
How long will I suffer before I die?
Will you abandon me too (the words not said, but often felt like the elephant in the room)?
Imagine the strength, breadth, and depth of the feelings behind the words, the tears that are shed, including the ones that are kept in, the anger, the resentment of a system that failed them, of a body that failed them, of not even knowing what questions to ask or what is to come next.
Before compassion can become action, one must start to “recognize the suffering of others” … and the “desire to alleviate their suffering.” May I encourage you to start thinking about having empathy towards those who have been given a terminal diagnosis? In doing so, I hope to spark the desire and motivation to act to reduce their suffering and, therefore, show compassion. How do you show compassion?
Compassion is a verb, meaning you must act on your desires and feelings to reduce suffering. Let's discuss what that looks like in hospice.
Compassion Towards the Patient
When someone is sick or hurting, they need much love and care. Compassion is when you understand their feelings and try to help them feel better. There are many ways to show compassion to a patient, but here are some of the most important ones:
Be on their level vs standing above them. When talking to a terminally ill loved one, try to be the same height as them. This can make them feel more comfortable and respected. If they are lying in bed, you can sit next to them or bend down to look at them. You can pull up a chair and sit with them if they are sitting in a chair. This way, you can see their face and hear their voice better, and they can see and listen to you, too.
Appropriate touch if body language shows you can get into “their space.” Sometimes, a patient may want a hug, a pat on the back, or a hand to hold. This can make them feel less alone and more supported. But before you touch them, you should always ask for their permission and look at their body language. They may be okay with touch if they smile, nod, or lean towards you. They may not want touch if they frown, shake their head, or move away from you. You should respect their wishes and touch them only if they are comfortable.
Nonjudgmental looks from one's eyes with the ability to use your body language to demonstrate you can feel their pain and suffering. When you look at a patient, you should show them that you care about them and are not judging them. You can do this by making eye contact, smiling gently, and nodding. You can also use your body language to show them you understand their feelings. For example, you can frown slightly and lower your eyebrows if they are sad. If they are angry, you can raise your eyebrows and open your eyes wider. You can widen your eyes and tilt your head if they are scared. This can help them feel that you are on their side and that you are listening to them.
Active listening and summarizing what they have shared using appropriate quotes from their words. When a patient talks to you, you should listen carefully and heed what they say. You can show them that you are listening by saying things like “uh-huh,” “I see,” or “go on.” You can also summarize what they have said using their own words. For example, if they say, “I'm so tired of being in pain all the time,” you can say, “You're feeling exhausted from the constant pain.” This can help them feel that you heard and understand them.
Asking appropriate questions based on active listening to explore thoughts, feelings, fears, concerns, and chief complaints. When patients share something with you, you can ask them questions to learn more about their thoughts, feelings, fears, concerns, and complaints. You should ask open-ended questions that start with words like “what,” “how,” “why,” or “tell me more.” For example, if they say, “I'm worried about the surgery,” you can say, “What are you worried about?” or “How are you feeling about the surgery?” You should avoid asking yes or no questions that start with words like “do,” “are,” or “is.” For example, instead of saying, “Are you scared of the surgery?” you can say, “How do you feel about the surgery?” This can help them express themselves better and feel that you are interested in them.
Advocating with various parties to maximize comfort. When you care for a patient, you should also speak up for them and help them get what they need. You can do this by talking to others involved in their care, such as doctors, nurses, therapists, or family members. You can tell them what the patient wants, needs, likes, or dislikes. You can also ask them questions, give them feedback, or make suggestions. For example, if the patient is in pain, you can ask the doctor for more pain medication. If the patient is bored, you can suggest some activities or entertainment. If the patient is lonely, you can invite some family members or friends to visit. This can help the patient feel more comfortable and happier.
Compassion Toward the Patient's Family and Loved Ones
When someone you love is sick or hurting, you may feel sad, scared, angry, or helpless. You may also have many questions and worries about what will happen next. You need someone who can understand how you feel and support you. Compassion is when someone does that for you. There are many ways to show compassion to a patient's family and loved ones, but here are some of the most important ones:
Unless there's no choice due to the geography of the environment, if you are meeting family and friends for the first time, let them see your compassion first demonstrated towards their loved one, the patient. Your companion towards their loved one often opens doors to show compassion and build trust with the family. When you meet a patient's family and friends for the first time, you should show them that you care about their loved one, the patient. You can do this by being kind, gentle, and respectful to the patient. You can also tell them something nice or optimistic about the patient, such as how brave, firm, or funny they are. This can make them feel you know and appreciate their loved one and are on their side. This can also help them trust you and open up to you more.
Always be aware that we never have the complete picture of what the family and loved ones have been through up until now, even through the process. Remember that every family and every situation is different. You may not know everything the family and loved ones have gone through before and during the patient's illness. They may have faced many challenges, losses, or changes you are unaware of. They may also have different beliefs, values, or preferences you may not understand. You should always be respectful and curious about their background and experience. You should not assume, judge, or criticize them. You should also not compare them to other families or situations. You should try to learn more about them and their needs by asking them politely and listening to them carefully.
Remember, there are entire sections of any area where people never saw another person die before them. This is all new to them. Death is a challenging and scary thing to face. Some people may have never seen someone die before, or they may have never lost someone they love. This can be very shocking and painful for them. They may not know how to cope or what to do. They may also have many questions, doubts, or fears about death and what happens after. You should be gentle and patient with them. You should not force them to talk or act in a certain way. You should let them express their feelings and thoughts in their own time. You should also try to answer their questions honestly and sensitively or help them find someone who can. You should also reassure them that they are not alone and that you are there to help them.
Always get on the same level as the other person if they are standing, sitting, etc. When you talk to a patient's family or loved ones, you should try to be the same height as them. This can make them feel more comfortable and respected. You can stand next to or in front of them if they are standing. You can sit next to or across from them if they are sitting. You can sit or kneel beside them or lean over them if they are lying down. This way, you can see their face and hear their voice better, and they can see and hear you.
While actively listening to them and appropriately summarizing, ask questions including the velocity of change (for the clinical side to judge estimated life left) and relational questions (tell me what matters most). When a patient's family or loved ones talk to you, you should listen carefully to what they say. You can show them that you are listening by saying things like “uh-huh,” “I see,” or “go on.” You can also summarize what they have said using their own words. For example, if they say, “I'm so worried about how much time he has left,” you can say, “You're feeling anxious about his life expectancy.” This can help them feel that you heard and understand them. You can also ask them questions to learn more about their situation and feelings. You can ask them about the velocity of change, which is how fast or slow the patient's condition changes. This can help you estimate how much time the patient has left and plan accordingly. You can also ask them about relational questions, which help you know more about their relationship with the patient. For example, you can ask them, “What do you love most about him?” or “What are some of your favorite memories of him?” This can help them remember the good times and celebrate the patient's life.
Advocate for their concerns if appropriate for and towards their loved one. When you care for a patient's family or loved ones, you should also speak up for them and help them get what they need. You can do this by talking to others involved in the patient's care, such as doctors, nurses, therapists, or social workers. You can tell them what the family or loved ones want, need, like, or dislike. You can also ask them questions, give them feedback, or make suggestions. For example, if the family or loved ones are worried about the patient's pain, you can ask the doctor for more pain medication. If the family or loved ones are confused about the patient's treatment, you can ask the nurse for more information. If the family or loved ones are stressed about the patient's finances, you can ask the social worker for more resources. This can help the family or loved ones feel more comfortable and confident about the patient's care.
Compassion Towards the Caregivers
When caring for a sick or dying person, they may feel tired, stressed, sad, or angry. They may also have many questions and worries about what will happen next. They need someone who can understand how they feel and support them. Compassion is when you do that for them. There are many ways to show compassion to the caregivers, but here are some of the most important ones:
Let them see your compassionate actions towards the patient. When you care for a patient, you should show them that you care about them and their well-being. You can do this by being kind, gentle, and respectful to the patient. You can also tell them something nice or optimistic about the patient, such as how brave, firm, or funny they are. This can make the patient feel better and more comfortable. It can also make the caregivers think you are on their side and doing your best for the patient. This can help them trust you and appreciate you more.
Include the caregivers in the advocacy process and to the degree you know they will not interfere with the patient's wishes and power of attorney in the decision-making process. When you care for a patient, you should also speak up for them and help them get what they need. You can do this by talking to others involved in the patient's care, such as doctors, nurses, therapists, or social workers. You can tell them what the patient wants, needs, likes, or dislikes. You can also ask them questions, give them feedback, or make suggestions. You should also include the caregivers in this process as long as they respect the patient's wishes and rights. You can ask them what they think, feel, or want for the patient. You can also listen to their opinions, concerns, or suggestions. You can also explain to them what is happening, why it is happening, and what the options are. This can help the caregivers feel more involved and informed about the patient's care. It can also help them feel more respected and valued in the care team.
Always know they are a part of the care team, and do your best not to consider them separate from the team. When you care for a patient, you should not think of yourself as the only one who can help them. You should also recognize and appreciate the role of the caregivers. They are the ones who know their residents best, who spend the most time with them, and who love them the most. They are also the ones who face the most challenges, sacrifices, and losses. They are not just bystanders or helpers but essential care team members. You should treat them as such. You should respect their knowledge, skills, and experience. You should also support their needs, goals, and dreams. You should work with them, not against them or above them. You should also thank them for their hard work, dedication, and love. This can help the caregivers feel more appreciated and recognized for their contribution. It can also help them feel more confident and empowered as caregivers.
Talk to them about their concerns for the patient's care, actively listen, and then act on those cares through education or advocacy. When you talk to the caregivers, you should not only focus on the patient's condition, treatment, or prognosis. You should also ask them about their feelings, thoughts, and worries. You should listen to them carefully and pay attention to what they say. You should show them that you are interested and concerned about them. You should also try to help them with their concerns by educating them or advocating for them. For example, if they are worried about the patient's pain, you can explain how pain is measured and managed. If they are worried about the patient's finances, you can help them find resources or assistance. If they are worried about the patient's quality of life, you can help them find ways to make them more comfortable or happy. This can help the caregivers feel that you care about them and their problems. It can also help them feel more informed and supported in their caregiving role.
In every case, validate the feelings of each person. Spend time with them. If your visits only involve vitals and physical assessment, then please spend time with them to get to know the person for whom you are serving. Actively listen to their stories and validate their feelings, and you will be amazed at the outcomes, which include, but are not limited to, increased trust in your care, which allows you to provide better care. When you visit a patient and their caregivers, you should not only focus on the medical aspects of the patient's care. You should also spend time with them as human beings. You should get to know them as individuals, not just as patients or caregivers. You should ask them about their lives, interests, hobbies, and dreams. You should also share some things about yourself, such as your background, passions, and goals. You should also listen to their stories, memories, hopes, and fears. You should validate their feelings, whether they are positive or negative. You should not judge them, criticize them, or dismiss them. You should acknowledge them, accept them, and empathize with them. This can help the patient and the caregivers feel that you see them as more than their illness or role. It can also help them feel that you respect them, like them, and trust them. This can lead to a stronger bond and a better relationship between you and them. It can also improve the quality and effectiveness of the patient's care.
Conclusion
Compassion is when you understand how someone feels and try to help them feel better. Compassion is especially important when you take care of someone who is sick or dying. You can show compassion to the person who is sick, their family, and their caregivers. You can do this by listening to them, touching them gently, and speaking up for them. The article “Demonstrating Compassion” tells you how to do this well. The article also tells you how compassion can make an enormous difference in the lives of people who are sick or dying. The article can teach you many things about compassion and hospice care. The article can also inspire you to be more compassionate and caring to others. The article shows you that compassion is the best way to take care of people who are sick or dying. Compassion is the best way to show them that you care and that they are not alone.
