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Confronting + Improving Healthcare Practices

Cultivating Compassionate Presence by Kirsten DeLeo

Offering skills training for healthcare professionals in compassion, mindfulness and meditation is an important part of the work of the Spiritual Care Programme. Here, Kirsten DeLeo describes her experience of offering inservice training to doctors and other staff at a major children’s hospital in the United States. Rosamund Oliver and Margaret Tatham from the Programme will offer a two-day training on Compassion and Presence in Health and Social Care on 26-27th October.

Kirsten Deleo
International Educator
Spiritual Care Programme 

Dr. Angela Anderson, a paediatrician at Hasbro Children’s Hospital in Providence, Rhode Island, is sitting with a group of her colleagues. She shares her experiences of caring for terminally ill children and responding to grieving parents. “No words of comfort can reach the parents or take away their pain when they lose their baby. I kept asking myself, What can I offer when nothing else can be done? I was trained to do, to fix... I felt helpless and inadequate.” As I listen to Dr. Anderson and her colleagues discussing the challenges that they face, my heart goes out to them. From my own experience in hospice care, I can relate to their feelings of helplessness and inadequacy—anybody who works as a carer can.

I met Dr. Anderson in 2011, during a weeklong residential session of the Spiritual Care Programme’s Contemplative End-of-Life Caretraining. You could feel that she was passionate about her work and cared deeply about her patients, and she was determined to seek answers to her questions. She found that the course, which includes basic meditation techniques and training in compassion, as well as exercises in communication, supported her in her life and enhanced her own clinical skills. The following year, she invited me to offer a series of one-day training sessions to her colleagues at the hospital.

These sessions was specifically designed for the first-year resident doctors, to give them practical tools to improve their confidence in communicating with young patients and their distressed parents, and to help the doctors to manage their own emotional responses. We decided to open up the training to other interested staff as a way to foster a greater sense of community across disciplines. Along with the first-year residents, the groups included physicians from other departments, nurses, social workers and child life specialists—all of them seasoned clinicians. A number of medical students, administrators, chaplains and a young mother also joined the training. She had lost her child and now worked as a parent advocate alongside the medical team. Very few of those who attended had any prior experience of meditation.

As neuroscientific research now confirms, witnessing suffering is itself a true experience of suffering. Similar areas of the brain are activated both in the person who is in distress and in the observer who witnesses what is happening. It is tempting to conclude from this that in order to safeguard our own well-being and be more effective as caregivers, we would be better off distancing ourselves from the pain and suffering of our patients. But studies have also shown that clinical detachment is neither effective for ensuring good care, nor a realistic strategy for preventing burnout. In fact, science is indicating that the secret to building resilience and enabling us to respond more effectively to others’ needs seems to lie in our ability to cultivate altruistic compassion, and to combine this with mindful awareness.

What is exciting about this research is that it provides a new framework for professional education and validates the main principles and practices that we have been teaching in the Spiritual Care Programme over the past twenty years. These latest studies confirm what has long been practised in the Buddhist tradition and known by many experienced clinicians: that a compassionate, unafraid and open presence is our most effective resource—and this is something that we can develop.

"I was astounded when I realized that being present is actually a skill that I can learn and practise,” Dr. Anderson explained to her colleagues. “My meditation and the practice of extending loving kindness helped me to gently befriend myself and accept my feelings. It is an on-going process. I am learning to show up in these extremely painful situations because I am more in touch with myself. Believe me, these situations have not become any easier, just more workable. I’m a big talker, and it is still hard to listen and receive in silence. But my confidence in offering my presence and heart is growing. To be present in those heartbreaking moments, I know I am offering the best of me to my patients. This does not deplete me. It nourishes me.”

When I invited Dr. Anderson’s colleagues to share their own experiences, it became clear that the younger clinicians set extremely high expectations for themselves. In the midst of an incredibly demanding work environment, they had a fear of appearing vulnerable, and felt the need to bury their own emotions. One admitted, with disarming honesty, “It is often easier to feign compassion and listening rather than to show up.” Another resident added, “I’m always thinking about what I have to do next, so I’m never really fully there in the moment.” After a long pause, a young doctor ventured, “It is tough just to be when you don’t know what to say.” As many of the other group members nodded, he continued, “It’s hard to allow myself to forgive and accept how I am. Being in the medical profession, it is common to never accept who you are, and try to be ‘better’.” Another resident explained, “I think it is tempting to distance yourself from a patient and make them a group of symptoms and diagnoses. However, that’s not what we’re called upon to do, since the patient is looking for healing, not just treatment.”

The Spiritual Care approach embraces both the whole person who suffers and the whole person who offers care. This view recognizes our fundamental essence or wholeness, and our human qualities and inherent capacity for healing, which we can unlock and come in touch with through meditation and compassion training. One does not have to become a Buddhist or an experienced meditator to benefit from these practices.

The way we talk to patients and clients, the way we touch and look at them, the whole quality of our presence, can make them feel understood and remind them of their sense of purpose and meaning. “In meditation, I am learning to be aware of myself, my emotions and states of mind, and how that might be projected onto my patients during a clinical encounter,” recognized one resident.

On each training day, and at the start of each session, we begin by checking our motivation and attitude, and if necessary adjust it. Establishing a compassionate motivation clearly in our minds helps to reinforce and sustain a caring attitude, especially when things get tough. To develop this new habit, we need reminders—plenty of them. For example, using the hand sanitizers next to each hospital room can serve as a reminder to settle our mind and set our intention for the visit. “Foam up, breathe, motivate!” was how one participant jokingly described the experience. Having tried it out, a child-life specialist reported, “I have been able to sit back and think about each action I am doing, especially the simple ones, and enjoy them. I used to be so frustrated with things I had to get done and it just got burdensome. I have really learned to slow down and become happy in whatever I am doing.”

Over the course of the training, the participants said they had gained a greater sense of awareness, acceptance and kindness for themselves. This in turn gave them more confidence to drop the self-protective guards and be authentically available for others. One of the residents said, “My experience with truly listening to another person has improved. I am learning how to open myself—to be receptive—accepting others’ stories instead of just waiting to ask a question or complete an objective.” Another said, “I have learned that just being present with someone can be enough, and having an open, caring attitude can be beneficial. I don’t always have to do something.”

One nurse had to go straight back to work after the second training session. “I was able to use some of what I learned that very night at work,” she said. “I was present for a mother whose son was in the trauma room. Her son had suddenly stopped breathing and had collapsed on the floor, and our team rushed to take care of him. The mother was distraught, to say the least. In the past I think I would have felt like I didn’t know what to say, but this time I approached her with confidence, just knowing that she needed someone to be with her at that moment.”

Feeling a sense of connectedness to the person we care for is essential. As one of the integration tasks, I ask the group to stop for a minute each day and view the patient in front of them as ‘just another you’, as just another human being with the same hopes and the same fears; and, as the next step, to put themselves in the patient’s shoes. In the next session, one of the third year residents said, “The biggest learning for me was that my patients and their families are really like myself. They need compassion, love and understanding. Keeping this in mind really has resulted in better care and health for my patients and myself.” One of the younger doctors ventured that “the purpose of understanding the other may not be to deconstruct their behavior, but to better understand the way our behavior impacts their lives.”

Being with these young doctors and their colleagues, it struck me more than ever before that we really need help to cultivate compassionate presence and maintain our passion for caring for our patients. We also need support to nurture the strength of heart to remain present in the face of suffering, particularly in the most difficult times. This passion and strength can easily be worn down or even crushed by the daily grind of our healthcare system. At the same time, it was clear that taking the time to learn these contemplative methods and listening skills helps not only to build a sense of connectedness with patients, but also with colleagues and other healthcare practitioners. As one of the medical educators in the group said, “This time gives me a sense of hope for the future of healthcare. A healthcare system where the care is integral to health and healing.”


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