Mind/Body/Spirit

Helping caregivers cope with death

In 2004, our Pediatric Intensive Care Unit (PICU) was experiencing a cluster of particularly painful patient deaths, bringing home the reality that over 80% of pediatric hospital deaths occur in the ICUs. The staff was feeling battered by the suffering and loss—and very close to burnout. All agreed that their university training hadn’t prepared them to tolerate so much death, day after day, in a profession of healing.

The idea of creating a retreat to help PICU staff members began after I returned from an eight-day Being With Dying workshop for healthcare professionals. We started assessing what it would take to offer a one-day retreat for pediatric nurses, physicians, respiratory therapists, social workers, chaplains, interpreters, and unit assistants. And in October 2004, we had our first quarterly, daylong retreat taught by the nationally recognized meditation teacher and psychotherapist, Trudy Goodman. Our eighth retreat was just held in October 2006. Between 22 and 32 health professionals have attended each session.

How it works

Our retreats have been successful largely because of the training and experience of the teacher, who radiates acceptance and kindness. The retreat day includes meditations of Mindfulness, Balance, and Nine Contemplations as well as experiential exercises, discussion before and after meditation, periods of silence and, ultimately, the grief work that naturally arises in the safety of the group with a highly skilled facilitator. Mindfulness, or insight, meditation is a cognitive behavioral intervention that can be applied to any situation. Its origins go back 2,500 years to Buddhist psychology.

Although contemplative wisdom is part of every religion, the practice of mindfulness is unique to Buddhism. At the retreat, this aspect of mindfulness meditation is presented in its historical context—separate from religion—to allay any concerns about a “religion-based” practice.
Actually, a secular approach to mindfulness meditation was established in the late 1970s by Dr. Jon Kabat-Zinn at the University of Massachusetts, Worcester. This approach focuses on integrating mindfulness meditation into the challenges of everyday life. Some of our early retreat participants confessed a reticence because of the “Buddhist dimension.” After the retreat, however, they said they felt very comfortable connecting the mindfulness experience to their own personal beliefs. Others needed mindfulness meditation to be firmly science-based, and the secular presentation has satisfied their needs.

What they say


The evaluations by retreat participants have been overwhelmingly positive. Of the nearly 200 professionals who have attended the retreat, only one would not recommend it to co-workers, and two said they were dissatisfied with it. All other respondents have said they would change nothing about the retreat (except the uncomfortable chairs). They felt nourished, would enthusiastically recommend the retreat to others, and would like to attend more mindfulness retreats.

Here’s a sample of the comments we’ve received:
“Thank you so much for making this available for hospital caregivers. I feel very well taken care of and more at peace with my work than I have for quite a while.”
“I found this to be helpful because there was an ability to hear from others and to be heard. The meditation brought a new element of learning.”
“I am very grateful that this was available—It does help.”
“I would recommend this to the entire hospital, over and over again.”

On-going benefits

Word-of-mouth has opened the retreat to professional staff throughout the hospital, beyond the PICU. The number of participants who return for subsequent retreats has increased. And the number of professionals who cite stress, burnout, or “compassion fatigue” as reasons for leaving their positions at the hospital has decreased. Many find that the retreat provides tools to help work within themselves to find peace, balance, and strength. Some nurses meditate on their own, taking just 5 or 10 minutes regularly to stay grounded. Others incorporate the “metta” or loving-kindness practice, focusing on small phrases as they work as a way to stay open to self-compassion and to the experience of others, rather than shutting down. Many have found that mindfulness in clinical practice shows itself in how they tolerate difficulties and how they maintain nonjudgmental attention to their moment-by-moment experience.
For nurses, physicians, social workers, and respiratory therapists at Children’s Hospital Los Angeles, participation in the retreat also means continuing education credit.

On-going challenge

By far, the greatest challenge to starting the retreat program was securing funding. Expenses include the costs of registration, packet materials, and CDs as well as the costs of an outside facility and the teacher. Our initial retreats were supported by education funds and donations from the community. One small family foundation generously provided start-up funding. Another small foundation donates on-going funding. Retreat participants now pay a $30 fee, but no one is turned away because of financial need. To expand the project to help other hospitals implement the training, to produce a manual, and to perfect data collection and interpretation require more resources than we have available…at least for now. For more specific information about the retreat, contactCatherine Klatzker at Cklatzker@chla.usc.edu.

Recommended resources

Carter B. Palliative Care for Infants, Children, and Adolescents: A Practical Handbook. Baltimore: Johns Hopkins University Press; 2004.

Coberly M. Sacred Passage: How to Provide Fearless, Compassionate Care for the Dying. Boston: Shambhala; 2002.

Halifax J. Compassionate Care of the Dying. Santa Fe: Prajna Mountain Publications; 2005.

Kabat-Zinn J. Full Catastrophe Living. New York: Delta/Bantam; 1990.

Keating T. Open Mind, Open Heart: The Contemplative Dimension of the Gospel. New York: Continuum; 2000.

Lipson J. Culture and Nursing Care. San Francisco: UCSF Nursing Press; 1996.

Longaker C. Facing Death and Finding Hope. New York: Main Street Books; 1997.

McCallum D. How children die in hospital. J Pain Symptom Manage. 2000;20(6):417-423.

http://www.aacn.org/AACN/NTIPoster.nsf/vwdoc/2006CSCKlatzker

http://www.centering.org/

http://www.insightla.org/. (Trudy Goodman meditation teacher and psychotherapist.)

http://www.umassmed.edu/cfm. (Center for Mindfulness in Medicine, Health Care and Society.)

http://www.upaya.org. (Being With Dying workshop for healthcare professionals by Roshi Joan Halifax, Santa Fe, New Mexico.

Catherine Klatzker, RN, is a Staff Nurse, Clin III, at Childrens Hospital Los Angeles.

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