“ELEPHANTS WITH PEARLS”

1. “ELEPHANTS WITH PEARLS” As you do unto others do unto self Dale Massender

2. Presentation Themes • Did I do enough? Am I making a difference? Moral Distress? • Compassion Fatigue • Self-Care

3. A Gaelic Blessing Deep peace of the running wave to you. Deep peace of the flowing air to you. Deep peace of the quiet earth to you. Deep peace of the shining stars to you. Deep peace of the gentle night to you. Moon and stars pour their healing light on you. Deep peace to you.

4. “Not all of us can do great things. But we can do small things with great love.” Mother Teresa

5. “Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around. It’s overwhelming to consider the continuous opportunities there are to make our love felt.” Leo Buscaglia

6. “Speak tenderly to them. Let there be kindness in your face, in your eyes, in your smile, in the warmth of your greeting. Always have a cheerful smile. Don’t only give your care, but give your heart as well.” Mother Teresa

7. Compassion is our sympathy for the suffering of others and the desire to free them from it. • Compassionate Presenceincorporates an intention to openness, to connection with others, and to comfort with uncertainty.

8. “The clinician who listens intentionally and with full presence creates an environment of trust, where the patient, sensing respect, and dignity, can share what is of deep concern. In so doing, the patient can find the understanding and clarity in which healing becomes an opportunity… Healing can be defined as the patient finding a way to cope with suffering, or a way to utilize his or her beliefs to feel better, or make the appropriate adjustments in their life to find peace and wellbeing. It can result in a greater sense of coherence, meaning and purpose. It may also impact on resilience and buffer against the negative effects of stress.” (“Spirituality as an Essential Domain in Palliative Care: Caring for the Whole Person”, Christina M. Puchalski, An Editorial.)

9. Practicing Compassionate Presence is about listening - listening empathically.

10. “I think three things are involved. We must reach out to a person, make contact. We must listen with the heart, be sensitive to the other’s needs. We must respond in a language that the person can understand. Many of us do all the talking. We must learn to listen and to keep on listening.” Princess Pale Moon

11. “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. This sort of denial is no small matter. The way we deal with loss shapes our capacity to be present to life more than anything else. The way we protect ourselves from loss may be the way in which we distance ourselves from life… We burn out not because we don’t care but because we don’t grieve. We burn out because we’ve allowed our hearts to become so filled with loss that we have no room left to care.” Rachel Naomi Remen, “Kitchen Table Wisdom”.

12. Compassion Fatigue is a condition characterized by a gradual lessening of compassion over time.

13. “Slow me down, Lord! Ease the pounding of my heart by the quieting of my mind. Steady my hurried pace with a vision of the eternal reach of time. Give me, amidst the confusion of my day, the calmness of the everlasting hills. Break the tension of my nerves with the soothing music of the singing streams that live in my memory. Help me to know the magical restoring power of sleep. Teach me the art of taking minute vacations of slowing down; to look at a flower; to chat with an old friend or make a new one; to pat a stray dog; to watch a spider build a web; to smile at a child; or to read a good book. Remind me each day that the race is not always to the swift; that there is more to life than increasing its speed.” Orin L. Crane

14. “How to Love and Care for Yourself Unconditionally.” • Accept that self-care isn’t selfish. It’s vital to our happiness and our holistic wellbeing. • Manage time effectively. Time management is essential. • Learn how to say “no” comfortably and confidently. • Set limits. I am not always available. • Live, love, and laugh every day. Yolanda G. Smith

15. “The secret to self-care is planning.” • The only thing I can change is myself.

16. “Seven Elements of a Balanced Life” • Emotional and mental self – get in touch with your feelings and express them more freely • Finances – believe you can create greater prosperity • Intimacy – experience more caring and trust in intimate relationships • Physical body – learn to love and care for your body • Relationships – commit to more authentic and honest communication • Soul and spirit – develop a vital and personal spiritual path • Work and career – balance the drive for success with your personal life Source: American Nurse Today, 2013.

17. “Life without silent space is not life at all. If we’re accustomed to leave the TV on in empty rooms while we work to the blur of the sounds it siphons through the house or we can’t wash dishes without the radio playing; if we’re never alone for a minute of the day and we never just stand and watch a flower grow; if we can’t drive across town without the car tape recorder blaring and if sitting in a chair in silence for thirty minutes a day simply thinking, thinking, thinking is one of the more painful possibilities we can imagine, then silence may be exactly what we need to wash away the frenetic energy of life and still its storms.” Joan D. Chittister

18. Strategies for managing the stress of being involved in emotionally demanding patient or family situations. • Practice mindfulness in the moments you have (eg. while hand-washing before seeing a patient, take slow deep breaths, think of a loved one, recite a favourite line, say a prayer, or imagine you are in a favouriteplace). • Stop to look out a window, or as you walk outside take time to notice something in nature or in your environment; fully attend to it for even a few moments.

19. Make connections with patients, family members, or colleagues; this can be through humour or by noticing something about the other person or his or her environment. • Reward yourself after completing tasks or resolving situations. • Deliberately shed your role when you leave work and do not take it home with you. • Use community resources and other professionals to help meet the needs of complex situations, as one person cannot meet the needs of a whole family. With a “team approach” members can be supportive of one another.

20. Know your limits. This involves not only medical limits (i.e. when to refer) but also with difficult situations with family dysfunction, mental illness, or refractory symptoms – cases in which it is challenging to achieve good outcomes no matter how hard you try. • Learn from your experiences. Use challenging situations to motivate yourself to acquire new knowledge, skills, or attitudes. • Do what relieves stress (eg. exercise, visit with friends, play sports).

21. Practise reflective writing or keep a diary. • Learn and practice mindfulness meditation. • Have a special place you like to visit as a “getaway.” “Compassion Fatigue”, Romayne Gallagher, MD CCFP FCFP, Canadian Family Physician, March 2013, Vol. 59 (3) pages 265- 268. (Adapted from Tedeschi and Calhoun).

22. Take Home “Pearls” • As you do unto others do unto self. • As you practice compassionate presence with others do the same with yourself. • You can’t be compassionately present with others if you haven’t been compassionate with yourself.

23. A Gaelic Blessing Deep peace of the running wave to you. Deep peace of the flowing air to you. Deep peace of the quiet earth to you. Deep peace of the shining stars to you. Deep peace of the gentle night to you. Moon and stars pour their healing light on you. Deep peace to you.

24. “Thank You!” Blessings and Peace Dale