Non-Pharmacologic Interventions for Pain & Anxiety:  Enhancing Skills for End-of-Life Comfort Care

Kate Dean-Haidet, PhD, RN, PMH-CNS from OhioHealth Hospice and I, (Sharon Stout-Shaffer, PhD, RN Professor Emeritus Capital University, Nursing Education Specialist S4NetQuest) are presenting the results of a pilot study at the AHNA annual conference this year.

This pilot study addressed two significant needs to improve hospice caregiving. First is strengthening the Therapeutic Capacity of hospice caregivers by learning and practicing holistic self-care. Second is teaching caregivers non-pharmacologic interventions that can be used with patients and families to promote comfort and relieve psychophysiological pain, anxiety and the intrinsic existential suffering that accompanies dying.

Aim & Objectives: The Aim of this project was to test an educational intervention for staff and obtain pilot data to support grant funding for a larger research project to transform hospice caregiving.

  1. To increase professional caregiver awareness of personal response to the stresses of end-of-life caregiving and practice specific self-care behavior.
  2. To enhance the Therapeutic Capacity of professional hospice caregivers through practice of contemplative self-care strategies and centering.
  3. To provide professional caregivers interventions to mitigate the “total pain” and suffering at the end-of-life.

Method: A 10-week educational intervention was provided to 86 interdisciplinary hospice caregivers at a large Midwestern medical center. Self-care strategies taught to participants were selected because they can be easily adapted to use with patients to promote comfort. Centering was a foundational strategy and other stress self-regulation strategies included breathwork, imagery, hand-heart, hand massage and movement.

Findings: Outcome measures include the Professional Quality of Life, Brief Resiliency Inventory and rich narrative data on self-care, development of Therapeutic Capacity, difficulties experienced integrating self-care into behavior and the impact of practicing non-pharmacologic interventions with patients and families.  Data is currently being analyzed.

Conclusions & Implications: Preliminary data suggests the program has been extremely helpful to in promoting personal self-care and building an organizational culture of self-care. Additionally, staff report significant changes in their ability to support patients and families during this profound transition. The program is applicable to interdisciplinary teams and other areas all of practice.

Norman Olsen’s Insight on Self-Reflection

Self-Reflection: Foundation for meaningful nursing practice


Florence Nightingale lived a life of reflection.


By Norman C. Olsen

How to gain wisdom and connect with truth and your inner self are important topics for nurses to explore. Ralph Waldo Emerson wrote, “None of us will ever accomplish anything excellent or commanding except when he listens to this whisper which is heard by him alone.” Self-reflection looks inward and listens to the whispers. Lautebach and Becher (1996) relate self-reflection to caring for the self. Purposeful reflection is a tool that helps nurses gain self-knowledge and insight (Palmer, 2007).

When nurses reflect, they purposefully “bend back” their attention in a focused attempt to discover personal meanings gained from professional nursing encounters and interaction with others. Lautebach and Becher suggest that self-reflection is a critical activity for nurses in their caring for others and, because it connects those who practice it with their inner selves and truth, is transformational. The Chinese philosopher Confucius (551-479 B.C.) wrote, “By three methods we may learn wisdom: first, by reflection, which is noble; second, by imitation, which is easiest; and third by experience, which is the most bitter.”

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