Growing from the San Francisco AIDS crisis in 1987, the Zen Hospice Project's Guest House in Hayes Valley opened in 1990. Building on the tradition of volunteers, the Zen Hospice Project partnered with Laguna Honda Hospital to serve more than 14,000 hours annually on the 60-bed hospice and palliative care floor. The organization has been recognized as an innovative leader, providing care for those facing advanced illness and their loved ones, while educating and supporting an ever-growing community of caregivers worldwide.
The mission of Zen Hospice Project in San Francisco is to change the experience of dying and caregiving through a human-centered model of care. Over the last 30 years, Zen Hospice developed a unique approach to caregiving, designed to reduce suffering in both patients and caregivers, and increase long-term resilience in both professional and family caregivers.
When the emotional and spiritual needs of both patient and caregiver are considered, caregiving at end of life can be mutually beneficial. When these needs are addressed, the typically overwhelming impacts of providing care to the seriously ill can be minimized, and the activity of caregiving itself can become an opportunity for personal development. Mindfulness offers a tool and strategy to support mutual understanding and encourage personal growth.
Mindfulness is intentional awareness of one's inner experience as well as the external environment. It is the inclination to be with things as they are. Through mindfulness practice, one can cultivate the ability to maintain awareness in each unfolding moment, regardless of the circumstances, and without judgment. The term "practice" is not used casually: maintaining open awareness, especially in the often-chaotic healthcare environment, requires considerable effort.
Clinical caregivers take on enormous responsibility in caring for the seriously ill. In addition to the constant physical and emotional needs of their patients, they must face recurring loss and grief every time a patient dies. When not addressed effectively, these detrimental stresses, inherent to the responsibility of caregiving, can accumulate, leading to burnout, compassion fatigue, and clinical errors.
The ability to maintain presence and open awareness in the midst of stress and human suffering is an invaluable tool. Mindfulness has the potential to focus the mind, relax the body, and open the heart, supporting caregivers to minimize errors, improve assessment skills, increase their general sense of well-being, and connect deeply with patients, families, and colleagues. Evidence is building to demonstrate the potential for mindfulness practices to decrease the frequency of clinical errors, increase patient satisfaction, and improve work satisfaction (Anthony & Vidal, 2010; Cohen-Katz et al., 2005; Horner et al., 2014; Mackenzie et al., 2006). Mindfulness practice develops resiliency, decreasing the risks associated with overwhelming and continuous stress.
In 1987, Zen Hospice Project began training professional and volunteer caregivers to provide mindful, compassionate bedside care and to practice techniques for self-care. The core tenets of this Mindful Caregiver Education (MCE) include compassionate self-awareness, nonjudgmental presence, and resilient responsiveness to the present-moment demands of providing care. Over the years, thousands of caregivers, including family members, volunteers, and professional staff have taken part, offering countless testimonials about the effectiveness of the MCE program. Nurses and nurse aides at Zen Hospice take part in MCE classes as part of their orientation. They are encouraged and supported to join further classes offered to family caregivers and the public. Nursing staff practicing mindful compassionate presence act as role models to others and help support each other to manage the many demands and risks of professional caregiving.
Mindfulness courses offer an opportunity to rest the mind in each unfolding moment. Course participants are encouraged to practice staying present to their emerging experience of learning and being. Basic meditation instruction is offered during periods of quiet contemplation. Participants are supported to find their own way of settling their minds and bringing attention to their immediate inner and outer experiences. At the end of all the courses, participants leave with practical ways to integrate mindfulness into their daily activities at work and at home.
Cultivating compassionate presence goes hand in hand with mindfulness. Each course includes modules that help explore individual personal barriers to experiencing compassion, and teach ways of maintaining compassion in the context of caregiving. Participants examine the common problem of "compassion fatigue" and ways of preventing it. This approach to cultivating compassion is built upon both the current scientific research and diverse wisdom traditions.
Based on many years of providing care for persons facing terminal illness, course leaders support participants in a deep inquiry into their relationship to death: both general loss and their own mortality. Professional experience shows that when caregivers' attitudes and emotional responses to death go unaddressed, they can impact caregiving in unpredictable ways. Caregivers may unconsciously ascribe their own emotional responses onto their patients for whom they are caring. This can occur for family caregivers, volunteers, and professionals alike. To reduce this risk and encourage mindful caregiving, the courses form a safe space for participants to honestly face their own emotions and assumptions regarding impermanence and change, and to acknowledge the importance of attending to their own eventual demise through advance directives and conversations with loved ones. Through instruction, exercises, and facilitated sharing, course participants are supported to become leaders capable of and comfortable with addressing the myriad issues that arise when facing the inevitability of death.
Ultimately, through the broad category of self-care, the role of intention, ethical orientation, personal ritual, and somatic expression in building caregiver resilience is examined. Course modules are created to teach, inspire, and compel caregivers to design their own self-care approach based on their unique needs and caregiving circumstances.
At Zen Hospice Project, the MCE program is making a difference in the lives and work of caregivers. Course participant surveys consistently demonstrate the value and impact of the program. Ninety-four percent (94%) of course participants report they would recommend an MCE course to a colleague and 91% have indicated that the course would change the care they provide.
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