Quality Caring
for living-dying
Dr. Vidette Todaro-Franceschi
nurse, educator, author, speaker, and researcher
for living-dying
nurse, educator, author, speaker, and researcher
In much of my work I have changed the term quality of life to quality of living-dying, in order to emphasize that quality of life is really about the quality of living a life and that, of necessity includes the quality of one’s death, or more accurately the quality of living while dying (or for that matter the quality of dying while living). We do a serious disservice to ourselves by trying to negate the fact that all living things die.
Quality of living-dying encompasses all aspects of our lives which are transformed on a moment-to-moment basis through the continual movement of us in and with our environment. The whole is “us,” or “we”; it is never simply “I” or “me” because we are not separate from our environment. It is all essentially one.
Professional quality of life (PQOL) is a catch all term that refers to the quality of our work lives. The majority of people spend more time throughout their adult lives at work, working, than they do anywhere else, doing anything else. How we go to work transforms our quality of living-dying and how we live transforms our PQOL.
Psychologists have been studying PQOL for many years and one whose work aligns closely with my thinking is that of psychologist and scholar Beth Stamm. There is an abundance of material related to Stamm’s work on her website. She has also developed a reliable tool to measure PQOL. The ProQOL tool is comprised of 3 subscales, all reflective of behavioral manifestations indicative of compassion satisfaction, compassion fatigue, and burnout. The ProQOL tool can be used to assess your own (or your staff’s) PQOL.
Health care professionals, and especially nurses, who choose to be responsible for assisting individuals, groups, communities and societies of people, to actualize their potentials, to live well and to die well, are those who recognize human vulnerability (and that we are thinking and feeling beings). In order to go about quality caring, one has to be cognizant of the fact that it is all one and that there is no way to simplify the complex nature of human living and dying. It is unique for every individual (both the cared for and the carers).
Quality caring, then, goes a step beyond providing quality care. It is contingent, at least in part, on the ability to put oneself in another’s place. As philosopher and scholar Martha Nussbaum noted, synonymous with the idea of compassion is the ability to say “this could be me.” In health care, our work is (or should be) predicated on the ability to imagine oneself in another’s place; the ability to feel with and for another. Of course, this is a double-edged sword since imagining ourselves in the place of a suffering person (or his/her loved ones) is scary; so scary that it could make many people want to walk away or at the least, shut their eyes, mind and heart to human suffering rather than bear witness to it. And that is not what health care is about, or what nursing is about.
Many people have highlighted the risk to self that carers face and nurses are noted to be especially at risk for compassion fatigue. Sometimes our compassion manifests so strongly it is hurting us, but we are not even aware that there is a problem brewing. This was the case in my experience with our John Doe (shared in the digital story Vestiges).
Nurses need to learn about compassion fatigue in nursing and also the incidence of burnout in nursing, because these syndromes are reaching epidemic proportions. When we are not content doing our work, chances are very good that many of the people we are working with are not content either, and it has a butterfly effect. Overall, the quality of care rendered winds up being less than optimal. While we might be meeting the basic needs of our patients, we are not facilitating health and healing the way we could or should be. That in turn contributes to further discontent all around.
There are many factors feeding into this problem but nurses are not victims; we have the power (and I think also the societal obligation) to transform the state of our own PQOL, individually and collectively, and in so doing we can transform the entire health care system.
We can take steps to heal from and/or possibly avert the syndromes of compassion fatigue and burnout. But where and how do we begin? For years I have strived to teach nurses how important we really are in the general scheme of health care and that is where I think we need to begin.
There is a trilogy of books in the works by Deborah Harkness; only two have been written thus far. The first is called A Discovery of Witches and it is all about energy, life and death, magic and love. In keeping with J.K. Rowling’s Harry Potter stories, it is beautifully written. While I was writing the book on compassion fatigue, I read her first book in the trilogy, and I was thinking about energy, love, and quality caring for living-dying. It was then that the thought crossed my mind that we need to begin with a discovery of butterfly power (and especially our own!).
Todaro-Franceschi, V. (2012). Compassion fatigue and burnout in nursing: Enhancing professional quality of life. New York: Springer.
Todaro-Franceschi, V. (1999). The enigma of energy: Where science and religion converge. New York: Crossroad. (Also see NYU dissertation and website)