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Best Practices for Increasing Compassion Resiliency and Moral Wellness in Post-Acute and Long-Term Care Settings

      The intensity and complexity of challenges that health care professionals have faced in the context of the COVID-19 pandemic have been remarkable. A medical director at a nursing home shared her experience of the pandemic in these terms: “We went from a belief that we could save everyone to the reality of losing six to seven patients per day, despite doing everything we could in terms of infection control, [personal protective equipment], etc. When my first patient died, I broke down and cried. Then we went into great trauma.”
      From infection control to safety and well-being, to staffing and regulatory oversight, the skills to successfully manage these situations require a high degree of compassion and empathy. Based on my decades of experience with nonviolent communication (https://www.cnvc.org/) and work with the Empathic Leadership Institute (ELI) (https://empathicleadershipinstitute.com/), I will address communication and relational skills to support health care professionals.

      Working With Health Care Professionals

      Back in 2021 I wanted to understand the barriers that prevent health care professionals from having consistent access to compassion and empathy toward residents and colleagues. My rationale was that people would certainly, if they could, choose a compassionate response more often than not. In partnership with AMDA – The Society for Post-Acute and Long-Term Care Medicine, I sent a survey to health care practitioners to ask people their preferred response to several difficult situations related to the pandemic (N = 35). The majority of responses confirmed the hypothesis: respondents preferred compassionate responses in relation to the proposed situations. (A summary of the ELI-AMDA survey from Oct. 2021 is available on Dropbox at https://bit.ly/3FobC7S.)
      In short, among the main blockers to empathy and compassion that I identified was the rapid and drastic increase in the pace of dying, which meant individuals were using all the resources available to them just to survive and adapt. This did not leave much room for empathic and compassionate approaches. In addition, not having space to process the omnipresent grief made it really hard for nursing home staff to find the stability needed to bring a more compassionate care to residents. A third factor mentioned was misinformation about the pandemic, which participants felt made it difficult to connect with compassion to some patients.
      In October 2021, I was fortunate to co-lead a webinar on this topic with James Wright, MD, PhD, CMD, as part of the Society’s “Healing Together” webinar series (“Best Practices for Increasing Compassion Resiliency and Moral Wellness,” YouTube, Oct. 15, 2021, https://youtu.be/Bw82AvzuRJ4). This collaboration helped me develop the following best practices and corresponding tools that can be used by anyone in the long-term care community to increase compassion, resiliency, and moral wellness.

      Best Practice 1: Refrain From Offering Nonempathic Responses

      Nonempathic responses not only create distance between oneself and others but also throw a wedge between our ability to be compassionate and our capacity to experience compassion. Typical nonempathic responses include giving advice, storytelling, changing the subject, and interrogating. For example, if someone tells you that he or she has a headache, typical nonempathic responses would be “You need to drink more water,” or “Don’t worry about it, it seems mild,” or “Didn’t you also have a headache yesterday when we started the meeting?” (The ELI offers this list of typical nonempathic responses via Dropbox at https://bit.ly/3HWb7Dq.)
      Often we believe that such responses are supportive and even empathic. In our trainings at ELI we regularly hear people say, “I was certain that this was empathic!” The receivers of nonempathic responses often report a sense of dismissal and an inclination to withdraw from the conversation, while those offering these habitual responses miss the opportunity to truly connect and offer a more appropriate compassionate response.

      Best Practice 2: Offer Empathic Responses

      An empathic response is an effective bridge between our hearts, our words, our actions, and other people. The two main types of empathic responses are empathic reflection and empathic guessing:
      An empathic reflection is a statement aimed at giving the speaker an experience of being heard and understood in a nonjudgmental way. An essential component of an empathic reflection is that it involves asking if the person has been heard accurately. For example, one might say, “Sounds like you are not considering getting vaccinated and that you’re prepared to leave your job although this is not your preference. Am I getting it?”
      Empathic guessing is an advanced empathic reflection. It involves exploring what might be happening behind the words that were expressed by the speaker. The purpose of empathic guessing is to support speakers in understanding themselves in a deeper and more precise way, and to experience being heard more completely. Typically, with empathic guessing the listener drops the reflection and only focuses on this deeper exploration of the speaker’s experience. For example, one might say, “Are you disappointed about this because you want to experience more support?” (The ELI offers more examples of empathetic responses via Dropbox at https://bit.ly/3qj8kyp.)

      Best Practice 3: Pause When Starting to Get Reactive and Choose Your Response

      As human beings with a highly nuanced physical drive for survival, we are subject to a nervous system that impacts our behavior. If the nervous system detects an actual or perceived threat, we become reactive. And, for most people, being reactive means that we lose our capacity to be empathic.
      At ELI, we designed a tool called the Reactivity Sequence to support an empathic response. This tool combines elements from empathic leadership, polyvagal theory, mindfulness meditation, and a leadership concept called Above or Below the Line.
      The sequence starts with a pause to invite awareness of emotions and body sensations, then clarifying whether our immediate reaction is immobilization (freeze) or mobilization (fight or flight). The next step explores choice and what options are available if we choose a response “above the line.” Finally, the sequence directs us to an inquiry of our higher wisdom available at this moment. (See https://bit.ly/3uQ6zLF to experiment with the Reactivity Sequence and learn about the different underlying concepts.)

      Best Practice 4: Decrease Blame

      Blame is a universal phenomenon that damages relationships and decreases our capacity to collaborate. In 2014, I wrote a short eBook titled: The Blame-Free State in which I described the key mechanics of blame and how to overcome it (see https://www.francoisbeausoleil.com/resources for a free download).
      The first step to decrease blame is to consider the other person’s experience, including what might be emotionally painful for this person. In the example of the employee who declined vaccination, Dr. Wright guessed that this individual may hold the perspective of not trusting the medical community and might be feeling resentment regarding the vaccine mandate. In turn, this could stimulate fear about accepting an injection with no trust in the people who manufactured the vaccination. This initial step is designed to offer an immediate decrease in the intensity of the blame that we feel. Decreasing blame does not necessitate that we agree with the other person; rather, it means that we choose an empathic response rather than a judgmental one.
      The next steps involve guessing what matters the most to the other person and reflecting on how we can integrate that information to create a narrative that further decreases the blame. Consider a situation in which you hold someone at fault and use the Blame-Dissolving Sequence (https://bit.ly/3I5Gaxn) to see if you experience a shift.

      Best Practice 5: Creating Empathic Support Structures

      Finally, we can proactively create empathic support structures to receive empathy from others and to practice these skills, especially when we experience a highly activating situation. A mutual relationship in which you can receive (and provide) empathy is paramount to creating new habits that support empathic and compassionate responses and decrease blame. It can be as simple as an agreement to check in with someone a couple of times a day. The ELI outlines suggestions and guidelines to navigate these sometimes challenging conversations at https://bit.ly/3rLSg91.

      Conclusion

      Compassion resilience includes a variety of skills. These five best practices are the foundation of compassionate living that can provide relief in distressing situations and stimulate progress toward resilience and moral wellness.
      François Beausoleil is a co-founder and lead trainer for the Empathic Leadership Institute. He trains, coaches, and supports individuals and organizations throughout the world. François’ previous career was as a musician with Cirque du Soleil. He has an MBA from Sherbrooke University in Quebec, is a certified trainer with the Center for Nonviolent Communication, and a registered corporate coach.

      Related Podcast

      March 30, 2022

      March 2022 – A Special Issue on Empathy and Trauma-Informed Care

      In this episode Karl Steinberg and Elizabeth Galik discuss our special issue on empathy and trauma-informed care in post-acute and long-term care (PALTC) settings. We also welcome special guest François Beausoleil to discuss best practices for increasing compassion in PALTC.

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