Help for Hospice Staff: Meaningful Rituals

Betty R. Ferrell, PhD, RN


December 13, 2016

Rituals and Hospice Caregivers

Rituals are symbolic activities that can provide comfort, meaning, and support and relieve anxiety associated with uncertainties, such as those faced at the end of life. Rituals offer opportunities for shared experiences and can be an important part of the healing process.

For clinicians who care for dying patients and their family members, rituals can offer a way to channel their responses to the secondary traumatic stress of repeated exposure to suffering and death.[1,2,3]Extensive models for staff support that include memorial services or public rituals already exist nationally within hospices. However, these types of rituals may occur sporadically, perhaps only once yearly. To gain insight into more frequent, personal, or private rituals used by those who work with patients at end of life, Montross-Thomas and colleagues[4] conducted a survey of hospice staff, including volunteers.

The online 55-item survey was completed by 399 respondents across 38 states. Most respondents (81%) worked in nonprofit hospices. They had an average of 20 years' experience in healthcare and 9 years in hospice and palliative care. Most (71%) reported using personally meaningful rituals, such as attending funerals, calling bereaved family members, journaling, lighting candles, and praying.

The most interesting results of this study were the links between rituals and personal factors. Hospice caregivers who reported using meaningful rituals had higher scores on a compassion-satisfaction scale and lower scores on a burnout scale. There were no significant differences in measures of secondary traumatic stress.


Compassion fatigue is a common topic at hospice and palliative care conferences and in the related literature. Less frequent attention has been given to interventions that can potentially mitigate compassion fatigue in the professionals and volunteers who care for seriously ill and dying patients and support their families. This interesting and valuable survey reports the responses of both staff and volunteers, describing personally meaningful rituals used to cope with patients' deaths.

This study raises important questions and should prompt greater attention to the role of ritual in sustaining the vital hospice workforce, now and in the future. Greater understanding of ritual and support for its use can benefit caregivers, and ultimately strengthen their ability to continue this sacred work.[5,6,7]


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