Abstract
Background: Sustaining and growing integrated hospice palliative care (HPC) for homeless populations, hinges on staff and volunteer workforce capacity to deliver high-quality specialized care focused on trauma-informed, compassionate, and anti-oppression approaches. However, multiple compounding work-related stressors may put these providers at risk for burnout, including heavy workloads, workplace harassment, and vicarious trauma. Burnout can lead to maladaptive coping and compromised client care. Our research team was invited to consider how mindfulness-based practices (MBPs) might support workplace wellbeing and prevent or mitigate burnout within meso-level brick-and-mortar hospice organizations for people experiencing homelessness (H4H).
Approach: In November 2024, we engaged mindfulness clinician academics (n=3) and leaders (n=3), staff (n=9), and volunteers (n=4) from three Canadian H4Hs in a 2-day planning meeting to build new partnerships and engage in exploratory work to design a future study. Over two days, attendees engaged in six co-design activities and experiential MBPs to define from their perspective, A) the most important challenges facing H4H providers, B) promising MBPs for addressing these challenges, and C) future research study scope including equitable engagement. Data was collected via a demographics survey (n=19), activity worksheets (n=67), and audio recordings of group discussions (n=7). Analysis involved descriptive statistics and interpretive description.
Results: Most attendees had worked in HPC for 1-year (37%) and with structurally vulnerable people for 6-10 years (26%). Many were in manager/coordinator roles (42%); nurses (16%), volunteers (21%), other clinicians (21%), and a personal support worker also attended. Most attendees were women (74%), few identified as 2SLGBTQ+ (11%) or visible minorities (21%). Attendees believed burnout is a universal challenge within H4Hs and agreed that due to a service-mindset they had difficulty prioritizing their own wellbeing. A) Using a socio-ecological model attendees identified the biggest factor contributing to burnout was misalignment in the values driving decision-making at the societal, organizational, and interpersonal levels. At the individual level, they identified a need for better coping skills and more education and training to deal with lived experiences of stress and trauma. B) Attendees were open to a variety of MBPs to prevent/mitigate burnout. Given the interplay of socio-ecological levels, attendees thought user-friendly, accessible MBPs such as pausing and self-compassion meditation could be helpful for all of H4H including providers, management and executives. Attendees felt MBPs aimed at improving emotional regulation and in-the-moment stress relief for individuals; improving team communication and connections; and increasing a compassionate culture will ultimately improve workplace wellbeing and capacity to provide equitable HPC. C) To address societal devaluing of H4H work and inequities, attendees were enthusiastic to engage with equity deserving groups (e.g., evening and overnight staff, Indigenous peoples, visible minorities, LGBTQ2S+), and consider how MBPs may extend to client populations.
Implications: Together with the three H4H organizations we will leverage these learnings and apply for a research grant to support us in co-developing and implementing an H4H MBP curriculum, to help meso-level organizations integrate MBPs into daily work as one approach to protecting workforce capacity and realizing more health equity in the delivery and receipt of HPC.