Tips for Death Doulas: How to Support the Dying ~ Webinar Recording

Webinar with Ellie Atherton, author of Stepping Stones: Following a Pathway to End of Life

Ellie Atherton, a long-time hospice nurse with the heart of a doula, shares tips for death doulas that include her techniques for honoring each person’s unique experience of dying. Ellie shares that she “got into trouble” early in her hospice nursing career for caring too much about her patient’s thoughts, emotions, and spiritual concerns. In our mechanistic and fragmented health care system, these were considered the realm of the social worker and chaplain. She was told to stop having these conversations and call in the other professionals, each covering his/her special domain. Thankfully, Ellie found a way to keep asking and keep listening to her patients. Following are some of the “take-aways” for death doulas.

Tips for Death Doulas

• Stay open to learning. Ellie shares that “every patient (over 1,000) taught me a lesson.” I love the encouragement to stay in a humble space of curiosity and openness to learning, acknowledging that our clients and the families we serve will always be our greatest teachers.
• “It’s all about the journey, and every journey is unique.”
• Building trust. Ellie emphasizes the importance of nonjudgmental listening. She calls it “compassionate listening” and says the key is to not try and fix it. Just listen.
• Life Review is a crucial aspect of end of life. Ellie encourages us to have the wisdom to recognize when the person is engaging in life review and to be curious and “gently be in it with them.” She recommends her podcast, Pearls of Passage, featuring life stories that each contain a spiritual moment at death.
• Allow for release of emotion.
• Be a detective. Ellie has found that usually there is one person the dying person is most worried about. Until they are reassured that this person will be cared for in their absence, they cannot be at peace about dying. Ellie recommends that we ask the question, “Who are you most worried about?” She reports that many times they are worried about simple, little things (e.g., Who will clear the driveway when it snows?). In some cases, however, there may be a lot of missing pieces that need to be addressed.
• Be an advocate. Ask “Is there anything you would like before you die?” What a powerful question! She says the answer may be something quite simple or it may present a logistical challenge (such as getting the person in a car for a last trip to the beach). But once we know their wish(es), it’s our job to advocate for it to be honored.
• Ask open-ended questions. Remember you don’t have to have an answer for everything. Ellie shares how she learned to sit in the quiet, uncomfortable spaces and found that it gave her patients permission to say more, to go on with their story or concerns. She learned there is always more.
• Give the dying back control. And do this in any small ways that you can. What would they like to wear? To eat? To discuss?
• Know that family dynamics are like quicksand. This summary statement jumped out at me: “You will not be the change agent for family dynamics.”

The Doula Model of Care

Ellie’s tips for end-of-life doulas are in complete alignment with the guiding principles of the doula model of care, depicted here. Learn more about becoming end-of-life doula with Lifespan Doulas.

Ellie Atherton began her work as a midwife to the dying in the early 90s as an herbalist. In 2003 she became a registered nurse and chose community hospice as her medical specialty. For Ellie, caring for patients in their home settings was a challenge, an honor, and a tremendous privilege. As a hospice nurse she continued to advance her training to include becoming a palliative care nurse educator and a hospice consultant. Ellie is the author of Stepping Stones: Following a Pathway to End of Life, now on our required certification reading list for end-of-life doulas. Her second book, More Stepping Stones: Unique Experiences and Vital Lessons Along Life’s Pathway was just released.