Ep20: Living While Dying- Jan Booth, MA, RN, NC-BC

About Jan Booth, MA, RN, NC-BC

Jan Booth, MA, RN, NC-BC

Jan has worked as a nurse for many years at the intersection of quality of life and end of life, as a hospice/palliative care nurse and as an end-of-life coach and educator. She serves as faculty for the Integrative Nurse Coach Academy, the Conscious Dying Institute & the New York Open Center, presents workshops on the transformative possibilities of end-of-life care, and is the author of the book, Re-Imagining the End-of-Life: Self-Development & Reflective Practices for Nurse Coaches.

Read more about Jan here>>>



Jan Booth Living while Dying

Ep 20: Living While Dying- Jan Booth, MA, RN, NC-BC Highlights

“There is so much taboo and phobia, and reluctance to talk about death and dying and even though I may be a conversation opener in end-of-life, I still grew up and was formed within a culture that did not want to talk about death and dying.”  ~Jan Booth

  • Nurse Coaches begin where a person is in their own health, and they are open to discussing brokenness, hope, wellbeing, resilience
  • All of us will die, yet there is an illusion that we all have time, so health is not urgent. Someone who lives with a serious illness, or is at their end of life has a different sense of urgency
  • Nurse Coaches make a difference by talking about difficult situations and use their voices to make change in the present broken health care system
  • Nurse Coaching is understanding how people change, seeing a readiness to change versus not readiness to change, and what contributes to their readiness to change
  • People must believe they can change and have a vision for something different than what is. This does not come easy to most, so a partnership with a Nurse Coach is essential
  • At the heart of coaching is a capacity to be fully present, to not be afraid of what someone is wrestling with, to not need to fix it, to not shut ourselves off because we’re afraid, but to be able to be fully present. These are the keys to working with someone who’s living with serious illness.
  • Death is a natural process. Nurse Coaches can teach the human skills of how to incorporate death and impermanence into how we live.  If we don’t learn the human skills of how to care for each other, we’ll continue to feel lost

Learn more about Jan’s Course called, Re-Imagining the End of Life: Self-Development & Reflective Practices for Nurses here>>

Blogs from Jan Booth >>

Ep 20: Living While Dying- Jan Booth, MA, RN, NC-BC Transcript

Nicole Vienneau  00:00

Welcome, everyone, to Integrative Nurse Coaches in ACTION! This is Nicole Vienneau, your host, and I’m also a Board-Certified Integrative Nurse Coach. And this is the podcast where we get to speak with inspirational Nurse Coaches who are shifting the paradigm of healthcare from disease care to real healthcare. And so today, we get to speak with Jan Booth, who is an end-of-life Nurse Coach and educator.

She has worked as a Nurse for many years at the intersection of quality of life and end of life, as a hospice palliative care Nurse, and as an end-of-life coach and educator. She serves as senior faculty for the Integrative Nurse Coach Academy, the Conscious Dying Institute, and the New York Open Center. Jan presents workshops on the transformative possibilities of end-of-life care, and is the author of the book, Re-Imagining the End of Life: Self-Development and Reflective Practices for Nurse Coaches. Welcome, Jan.

Jan Booth  01:10

Thank you, Nicole, it’s great to be here.

Nicole Vienneau  01:13

I am thrilled you are here because your voice in Nurse Coaching has been very inspiring, very powerful in bringing to light, the end-of-life process and conversations and safe spaces about this process within our life. And so, we’re looking forward to hearing all that you’d like to share with us today. And just looking forward to touching base and soaking up all of your wisdom.

Jan Booth  01:43

Well, that’s great.

Nicole Vienneau  01:44

So, before we get into all of that, we’ve got to go back into history and ask you to tell us a little bit about why you decided to become a Nurse.

Jan Booth  01:57

Well, I decided to become a Nurse after having worked in West Africa as a Peace Corps volunteer in women’s health. And I got so excited about being around birthing babies and women’s health that I decided that I would become a Nurse midwife. So, I came back to the states and did what I had to get all my requirements, because I had not studied anything in science in my first degree, and went to Nursing school with a full intention of returning to Africa as a Nurse midwife.

In my first semester of Nursing school, someone gave me a book that changed my life. They gave me a copy of a book called Who Dies? by Stephen Levine, who is an American Buddhist writer. And I won’t go into the longer story about that, but it was one of those pivotal moments, that I imagine we all have, when the course of my life took a different direction. And I realized in my heart and soul that it was not birthing babies and being a midwife, but it was being a midwife for dying people, and that felt like a deep calling.

I shifted gears, got into hospice as soon as I could, after some… about a year and a half of Nursing in the hospital. Have been very much on the end-of-life path since then. I also had a parallel Nursing career in health and wellness, mostly health promotion, health education, developing curricula, a lot of teaching, and that’s what led me to Nurse Coaching.

Nicole Vienneau  03:40

So, then tell us the story that really led you to Nurse Coaching.

Jan Booth  03:45

I met someone who was interning for us at hospice as a health educator, and she had just finished taking a health coaching course. And I said, “What’s health coaching?” And she said, “Well, it’s very different from health education.” And as she talked about it, I realized that that was the missing piece that I felt in all those years of health promotion. And that was really engaging with what’s most important to the person in front of me, not coming in with all the best intentions, and all the data, and all the good health promotion materials to tell people what they needed to do.

So, I started a health coaching program and then one day, in a bit of a rabbit hole of internet exploration, I found the International Nurse Coaching Association website and realized, oh my goodness, this is coaching just for Nurses. Yes. This is being spearheaded by Nurse leaders that I had been tracking, particularly Barbie Dossie, for a number of years. I’ve been a holistic Nurse early on in my career, and it was clear this was the place to be.

So, I joined the mighty Cohort Four in New York City, and that also very much changed the trajectory of my career. And I would say that, initially, I was imagining that I would bring this coaching more into the wellness piece of my career, but about halfway through the program, I realized that what I wanted to do, although I had no idea how to do it, what I wanted to do was to bring together my love of end-of-life work, and my love of guiding people, supporting people, to be as well as they could be. And that I saw the connection.

Once I shifted from the word wellness to wellbeing, I could then see, ah, of course, there’s wellbeing at end of life as much as it is at any other part of life. And that’s what allowed me to see the vision for myself for end-of-life coaching as life coaching.

It’s not two separate things. You know, so often, so many people see anything having to do with end-of-life as being shuttered off to the side, or that’s what hospice does, or, you know, a sort of specialty that only just a few people like to talk about, or want to talk about, and most people don’t want anything to do with it.

And the vision that I had was how can we use the same wonderful skills, capacities, and tools in coaching, where we help people to focus on what matters most to them, to have the most vital life based on what matters to them and their own priorities? How could we bring that same spirit into people moving into the last part of their lives?

Although the vision was clear, I wasn’t always, you know, I had to figure out, like a lot of us, I had to figure out how to carve that new territory, because both of these areas that I work in –you know, the Nurse Coaching and the end-of-life care, that is particularly wanting to be more conscious end-of-life care — both of these are new paradigms. And so, carving out new territory really takes imagination and support of other people, willingness to take risks, to make mistakes, to re-caliber, you know, your path.

So, it’s been so cool for me to be able to bring these two together and to use my imagination and my skill set to try to express why this matters, and why I think Nurses in particular have such an important voice in illuminating the value of coaching and coaching for wellbeing for people living with serious illness and into end-of-life.

Nicole Vienneau  07:52

Jan, you have such a fascinating history. Thinking of you in the Peace Corps, imagining you working with people there in Africa, you said, and birthing babies and thinking that’s where you wanted to go, and here you do a 180 turn-around to say, “Hey, that’s not really where my heart lies. That’s not where I feel I can best use my skills, my passion, my love for people.” Instead, now you are working with end-of-life.

I love the whole process of, you know, using imagination and creativity and not really knowing exactly how you’re going to get there, especially because, yes, Nurse Coaching is a relatively new area within Nursing. And then, end-of-life. And so, two different areas, combining two innovative areas, and then looking to see how can I do this? Because that is what is calling to you.

And so, I know for our fellow Nurses, your fellow Nurse Coaches, fellow healthcare professionals who are thinking, gosh, I have a calling, it’s not exactly what I’m doing right now, so how can I move towards that? And they’d love to hear from you and how you decipher that, how you saw yourself moving forward, and what skills and tools did you use to help yourself move towards what spoke to your heart?

Jan Booth  09:24

Yeah, that’s a great question because I think this is… you’re touching on something that is very important to how we grow and develop in new ways. Let’s say there are two main pieces that I see. One is the deep dive inside, right, so that I know myself and the passion that I’m feeling for this, that I understand what that is. I look at places within myself that I might have put up barriers or limitations, I look at my own beliefs and possible biases around that.

So, you know, the willingness to really explore what is it that I love? Why do I love it? What are the things that might get in the way? So that I can show up more fully, and in the end-of-life piece, that’s particularly important because there is so much taboo and phobia and reluctance to talk about death and dying and even though I may be a conversation opener in end-of-life, I still grew up and was formed within a culture that did not want to talk about death and dying.

And I worked, particularly more in the past, in a healthcare system that does everything it can to stop dying. That kind of always staying engaged with, am I being authentic in this, you know, recalibrating all the time? What’s my true north, and trying to stay honest about that. So, that’s the inner work that I think is really important when you’re carving out new territory. And it’s ongoing, it’s not like I just did it once and like, well, that’s done.

And then the second part is knowing the landscape so that you know what’s yours to do, and what’s not yours to do. Just like in Nurse Coaching, we recognize that some people are going to take this newly developed skill and capacity to work out of a coaching model, and they’re going to bring it into a system where that might be a minority approach, and they may feel like they’re wanting to make a difference within a system that is still very much focused on sick care and disease care.

Other people may take that and their territory that they’re going to carve out is going to be all on their own terms, they’re going to have an independent practice, or they’re going to work with practitioners who are like-minded. So, knowing the territory, you know, the landscape out there, and saying,

“Where do I want to put myself? Where do I need to put myself?” You know, maybe I’m someone who’s… I carry the insurance, as I did for many years for our family, and so I may have some limits to where I am going to work. So, knowing the landscape, so you know what’s yours to do next.

And then I’d say that — I said two, but it’s really three things — the third thing is the support of other people, other Nurses, other Nurse Coaches, like-minded people, knowing who your allies are, you know, that wonderful feeling when you get with people who are like-minded, and it’s like, I don’t have to explain, I don’t have to defend, I don’t have to tell the same story over and over, because they get it.

It’s like Nurses who get that our healthcare system is broken, and that we don’t value proactive, preventive immune boosting health, and that there’s a lot, actually, that the system not only doesn’t value, but doesn’t know and recognize. And so, when you’re with a group of Nurses who have discovered that, in the variety of ways that they’ve discovered it, it’s just a feeling of coming home.

And you know that this group of people, and many of whom may be listening to this podcast, will support you to amplify this new voice, because that’s a lot of what we’re talking about, is it’s either a new voice, or it’s a voice that is not as valued.

And so, knowing who I am, knowing what’s mine to do, and then building those relationships with other people, I think that gives, for me, let me say, that has given me the best chance to make a difference, and not have it stay in the world of, “Oh, I wish… Oh, wouldn’t it be great if… Oh, someday, maybe…” You know?

But all those three things coming together are what give me the courage to use my voice, to say things that may be different, to say things that maybe people don’t want to hear. And that courage is a big part of carving out new territory.

You know, I’m a very introverted person, although I can be very social, so for me the courage to really stand up and speak to something and, hey, and death and dying, end of life, you know, most people don’t want to talk about it. So, you know, just the creativity and the courage to be able to have people want to open the conversation. Yeah. So, I think those are some of the pieces of how I took what was clearly a calling and passion and moved forward.

One other part of that is paying attention to whatever your compass is. You know, for me, I feel it in my gut. I feel it intuitively that something is right. So, I knew in Nursing school, even though I was all set to be a midwife and go back to West Africa, I knew when I read that book. It was like, boom, clear as could be.

I knew when I came across the INCA website, boom, that’s where I needed to be. I knew when I had that coming together of, oh, life coaching, end-of-life coaching, wellbeing. Yes. The Nurse’s voice, the tools of coaching to help open conversations. Yes. Right? I follow that, and then I just use that going on.

For example, when I first went to the New York Open Center’s Art of Dying conference in 1995 — was a brand new conference, and I knew I needed to be there — I read the description, and something just spoke to me because of that part of end-of-life care that brings in more of the consciousness, the spiritual aspect, the… you know, end-of-life is a meaningful developmental part of being human. It’s part of what makes us human. It’s like, people were talking that way, it was like, boom, that’s another place that I need to be.

So, listening to where the compass needle is vibrating, like this is for you. This may not be for anyone else, but for you in, you know, in my time on the planet, in whatever ways I’m wired, in whatever capacities I have, and what I came here to do, those are like times to keep moving for. So, I just really encourage people to listen to that, to pay attention, because it’s another piece of what we do when we’re coaching others, which is to find what energizes someone, what makes you come alive. The world needs people who have come alive. So, there are ways to follow that in a professional sense, as well.

Nicole Vienneau  16:38

I just want to give you a big hug.

Jan Booth  16:43


Nicole Vienneau  16:43

Done. Yes. We did air hugs.

I can’t help but think of my fellow colleagues, my fellow Nurses, who are in the broken healthcare system, who are doing this unbelievable work, selfless work, hard, hard work, soul crushing work, body breaking work, spirit turmoiled work, and I can recall, myself, being a critical care Nurse and feeling all of those things. Feeling suppressed and feeling overwhelmed with the burden of working in this broken healthcare system.

I noticed in myself, and perhaps fellow Nurses are feeling this, too, that we don’t feel that boom, we don’t feel called to something, because we are being suppressed. And I would love to know your thoughts on how to help people who are feeling that suppression or that compression or the burden of where they are now and feeling numb, and how they can overcome that sense to move themselves forward.

Jan Booth  18:00

Oh, wow, that is such an important question for the soul of Nursing right now. And I know that’s true for other professions, but I speak to Nurses. Yeah, it’s heartbreaking to see what happens to the healing spirit that, for most of us, brings us into this work. And how crushed that can get in a system that — I mean, I’m going to, you know, broad, broad, sweeping statements. I know there are exceptions — but mostly, the system is driven by sick-care, by profit, by data that doesn’t take into account the human relationship, which is all the art of the work we do.

So, no wonder that year after year of working within a system that doesn’t allow for time, or that doesn’t seem to respect and hold up the humanity of the work we’re doing — it’s medical, technical, technological — and so the whole piece of the human that is interpersonal, relationship oriented, part of a collective, has a psycho spiritual part of life that brings meaning, like where do you put that in an electronic medical record? Where do you put that when you have five minutes to be with someone?

So, this is very real, very real. And each of us are going to find a different way in it based on what our life situation is and what kind of work we feel we need to be doing. I think the key piece that we bring in the Integrative Nurse Coach Academy programs for Nurse Coaches is we start with where that person is in their own health, their own sense of brokenness, their own sense of hope, their own sense of what they went into Nursing for, what they believe about what contributes to health and wellbeing and resilience.

And just put aside for now the systems that may be doing the crushing work — you know, even though the systems are made up of humans, most of whom really don’t want that to happen, but it’s like, we can’t stop it — and start with what do I have control over? Where can I make decisions differently for myself, even if nothing changes within the system. And I think that’s a really key place of reclaiming our own power, reclaiming our ability to set intentions for our lives.

So, even though I may be exhausted, I’m going to get up 20 minutes earlier than I normally do, and I’m just going to go outside. And maybe the first day, I just go outside and stand there and walk around my parking lot, and that’s all I do, you know, but slowly building in the things that I’ve decided, for me, bring me energy, give me hope, connect me to other people, help me to feel energized, so I can make it through the day. So, again, always starting with ourselves, and what do we want? And use that coaching process.

The coaching process is, what’s the vision that I have? Forget all the logistics, “Oh, I can’t. Oh, we couldn’t. That’ll never work.” You know, it’s like, vision, where am I now, and how am I going to move towards that? And so, using that coaching process for the Nurses that come into our program, around their own health and wellbeing, is… it’s life-changing, because nothing else has changed, none of the relationships in the family, none of the structural things, right?

The second part is looking, you know, being willing to then professionally look at what is it that is calling me? And again, it needs to be that vision piece, it’s so important. It’s really helpful to have someone help you with that, because our own minds are habitual. And it’s likely that when I come up with an idea of what I really want to do, that my mind may just shut it right down. “Oh, you can’t do that. You’re just always going to be stuck working in the hospital. That’s just the way it is.”

Having that vision for what do I really want to do? What do I believe is the best use of my skills and capacities as a Nurse? What landscape do I want to work in? Who’s the population that I want to work with? To really allow ourselves to think outside the box and to be imaginative, because there are more and more places within healthcare where you can bring a holistic model, where you can work with people who are more like-minded. It’s hard, you have to look, you have to talk with other people.

I think we all have to be willing to stand up and use our voice, give the case in a really well done way, why someone might hire me or bring me into their department. So, that communication piece is really important, as well. But I guess I’m, you know, I’m just realizing that what I’m saying is mirroring what I did for myself, which is the deep dive inside, the kind of recognizing where do I really want to be? And then the support, because I think part of what is soul-crushing is… there are a couple things, you know, generally we’re not taking good care of ourselves.

So, physically, we’re exhausted. We’re not investing in the relationships because we’re burnt out and all we want to do when we come home from work is just vege. So, all the things that normally bring energy and make life more meaningful and fun, fulfilling, it’s really, really hard to do. So, finding other people who will not only inspire us, but help hold us accountable, is also important, because when we’re burned out, it’s so easy to not only have the energy to make change, but to sustain it.

And I think that’s something that people in our program find in the six months that they’re in the program, that they’ve got people holding them accountable, so that these changes, and these new habits, and these new outlooks have a chance to really take root, because it’s hard. I mean, that seed may be a potent seed, like I want change, I can’t keep doing this, this is soul crushing. For that seed of something new to take root, it takes some time. You know, it’s got to be a good soil and the sun and all that good stuff.

And those are all metaphors for what we bring in to give that little seed the best chance it has and being with other people who are going to cheer us on and get why we’re wanting to make change and believe that we can do it, who see us like, “Yes, I see you doing that!” And then, “You are brave” and “I’m so inspired by you” and, you know, cheering each other on, that’s all sun and rain on that seed.

And so, for example, in a program of six months, like the Nurse Coaching, it is long enough for those roots to go deep enough. Commit to this is something not only that I want to do, but that I can do, because that’s part of the mindset, as well. I can do this even though I may not know anybody else who’s doing it, even though most everyone I work with is burned out, let’s say, in this scenario. I can make a difference, and I can choose with my, what Mary Oliver calls, my one wild and precious life.

Nicole Vienneau  25:47

I see you see the vision within yourself, without all the “Oh, I can’t do that. I can’t. I don’t have time, I don’t have the money”, put that aside and look to see ahead, what could I possibly do? Where am I now? What is my reality? And then how am I going to get there? But the biggest piece that I heard you talk to quite a few times is finding people to support you, finding potentially like-minded, or potentially not like-minded, who can offer those touch points.

But people who can really see you for who you are, your strengths, your capacity, your knowledge, your wisdom, and who can cheer you on when you need to have the cheering, and then can also hold you accountable when you’re falling back into those old patterns, which is very easy to have happen. As you say, it takes time for things to really root.

You can sprout, but are you truly rooted and grounded and, you know, just feeling that and growing with the stem… everything’s growing together to really be supporting your new vision. So, thank you for sharing that. There’s a lot of inner work that goes alongside this, and a lot of soul searching of self, before we can ever really extend beyond some of the present that we’re doing. So, I really appreciate you bringing all of that to life.

Jan Booth  27:18

Yeah, and as I hear you say that, one of the reasons I love the coaching process is it’s so simple, and yet, it’s complex. And the coaching process is a lot about change, right? Many things, each of us navigates on our own. Many changes that we do on our own, we don’t need other people to help with, we just do it. We’ve been doing it from the time we were kids. There are places where we get stuck, and that’s often when a coach can be so helpful.

And in the coaching process, in the science, you know, the behavioral science that’s involved in coaching, at least as we teach it and as we understand it through Nurse Coaching, is understanding how people change, how we change, and a readiness to change versus not readiness to change, and what contributes to that readiness to change.

What you were describing earlier about Nurses who feel completely, legitimately, feel stuck, feel burned out, feel that the healing and the soul work that somehow, they want to bring into their work, is not possible.

In the stages of change, that person has to believe that they can make change, that they want to make change. And in a sense, you know — here’s another coaching term: decisional balance, we call it — your desire to change has to be greater than your desire to keep things the same. Because part of being stuck — there are a lot of faces to that… or facets — one of the facets to being stuck is that at least it’s comfortable and it’s familiar where I am.

I may not like it, but let’s say I’m the one that is the main breadwinner, I’m the one that carries the insurance, or we have to live in this small town because of my partner’s work, all the things that each of us has in our lives, right? So, whatever our individual story is, there’s a certain familiarity, even if we’re not happy or fulfilled. And so, my desire to change, and to take risks, and to go into new behaviors, and to take steps towards a different vision, has to be greater than my desire to keep things just as they are.

And all of these things we practice in coaching with ourselves, first, so that when we’re working with other people, we really know, we have a real feeling in our bones about why it’s hard to make change.

That way we can also be gentle with ourselves, as with other people — when other people are stuck, and we can see something for them, but they can’t, they can’t see it — to be gentle, to be affirming, to maybe push and encourage where it might be effective, but to know that timing is also a really important part of it.

We have to be ready to change, we have to believe that we can change, we have to have some kind of a vision for something different from this. Those don’t come easily to most of us. It really helps to have either be working with a coach, to have some knowledge of the coaching process, or to be with friends or colleagues who, whether they’ve been through a program or not, have this belief that things can be different. I think those limiting beliefs are powerful. They’re powerful in keeping us stuck, even in the muck of unhappiness.

Nicole Vienneau  30:55

So, with all of that being said, how are you linking the coaching aspect with end-of-life? And what does that look like?

Jan Booth  31:05

Something that happens when people are living with serious illness, is that there’s a different sense of urgency than the rest of us, you might say, have. So, the truth is, we’re all going to die, we don’t know when, but there is a little bit of an illusion that it’s not my time, so I don’t have to have a sense of urgency. Someone living with serious illness, who is looking at the end of their life as not so far away, has a different sense of urgency. And that could be channeled in different ways.

It could be channeled in the area of fear and grasping. You know, I’m going to fight, fight, fight to do whatever treatment I can because I can’t die, and the system is going to mirror that back, we’re going to do everything we can to keep you alive. And there’s another path, which is in the time that I have left — quality of time, not just quantity of time — in the time that I have left, how do I want to live there?

And that is, for many people — if they can shift from the fear to the curiosity, to the openness, to look at quality of life — that is life-changing in whatever time they have left, to be able to make choices of how they spend their energy, their time, doing the things that matter most to them. People can do that on their own. Many people who live with serious illness, it was a wakeup call. And the wakeup call itself, to the preciousness of life and to the impermanence of life, is enough to push them into what really matters.

But many times, that fear or the limited beliefs is so strong that it really helps to have someone guide you in that work. And I see the coaching process is working beautifully here, because at the heart of our coaching is our capacity to be fully present with someone where they are, to not be afraid of what someone is wrestling with, to not need to fix it, to not shut ourselves off because we’re afraid, but to be able to be fully present. And that is key to working with someone who’s living with serious illness.

The next part is to do what we’ve been talking about through this conversation, is to bring this idea to someone who may have a sense of I want to live differently, but I’m not sure how because everyone around me is just telling me to fight, fight, fight.

No one wants to really talk about it. No one wants to talk about grief or sadness. And so, it helps to have someone in a guiding, coaching role, to be able to say, “Let’s talk about what matters most to you. What’s happening with you? You can say anything you want, and let’s work with it.”

So that someone can say, “This is the vision I have.” Whether it’s three weeks or three months or three years left, this is the vision that I have. And we look at where are they and what might be some reasonable steps.

They’re concrete steps. It’s what we call SMART goals, you know, they’re specific, they’re doable. That can bring a deeper quality of life to someone who’s living with serious illness. And so, that’s one way that the coaching process can be so helpful in shifting priorities and shifting the behaviors of how someone lives out the last part of their life.

It’s no different than life coaching with someone who’s 35 or 55, and in good health, and feels lost and feels like they’re not really living the life they want, and they aren’t the person they really want to be. It’s no different, except that there’s a little more sense of urgency at the end of life. But there are also many other ways that coaching can come into the end-of-life world, and I’ll give you just some quick examples of a few of them.

One of them is, now talking about Nurse Coaches, Nurses using a coaching perspective and a coaching skill set can talk with people and open conversations much further back in the trajectory of illness, to engage people with what matters most to you. What are the behaviors? What are the actions? What are the priorities for you right now, wherever you are, so that people are living their life more fully, more intentionally, in whatever time they have?

So, someone living with chronic illness, someone whose end of life may be a long way away, but you’re planting those seeds of intentionality, which is, in a sense, life coaching all the way through so that decisions within their medical treatment are coming more out of what is meaningful to them, based on their priorities, not just based on what others think they should do, like in the old health promotion model, right? You got to do this treatment, you got to do this test, you got to take this time.

Well, maybe yes, but maybe not. Maybe there are some other ways I might go. But if I don’t know what is driving my priorities, it’s really hard to take a stand within the medical system when people with white coats and degrees behind their names are telling you what you should do.

So, having Nurses who are so trusted — we know that — whose voice matters to patients, who patients often can be vulnerable with, those Nurses can bring in that coaching perspective and open up those conversations so that these are ongoing conversations about life. They’re like chances to recalibrate all the way along.

And if not, what I see happen is that our medical healthcare system has a strong preference for quick decisions, decisions based on not dying, goals of care and a model of care that is not holistic, that is more focused on the body and on symptoms. So, bringing in the holistic coaching model much earlier, to me, changes the trajectory people are on so that people come into end-of-life having lived differently.

Because one of the things that drives me, after having seen so many unprepared families, it drives me to keep going because so many people come into the last part of their life feeling like they never really lived. Who they wanted to be, they didn’t do the things… they would have done things differently the last three or six months of their life. How many hospice families did I hear say that again and again? Coaching and Nurses can really affect those trajectories.

And another way I see the coaching in more of a kind of societal transformative way is the conversation about dying is a hard one to start. Most people see the conversation about dying being about advanced directives, and that’s an important one, but that’s often THE conversation, right?

And even with that, we only have about a third of adults completing their advanced directives. So, something is not working. So, I see part of what we’re bringing, as Nurse Coaches who want to help transform how people die, how we die, I see the ability to change the conversation at a higher level.

So, in coaching, we talk about building on strengths, right? Not just saying, well, I can’t do this, or I can’t do that. But what are my strengths? What is my resilience? And let me build on that. That’s a positive psychology that is another one of the behavioral science tenets of coaching. So, where in our culture, right now, is there an openness to a different conversation about dying? Where’s the change happening? Who are the disruptors?

Because the system — we have already talked plenty about it, I can talk more about it, you know, but let’s not — we know the system is not working for a more meaningful, valuable end of life. Developmentally seen as a key part of being human, not only our dying and how we die (and modeling that for others, having that be part of our legacy) but how we care for each other in the last part of life. This is a central part of being human. And it’s been so shuttered off, right?

So, where are the places right now that people are saying I want a different conversation? I want to be more involved. I’m not going to be a Nurse or social worker for hospice, I want to be an advocate for a different end-of-life care, as a person in my community.

And so, I’m really drawn — as someone who is interested in new ground through Nurse Coaching, through more conscious end-of-life care — I’m really drawn to those places of strength in our communities, in our society, like the community death cafes and the number of death doula programs where people without any, mostly without any healthcare background, are saying I want to be part of something different to help people die.

And so, I see part of my role not just individually working with families or with individuals to have a more open conversation about what matters most, but I also see bringing that same skill set and capacity at a higher level to track and support my allies and those fresh voices, the new thinking that’s happening now. Because those cultural disruptors are there for a reason. They’re helping us to break the new ground.

So, instead of feeling like I just have to do it myself, in my own little world as an integrative end-of-life coach, that I’m noticing where are these disruptive voices? And how can I be a part of that? And that’s a lot of where my direction is going now, teaching a death doula program, and helping to create models for community death caring. What does it look like for a community to be death friendly? How do we care for each other? How do we learn these human skills that over the last 60, 80 years have been outsourced?

You know, we used to care for each other at home, right? We used to know even though there still is grief and loss and sadness and suffering, we knew somehow, differently in the past, that death was a part of life. And a strange thing that’s happened over the last 50, 70 years is that we have lost some of that thread.

And death seems like an aberration, like there’s something wrong with the model. Whereas, actually, death is an essential part of the model. We just need to look to the natural world to see that ongoing living and dying.

So, that’s really, I guess, the last thing that I would share is not just my draw to working with individuals and families, but my draw to seeing who my allies are in these new paradigms that may be very different than they were 30 years ago, or 15 years ago, when most of my allies were within hospice and palliative care. Now, most of the disruptors around end-of-life aren’t in the institutions of hospice and palliative care because those have become, in a sense, too unmovable.

I think it’s just part of change, you know, there’s cycles, things grow, the disruptors grow, then they become more entrenched, and then there’s some part of them that dies so that newer models can come up that are reflecting what people are wanting in the culture at the time.

And we are in a time of moving the needle back from dying in isolation to dying more in community, from seeing death as mostly biomedical, and seeing now a more whole picture of dying within community, within family, talking about the spiritual aspects of death and dying.

And we’re moving from this idea that death is a failure, that we couldn’t cure it, to saying death is natural, death is part of the system. And if we don’t learn the skills, the human skills of how to incorporate death and impermanence into how we live, if we don’t learn those human skills of how to care for each other, we’re going to continue to feel so lost, I think. A lot of the work that I’m doing now is to bring this way of thinking, that to me is meaningful, to other people.

So, as I said before, I’m teaching within the Integrative Nurse Coach Academy and I’m offering a course based on the book that you mentioned, Re-Imagining the End of Life, I’m offering a course for Nurses and Nurse Coaches that is helping them, hopefully, helping them to do that deep dive, to feel connected with other like-minded people, and to see how big the landscape is right now for change, how much opportunity there is.

I’m also affiliated with the Conscious Dying Institute, which is one of the training programs for death doulas and end-of-life coaches. I teach and help facilitate the Integrative Thanatology Certificate program, it’s a mouthful, to the New York Open Center.

And all of this is online now, which has opened up a lot of possibilities. And then I teach some courses on the side for people who want to take a deeper dive into their own impermanence, you know, who want to take a period of time and live as if they only had three years, six months to live and how that changes. It’s a different kind of life coaching.

And then the last area that I’ll say that I find I’m doing more teaching and learning myself is in the whole area of grief and loss. Another area that has been taboo, but to me is an essential piece of how we can engage more in these topics, if we’re able to engage more with the grief that we carry. That grief is very real for many Nurses who are feeling burned out and feeling lost. There’s a lot of deep grief about a variety of things.

And so, my understanding and wanting to open the conversations about grief and loss is part of a new trajectory for me. That is probably a good place to summarize where I am and what I’m doing, and I know that there’ll be some links with this podcast, in case you want to take a look at some of these interesting programs that are part of the new landscape of a different conversation about living and dying.

Nicole Vienneau  46:21

Yes, we will definitely share all of these links for our listeners. And of course, our listeners would love to be able to connect directly with you, so where could they find you to do that?

Jan Booth  46:34

I think probably the easiest way that I’ve noticed is through my email. And I’m definitely open to communicating via email: janetbooth15@gmail.com.

Nicole Vienneau  46:50

And we’ll definitely share that, as well, with our listeners. I just want to say thank you so much for spending time with us, for sharing your passion, your heart, your skill, all your nuggets of wisdom, to help us through understanding a little bit more about how coaching can be used in end-of-life.

And also, all of the interesting thoughts that you had around just coaching in general, and how that can help us move beyond getting stuck, and being stuck, into more of moving forward instead of just jumping up and down in one spot. So, thank you for being here, so much, Jan.

Jan Booth  47:30

You’re very welcome, Nicole. And thank you for doing these podcasts because I find them inspiring to listen to, as each of us are trying to find our own territory and make a difference in the things that matter most to us. So, I really love this podcast series that you’re doing and thank you for inviting me to be part of it.

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